Chi Ru-Chien, Jackson Lisa A, Neuzil Kathleen M
Division of Gerontology and Geriatric Medicine, Department of Medicine, School of Medicine, University of Washington, Seattle, Washington, USA.
J Am Geriatr Soc. 2006 Jan;54(1):115-20. doi: 10.1111/j.1532-5415.2005.00528.x.
To describe baseline characteristics and clinical outcomes of older adults with pneumococcal bacteremia, compare the frequency of serious outcomes according to pneumococcal vaccination status, and assess factors associated with mortality.
Population-based case-series.
Group Health Cooperative, a health maintenance organization in Washington State.
Community-dwelling adults aged 65 and older with a first episode of pneumococcal bacteremia between 1988 and 2002.
Demographic characteristics, underlying medical conditions, vaccination status, and clinical outcomes, including death, hospitalization, length of hospital stay, and postdischarge care, were assessed using chart review.
The mean age of the 200 elderly patients with pneumococcal bacteremia was 78; 61% were female. Forty percent had had chart-documented pneumococcal vaccination before the onset of bacteremia. The spectrum of clinical severity and consequences was broad. Ten percent were treated as outpatients. Of the 90% who were hospitalized, 16% were admitted to the intensive care unit. All-cause mortality at 30 days was 11%. Of survivors, 23% were discharged with home services, and another 20% were discharged to a nursing home. After controlling for age, sex, and pneumococcal vaccination status, predictors of death included coronary artery disease (odds ratio (OR)=4.6, 95% confidence interval (CI)=1.4-14.5) and immunocompromising conditions (OR=5.0, 95% CI=1.6-15.7). Outcomes were similar in patients who did and did not receive pneumococcal vaccination.
In this elderly group, pneumococcal bacteremia was associated with substantial morbidity, mortality, and loss of independence. Coronary artery disease and immunocompromising conditions were independent predictors of death.
描述肺炎球菌血症老年患者的基线特征和临床结局，比较根据肺炎球菌疫苗接种状况出现严重结局的频率，并评估与死亡率相关的因素。
基于人群的病例系列研究。
华盛顿州的健康维护组织Group Health Cooperative。
1988年至2002年间首次发生肺炎球菌血症的65岁及以上社区居住成年人。
通过病历审查评估人口统计学特征、基础疾病状况、疫苗接种状况和临床结局，包括死亡、住院、住院时间和出院后护理情况。
200例肺炎球菌血症老年患者的平均年龄为78岁；61%为女性。40%在菌血症发作前有病历记录的肺炎球菌疫苗接种史。临床严重程度和后果范围广泛。10%作为门诊患者治疗。在住院的90%患者中，16%入住重症监护病房。30天全因死亡率为11%。在幸存者中，23%出院后接受居家服务，另外20%出院后入住养老院。在控制年龄、性别和肺炎球菌疫苗接种状况后，死亡的预测因素包括冠状动脉疾病（比值比（OR）=4.6，95%置信区间（CI）=1.4-14.5）和免疫功能低下状况（OR=5.0，95%CI=1.6-15.7）。接种和未接种肺炎球菌疫苗的患者结局相似。
在这个老年人群中，肺炎球菌血症与严重的发病率、死亡率和独立性丧失相关。冠状动脉疾病和免疫功能低下状况是死亡的独立预测因素。
