Guía de consenso para el abordaje de la neumonía adquirida en la comunidad en el paciente anciano

Abstract

The incidence of community-acquired pneumonia increases with age and is associated with an elevated morbidity and mortality due to the physiological changes associated with aging and a greater presence of chronic disease. Taking into account the importance of this disease from an epidemiological and prognostic point of view, and the enormous heterogeneity described in the clinical management of the elderly, we believe a specific consensus document regarding this patient profile is necessary. The purpose of the present work was to perform a review of the evidence related to the risk factors for the etiology, the clinical presentation, the management and the treatment of community-acquired pneumonia in elderly patients with the aim of producing a series of specific recommendations based on critical analysis of the literature. This document is the result of the collaboration of different specialists representing the Spanish Society of Emergency Medicine and Emergency Care (SEMES), the Spanish Society of Geriatrics and Gerontology (SEGG), the Spanish Society of Chemotherapy (SEQ), the Spanish Society of Internal Medicine (SEMI), the Spanish Society of Respiratory Medicine and Thoracic Surgery (SEPAR), Spanish Society of Home Hospitalization (SEHAD) and the Spanish Society of Infectious Disease and Clinical Microbiology (SEIMC).

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

“…Although there are no specific studies on this population, it is generally assumed that there are no significant differences between the management of older and younger patients with the same characteristics [18]. In this study, however, we found that older patients have higher 30-day mortality.…”

“…As a consequence, it has recently been proposed that diagnostic and therapeutic decisions should be based more on the patients’ degree of frailty than their age [18, 19]. This concept may be a better reflection of biological than chronological age.…”

Clinical practice guidelines for the management of community‐acquired pneumonia: A critical appraisal using the AGREE II instrument

“…[49][50][51][52] CPGs that included pneumonia associated with health care, 53,54 audit, 55 note, 56 summary and comment, 57 "Consensus statements", [58][59][60][61][62] reviews, [63][64][65] includes various types of infections not only pneumonia, 66,67 description of adaptation of a CPG, 68 newsletter, 69 very little information available, 70 updated guidelines, [71][72][73] could not be downloaded the full version, 74 and there was a special case of a CPG published in different journals in the same year and it was excluded because it was a consensus on the two different publications. 58,59 About the 18 CPGs selected: there is an American guideline (IDSA), 34 one is from Brazil, 33 one from Italy (Gulf), 22 one from India, 27 two European (ERS and Multidisciplinary), 20,28 two from Spain (SEPAR and Andalusian), 21,31 a Peruvian guideline, 23 a Dutch guideline (SWAB), 29 two British guidelines (NICE and BTS), 17,32 a Lebanese guideline, 18 one from Latin America (Consensur), 30 one Colombian guideline, 24 one Chinese, 25 one Korean 26 and one Swedish. 19…”

Manejo de la neumonía adquirida en la comunidad en el adulto mayor

“…La ausencia de fiebre, hipoxemia o síntomas respiratorios no permiten descartar el diagnóstico de neumonía. 7 Al ser este un grupo poblacional clínicamente muy heterogéneo, ha surgido la necesidad de categorizar al paciente adulto mayor. 7 Un anciano sin criterios de fragilidad es aquel que es independiente para las actividades básicas e instrumentales de la vida diaria, sin comorbilidad significativa, ni otros problemas mentales ni sociales asociados.…”

“…aparato respiratorio e inmunitario, junto con la mayor probabilidad de situaciones clínicas, sociales y de enfermedades crónicas que van siendo acumulativas con la edad, lo cual convierten al anciano en un sujeto más vulnerable al desarrollo de infecciones, más específicamente de la neumonía, así como de riesgo incrementado de un peor resultado de las misma. 2,4,7,8…”