Bacteremic pneumococcal pneumonia in elderly and very elderly patients: host- and pathogen-related factors, process of care, and outcome.

BACKGROUND

Hospitalizations due to pneumonia increase steadily with age. The purpose of this study is to explore differences in host- and pathogen-related factors, process of care, and outcome as a function of age in elderly patients with bacteremic pneumococcal pneumonia and identify factors related to mortality.

METHODS

This was a prospective observational study of a cohort of elderly (65-79 years) and very elderly patients (≥ 80 years old) diagnosed with bacteremic pneumococcal pneumonia. The serotypes of the strains isolated and their resistance were also analyzed.

RESULTS

During the study period, 399 patients were identified, of whom 225 patients (140 elderly and 85 very elderly patients) were included. Despite the groups having similar characteristics on admission, very elderly patients had higher rates of both hospital (16.47% vs 7.14%, p = .028) and 30-day (20% vs 6.43%, p = .002) mortality. Factors found to be predictors of mortality were: altered mental status (odds ratio [OR]: 13.18; 95% confidence interval [CI]: 3.68-47.23), respiratory rate more than or equal to 30/min (OR: 5.82; 95% CI: 1.82-18.64), systolic blood pressure less than 90 mmHg (OR: 10.90; 95% CI: 1.45-81.93), blood urea nitrogen more than 30 mg/dL (OR: 5.41; 95% CI: 1.03-28.42), bilateral or multilobar lung involvement (OR: 5.24; 95% CI: 1.55-17.76), and age (OR: 1.19; 95% CI: 1.09-1.30).

CONCLUSIONS

Very elderly patients have poorer outcomes with no significant differences in host- and pathogen-related factors or process of care. Mortality rates in these patients are associated with age and the severity of their clinical condition.