Department of Pulmonary and Critical Care Medicine, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu City, Mie Prefecture, Japan.
Respir Med. 2010 Apr;104(4):584-92. doi: 10.1016/j.rmed.2009.12.008. Epub 2010 Jan 8.
The rapid increase in the elderly population is leading to a corresponding increase in the number of people requiring medical care. To date no comparative study between community-acquired pneumonia (CAP) and nursing home-acquired pneumonia (NHAP) has been reported in the very elderly non-intubated patients. The present study was undertaken to compare the clinical characteristics and microbial etiology between CAP and NHAP in elderly patients >/=85-years old. There were 54 patients with NHAP and 47 with CAP. Performance status was significantly worse in the NHAP than in the CAP group. Among all patients, the most frequent pathogens were Chlamydophilia pneumoniae followed by Streptococcus pneumoniae, Mycoplasma pneumoniae influenza virus and Staphylococcus aureus. The frequency of S. peumoniae was significantly higher in NHAP patients than in CAP patients after adjusting for age and sex. Physical activity, nutrition status and dehydration were significant prognostic factors of pneumonia among all patients. In-hospital mortality was significantly higher in NHAP than in CAP after adjusting for age and sex. This study demonstrated that the etiology and clinical outcome differ between CAP and NHAP patients in the very elderly non-intubated population.
人口老龄化的迅速增加导致需要医疗护理的人数相应增加。迄今为止，尚未有研究报告在非常高龄、非插管的患者中比较社区获得性肺炎（CAP）和疗养院获得性肺炎（NHAP）。本研究旨在比较年龄≥85 岁的老年患者中 CAP 和 NHAP 的临床特征和微生物病因。NHAP 组有 54 例患者，CAP 组有 47 例患者。NHAP 组的体能状态明显差于 CAP 组。在所有患者中，最常见的病原体是肺炎衣原体，其次是肺炎链球菌、肺炎支原体、流感病毒和金黄色葡萄球菌。调整年龄和性别后，NHAP 患者中肺炎链球菌的频率明显高于 CAP 患者。所有患者中，体力活动、营养状况和脱水是肺炎的显著预后因素。调整年龄和性别后，NHAP 患者的住院死亡率明显高于 CAP 患者。本研究表明，在非常高龄、非插管人群中，CAP 和 NHAP 患者的病因和临床结局不同。
