Loeb M, McGeer A, McArthur M, Walter S, Simor A E
Department of Laboratory Medicine, Hamilton Health Sciences Corporation.
Arch Intern Med. 1999 Sep 27;159(17):2058-64. doi: 10.1001/archinte.159.17.2058.
Little is known about the risk factors, outcome, and impact of pneumonia and other lower respiratory tract infections (LRTIs) in residents of long-term care facilities.
To determine the risk factors and the effect of these infections on functional status and clinical course.
Active surveillance for these infections was conducted for 475 residents in 5 nursing homes from July 1, 1993, through June 30, 1996. Information regarding potential risk factors for these infections, functional status, transfers to hospital, and death was also obtained.
Two hundred seventy-two episodes of pneumonia and other LRTIs occurred in 170 residents during 228 757 days of surveillance for an incidence of 1.2 episodes per 1000 resident-days. Multivariable analysis revealed that older age (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.1-2.6 per 10-year interval; P = .01), male sex (OR, 1.9; 95% CI, 1.1-3.5; P = .03), swallowing difficulty (OR, 2.0; 95% CI, 1.2-3.3; P = .01), and the inability to take oral medications (OR, 8.3; 95% CI, 1.4-50.3; P = .02) were significant risk factors for pneumonia; receipt of influenza vaccine (OR, 0.4; 95% CI, 0.3-0.5; P = .01) was protective. Age (OR, 1.6 [95% CI, 1.0-2.5] per 10-year interval; P = .05) and immobility (OR, 2.6; 95% CI, 1.8-3.8; P = .01) were significant risk factors for other LRTIs, and influenza vaccination was protective (OR, 0.3; 95% CI, 0.2-0.4; P = .01). Residents with pneumonia (OR, 0.7; 95% CI, 0.3-1.4; P = .31) or with other LRTIs (OR, 0.5; 95% CI, 0.2-1.1; P = .43) were no more likely to have a deterioration in functional status than individuals in whom infection did not develop.
Swallowing difficulty and lack of influenza vaccination are important, modifiable risks for pneumonia and other LRTIs in elderly residents of long-term care facilities. Our findings challenge the commonly held belief that pneumonia leads to long-term decline in functional status in this population.
关于长期护理机构居民发生肺炎及其他下呼吸道感染（LRTIs）的危险因素、结局及影响，人们了解甚少。
确定这些感染的危险因素及其对功能状态和临床病程的影响。
1993年7月1日至1996年6月30日，对5家养老院的475名居民进行了这些感染的主动监测。还获取了有关这些感染潜在危险因素、功能状态、转院及死亡的信息。
在228757天的监测期间，170名居民发生了272次肺炎及其他LRTIs发作，发病率为每1000居民日1.2次发作。多变量分析显示，高龄（优势比[OR]，1.7；95%置信区间[CI]，每10年间隔为1.1 - 2.6；P = 0.01）、男性（OR，1.9；95% CI，1.1 - 3.5；P = 0.03）、吞咽困难（OR，2.0；95% CI，1.2 - 3.3；P = 0.01）及无法口服药物（OR，8.3；95% CI，1.4 - 50.3；P = 0.02）是肺炎的显著危险因素；接种流感疫苗（OR，0.4；95% CI，0.3 - 0.5；P = 0.01）具有保护作用。年龄（每10年间隔OR，1.6 [95% CI，1.0 - 2.5]；P = 0.05）及活动受限（OR，2.6；95% CI，1.8 - 3.8；P = 0.01）是其他LRTIs的显著危险因素，流感疫苗接种具有保护作用（OR，0.3；95% CI，0.2 - 0.4；P = 0.01）。发生肺炎（OR，0.7；95% CI，0.3 - 1.4；P = 0.31）或其他LRTIs（OR，0.5；95% CI，0.2 - 1.1；P = 0.43）的居民，其功能状态恶化的可能性并不高于未发生感染的个体。
吞咽困难及未接种流感疫苗是长期护理机构老年居民发生肺炎及其他LRTIs的重要且可改变的危险因素。我们的研究结果挑战了普遍认为的肺炎会导致该人群功能状态长期下降的观点。
