Nursing home acquired pneumonia (NHAP) is thought to be clinically distinct from community acquired pneumonia (CAP). This observation, based on studies conducted mainly in North America, may not be relevant in countries with a different healthcare system.The authors describe an 18-month prospective cohort study of 437 patients admitted to hospital with CAP, 40 (9%) of whom came from nursing homes. Detailed microbiological tests were performed in a subset of patients over 12 months.Patients with NHAP were less likely to have a productive cough (odds ratio (OR) 0.4, p=0.02) or pleuritic pain (OR 0.1, p=0.03), but they were more likely to be confused (OR 2.6, p<0.001). They had poorer functional status (p<0.001) and more severe disease (p=0.03). Mortality was higher compared to CAP (53%versus13%), but this was mainly explained by prior functional status (OR 0.5, after adjustment for functional status). Pathogens were identified in 68% of 22 NHAP and 80% of 44 matched CAP patients.Streptococcus pneumoniaewas the most common (55% NHAP, 43% CAP). Atypical pathogens, enteric Gram negative bacilli andStaphylococcus aureuswere uncommon.In conclusion, differences in functional status accounted for the increased mortality in nursing home acquired pneumonia compared to community acquired pneumonia. The pathogens implicated were similar. No grounds for a difference in choice of empirical antibiotics were apparent.

Defining prognostic factors in the elderly with community acquired pneumonia: a case controlled study of patients aged ¢75 yrs. W.-S. Lim, J.T. Macfarlane. #ERS Journals Ltd 2001. ABSTRACT: Severity assessment in the elderly with community acquired pneumonia (CAP) may be different compared with younger patients. In particular, age per se may not be of prognostic significance in older patients. A case-control study in 158 patients aged ¢75 yrs with CAP was conducted to determine the factors associated with in-hospital mortality.Cases were drawn from all patients aged ¢75 yrs with CAP who died in 1997 in five hospitals in the mid-Trent region of the UK (Nottingham City Hospital, University Hospital Nottingham, Derby Royal Infirmary, Derby City General Hospital and Kings Hill Hospital). Controls were randomly selected from survivors also aged ¢75 yrs. Factors associated with mortality were identified following a review of the medical casenotes and the contribution of these factors to mortality was determined using multivariate analysis.Absence of fever, tachycardia and chest radiograph features of bilateral involvement or an effusion were independently associated with mortality on multivariate analysis. The British Thoracic Society (BTS) severity rule was 50% sensitive and 64% specific in predicting death while the modified BTS rule displayed 67% sensitivity and 58% specificity.Age was not significantly associated with mortality in this group of patients aged ¢75 yrs. Similarly, the clinical features employed in the British Thoracic Society rule, namely respiratory rate, diastolic blood pressure and blood urea, were not of prognostic significance and the rule itself performed poorly. The modified British Thoracic Society rule performed better.

This study was approved by the Ethics Committee of Yamagata University School of Medicine (2021-40) and the ethics committee of Niigata University (G2015-0849). Written consent for the publication of this report was obtained from the patient and the patients' family. Data availability statementAll data generated or analyzed during this study are included in this published article.

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