Outcome of CAP: influence of age, residence status, and antimicrobial treatment

¹ Dept of Medicine III, University of Lübeck, Germany
² Center for Pneumology and Thoracic Surgery Heckeshorn, HELIOS Clinic Emil von Behring, Berlin, Germany
³ Dept of Medical Microbiology and Hygiene, University of Ulm, Germany
⁴ Dept of Internal Medicine/Infectious Diseases and Pulmonary Medicine, Charité, Humboldt-University - Medicine Berlin, Germany
⁵ Dept of Pneumology, Hannover Medical School, Hannover, Germany

^* To whom correspondence should be addressed. E-mail: HenningKothe-tenor{at}web.de.

	Abstract

Community-acquired pneumonia (CAP) remains a major cause of mortality in developed countries. There is much discrepancy in the literature regarding factors influencing the outcome in the elderly population.

Data derived from a multicenter prospective study initiated by the German Competence network CAPNETZ.

2647 patients (1298 <65 years, 1349 >65 years) with CAP were evaluated. 72.3% were hospitalised, 27.7% treated in the community.

Clinical history, residence status, course of disease and antimicrobial treatment were prospectively documented. Microbiologic investigations included cultures and PCR from respiratory samples and blood cultures. Factors related to mortality were included in multivariate analysis.

Overall 30-day mortality was 6.3%. Elderly patients had a significantly higher mortality rate which was associated independently with age, residence status, the CURB score, comorbidities and failure of initial therapy. Increasing age remained predictive for death in the elderly. Nursing homes residents had a fourfold increased mortality rate and an increased rate of gram-negative bacillary infections compared to patients dwelling in the community. The CURB score and cerebrovascular disease were confirmed as independent predictors of death in this subgroup.

Age and residence status are independent risk factors for mortality after controlling for comorbidities and disease severity. Failure of initial therapy was the only modifiable prognostic factor.