Age-related differences in management and outcomes in hospitalized healthy and well-functioning bacteremic pneumococcal pneumonia patients: a cohort study

Abstract

BackgroundLimited data are available regarding fit and healthy patients with pneumonia at different ages. We evaluated the association of age with clinical presentation, serotype and outcomes among healthy and well-functioning patients hospitalized for bacteremic pneumococcal community–acquired pneumonia.MethodsWe performed a prospective cohort study of consecutive healthy and well-functioning patients hospitalized for this type of pneumonia. Patients were stratified into younger (18 to 64 years) and older (≥65 years) groups.ResultsDuring the study period, 399 consecutive patients were hospitalized with bacteremic pneumococcal pneumonia. We included 203 (50.8%) patients who were healthy and well-functioning patients, of whom 71 (35%) were classified as older. No differences were found in antibiotic treatment, treatment failure rate, antibiotic resistance, or serotype, except for serotype 7F that was less common in older patients. In the adjusted multivariate analysis, the older patients had higher 30-day mortality (OR 6.83; 95% CI 1.22–38.22; P = 0.028), but were less likely to be admitted to the ICU (OR 0.14; 95% CI 0.05–0.39; P < 0.001) and had shorter hospital stays (OR 0.71; 95% CI 0.54–0.94; P = 0.017).ConclusionsHealthy and well-functioning older patients have higher mortality than younger patients, but nevertheless, ICU admission was less likely and hospital stays were shorter. These results suggest that the aging process is a determinant of mortality, beyond the functional status of patients with bacteremic pneumococcal pneumonia.

Mortalidade e custos da pneumonia pneumocócica em adultos: um estudo transversal

“…A study conducted in the Netherlands in 2016 had similar results, with an average length of hospital stay of 12 days. (10) Ruiz et al identified a mortality risk in the ICU of 4.2 (p = 0.10); (8) however, in our study, the in-hospital mortality was higher (OR: 156.3) because all 37 patients who died were in the ICU.…”

“…This outcome may be related to immunosenescence because the participants were healthy and functional elderly people. (8) The presence of chronic diseases influences both the chance of acquiring PP because of changes in immune response and the severity of the disease and its outcomes. Patients with comorbidities have a high rate of pneumococcal disease-related mortality in short-(30 days) and long-term (1 year) periods.…”

“…The authors found that patients aged ≥ 65 years had a higher 30-day mortality rate; however, elderly patients were less frequently admitted to intensive care units (ICUs) and had shorter hospital stays. (8) Epidemiological data from Europe revealed 21,118 confirmed cases of pneumococcal disease in 2015, with a mortality rate of 14% (1,312 patients) and hospital costs for PP and BPP of approximately 13,611 euros (EUR) per hospitalized patient. (9) Hospitalizations of patients aged over 50 years have a greater economic impact, compared with hospitalizations of individuals aged 18 years or younger (average cost per episode of EUR 5,000 vs. EUR 2,750, respectively).…”

Mortalidade Dos Pacientes Admitidos Com Pneumonia Que Foram Submetidos À Intubação Orotraqueal No Serviço De Emergência Em Hospital Secundário Do Distrito Federal / Mortality of Patients Admitted With Pneumonia Who Underwent Orotracheal Intubation in the Emergency Department at a Secondary Hospital in the Federal District

“…outras patologias associadas. A pneumonia em pacientes idosos necessita de ser acompanhada de perto, pois há maior risco de evolução para quadros mais graves, Estes resultados são condizentes com os achados de Ruiz et al(19) onde comparam adultos de 18 a 64 anos e idosos ( ≥ 65 anos de idade) diagnosticados com pneumonia, e constataram que pacientes com idade maior que 65 anos apresentavam uma taxa de mortalidade maior em 30 dias de internação; entretanto, os idosos que foram internados com menor frequência em unidades de terapia intensiva tiveram menor tempo de internação hospitalar.…”

A Study Of Covid-19 Mortality Under Varying Patient Frailty

“…Some individuals infected with COVID-19 may develop COVID-related pneumonia, a serious complication in which the air sacs within the lungs become infected. If pneumonia develops, patients may experience a phlegm-filled cough in addition to COVID-19 symptoms[4].…”