Service d'Hygiène, Epidémiologie, Infectiovigilance et Prévention, Hospices Civils de Lyon.
Équipe Santé Publique, Epidémiologie et Eco-évolution des Maladies Infectieuses (PHE ID), Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon.
Curr Opin Infect Dis. 2024 Apr 1;37(2):144-153. doi: 10.1097/QCO.0000000000001005. Epub 2024 Feb 5.
This review covers updated perspectives on different aspects of pneumococcal community-acquired pneumonia (pCAP), including the epidemiology, clinical presentation, risk factors, antibiotic treatment, and existing preventive strategies in older adults.
pCAP remains the most prevalent condition among lower respiratory tract infections in the older adults according to Global Burden of Diseases 2019. Older adults can display atypical symptoms such as confusion, general clinical deterioration, new onset of and exacerbation of underlying illness that might trigger clinical suspicion of pCAP. Older adults with pCAP often experience increased disease severity and a higher risk of pulmonary complications compared with younger individuals, owing to age-related changes in immunity and a higher prevalence of comorbidities. Vaccination stands fundamental for prevention, emphasizing the need for effective immunization strategies, specifically tailored for older adults. There is a pressing need to reinforce efforts aimed at boosting pneumococcal vaccination rates.
Despite a high morbidity and mortality, the burden of pCAP, in particular hospital admission and occurrence of invasive infections, among the elderly population is not sufficiently documented. This review findings emphasize the substantial burden of pCAP in this vulnerable population, driven by factors such as advancing age and underlying comorbidities. The emergence of antibiotic-resistant pneumococcal strains further complicates treatment decisions and highlights the importance of tailored approaches for managing pCAP in older adults.
本综述涵盖了肺炎链球菌性社区获得性肺炎（pCAP）不同方面的最新观点，包括流行病学、临床表现、危险因素、抗生素治疗以及老年人中现有的预防策略。
根据 2019 年全球疾病负担研究，pCAP 仍然是老年人下呼吸道感染中最常见的疾病。老年人可能表现出不典型的症状，如意识模糊、一般临床恶化、基础疾病的新发和恶化，这可能引发对 pCAP 的临床怀疑。与年轻人相比，患有 pCAP 的老年人往往病情更严重，发生肺部并发症的风险更高，这是由于与年龄相关的免疫变化和更高的合并症患病率所致。疫苗接种是预防的基础，强调需要针对老年人制定有效的免疫策略。迫切需要加强提高肺炎球菌疫苗接种率的努力。
尽管 pCAP 具有较高的发病率和死亡率，但老年人中 pCAP 的负担，特别是住院和侵袭性感染的发生率，尚未得到充分记录。本综述的研究结果强调了 pCAP 在这一脆弱人群中的巨大负担，这是由年龄增长和潜在合并症等因素驱动的。抗生素耐药性肺炎链球菌菌株的出现进一步使治疗决策复杂化，并强调了针对老年人管理 pCAP 的个体化方法的重要性。
