Community-acquired bacteremic pneumococcal pneumonia. Effect of age on manifestations and outcome.

The cases of 38 hospitalized adults with community-acquired bacteremic pneumococcal pneumonia were evaluated prospectively to identify age-related differences in presenting features, clinical course, and outcome. Ten of 18 elderly patients (older than 65 years) were admitted from chronic care institutions v one of 20 younger adults. Coronary artery disease was more prevalent among the aged patients, and alcohol abuse and cigarette smoking were more common among the younger patients. All of the elderly persons and 90% of the younger had at least one serious underlying disorder. Older patients tended to report rigors and pleuritic chest pain less frequently than did the younger. Azotemia and roentgenographic evidence of multiple-lobe involvement were found more commonly in elderly persons. However, age-associated discrepancies were not observed in the duration of symptoms before admission, the prevalence of respiratory failure or metastatic infection, the interval between presentation and antibiotic administration, the duration of fever, the length of hospitalization, or the case fatality rates. Thus, the effects of advanced age on the manifestations and clinical course of community-acquired bacteremic pneumococcal pneumonia appear less pronounced than has been reported previously.