Effects of age, comorbidity and adherence to current antimicrobial guidelines on mortality in hospitalized elderly patients with community-acquired pneumonia
Abstract Background Limited information exists on the clinical characteristics predictive of mortality in patients aged ≥65 years in many countries. The impact of adherence to current antimicrobial guidelines on the mortality of hospitalized elderly patients with community-acquired pneumonia (CAP) h...
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2018-04-01
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Online Access: | http://link.springer.com/article/10.1186/s12879-018-3098-5 |
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Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Xiudi Han Fei Zhou Hui Li Xiqian Xing Liang Chen Yimin Wang Chunxiao Zhang Xuedong Liu Lijun Suo Jinxiang Wang Guohua Yu Guangqiang Wang Xuexin Yao Hongxia Yu Lei Wang Meng Liu Chunxue Xue Bo Liu Xiaoli Zhu Yanli Li Ying Xiao Xiaojing Cui Lijuan Li Jay E. Purdy Bin Cao for the CAP-China network |
spellingShingle |
Xiudi Han Fei Zhou Hui Li Xiqian Xing Liang Chen Yimin Wang Chunxiao Zhang Xuedong Liu Lijun Suo Jinxiang Wang Guohua Yu Guangqiang Wang Xuexin Yao Hongxia Yu Lei Wang Meng Liu Chunxue Xue Bo Liu Xiaoli Zhu Yanli Li Ying Xiao Xiaojing Cui Lijuan Li Jay E. Purdy Bin Cao for the CAP-China network Effects of age, comorbidity and adherence to current antimicrobial guidelines on mortality in hospitalized elderly patients with community-acquired pneumonia BMC Infectious Diseases Community-acquired pneumonia Overtreatment Adherence to guidelines Elderly |
author_facet |
Xiudi Han Fei Zhou Hui Li Xiqian Xing Liang Chen Yimin Wang Chunxiao Zhang Xuedong Liu Lijun Suo Jinxiang Wang Guohua Yu Guangqiang Wang Xuexin Yao Hongxia Yu Lei Wang Meng Liu Chunxue Xue Bo Liu Xiaoli Zhu Yanli Li Ying Xiao Xiaojing Cui Lijuan Li Jay E. Purdy Bin Cao for the CAP-China network |
author_sort |
Xiudi Han |
title |
Effects of age, comorbidity and adherence to current antimicrobial guidelines on mortality in hospitalized elderly patients with community-acquired pneumonia |
title_short |
Effects of age, comorbidity and adherence to current antimicrobial guidelines on mortality in hospitalized elderly patients with community-acquired pneumonia |
title_full |
Effects of age, comorbidity and adherence to current antimicrobial guidelines on mortality in hospitalized elderly patients with community-acquired pneumonia |
title_fullStr |
Effects of age, comorbidity and adherence to current antimicrobial guidelines on mortality in hospitalized elderly patients with community-acquired pneumonia |
title_full_unstemmed |
Effects of age, comorbidity and adherence to current antimicrobial guidelines on mortality in hospitalized elderly patients with community-acquired pneumonia |
title_sort |
effects of age, comorbidity and adherence to current antimicrobial guidelines on mortality in hospitalized elderly patients with community-acquired pneumonia |
publisher |
BMC |
series |
BMC Infectious Diseases |
issn |
1471-2334 |
publishDate |
2018-04-01 |
description |
Abstract Background Limited information exists on the clinical characteristics predictive of mortality in patients aged ≥65 years in many countries. The impact of adherence to current antimicrobial guidelines on the mortality of hospitalized elderly patients with community-acquired pneumonia (CAP) has never been assessed. Methods A total of 3131 patients aged ≥65 years were enrolled from a multi-center, retrospective, observational study initiated by the CAP-China network. Risk factors for death were screened with multivariable logistic regression analysis, with emphasis on the evaluation of age, comorbidities and antimicrobial treatment regimen with regard to the current Chinese CAP guidelines. Results The mean age of the study population was 77.4 ± 7.4 years. Overall in-hospital and 60-day mortality were 5.7% and 7.6%, respectively; these rates were three-fold higher in those aged ≥85 years than in the 65–74 group (11.9% versus 3.2% for in-hospital mortality and 14.1% versus 4.7% for 60-day mortality, respectively). The mortality was significantly higher among patients with comorbidities compared with those who were otherwise healthy. According to the 2016 Chinese CAP guidelines, 62.1% of patients (1907/3073) received non-adherent treatment. For general-ward patients without risk factors for Pseudomonas aeruginosa (PA) infection (n = 2258), 52.3% (1094/2090) were over-treated, characterized by monotherapy with an anti-pseudomonal β-lactam or combination with fluoroquinolone + β-lactam; while 71.4% of intensive care unit (ICU) patients (120/168) were undertreated, without coverage of atypical bacteria. Among patients with risk factors for PA infection (n = 815), 22.9% (165/722) of those in the general ward and 74.2% of those in the ICU (69/93) were undertreated, using regimens without anti-pseudomonal activity. The independent predictors of 60-day mortality were age, long-term bedridden status, congestive heart failure, CURB-65, glucose, heart rate, arterial oxygen saturation (SaO2) and albumin levels. Conclusions Overtreatment in general-ward patients and undertreatment in ICU patients were critical problems. Compliance with Chinese guidelines will require fundamental changes in standard-of-care treatment patterns. The data included herein may facilitate early identification of patients at increased risk of mortality. Trial registration The study was registered at ClinicalTrials.gov (NCT02489578). |
topic |
Community-acquired pneumonia Overtreatment Adherence to guidelines Elderly |
url |
http://link.springer.com/article/10.1186/s12879-018-3098-5 |
work_keys_str_mv |
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doaj-226e2e7fb1f64d8bb891bcb0fc61402d2020-11-25T03:40:26ZengBMCBMC Infectious Diseases1471-23342018-04-0118111110.1186/s12879-018-3098-5Effects of age, comorbidity and adherence to current antimicrobial guidelines on mortality in hospitalized elderly patients with community-acquired pneumoniaXiudi Han0Fei Zhou1Hui Li2Xiqian Xing3Liang Chen4Yimin Wang5Chunxiao Zhang6Xuedong Liu7Lijun Suo8Jinxiang Wang9Guohua Yu10Guangqiang Wang11Xuexin Yao12Hongxia Yu13Lei Wang14Meng Liu15Chunxue Xue16Bo Liu17Xiaoli Zhu18Yanli Li19Ying Xiao20Xiaojing Cui21Lijuan Li22Jay E. Purdy23Bin Cao24for the CAP-China networkDepartment of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical UniversityDepartment of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical UniversityNational Clinical Research Center of Respiratory Diseases, Center for Respiratory Diseases, China-Japan Friendship HospitalDepartment of Respiratory Medicine, Yan’an Hospital Affiliated to Kunming Medical UniversityDepartment of Infectious Disease, Beijing Jishuitan HospitalNational Clinical Research Center of Respiratory Diseases, Center for Respiratory Diseases, China-Japan Friendship HospitalDepartment of Respiratory Medicine, Beijing Huimin HospitalDepartment of Respiratory Medicine, Qingdao Municipal Hospital GroupDepartment of Respiratory Medicine, Linzi District People’s HospitalDepartment of Respiratory Medicine, Beijing Luhe Hospital, Capital Medical UniversityDepartment of Pulmonary and Critical Care Medicine, Weifang No. 2 People’s HospitalDepartment of Respiratory Medicine, Shandong University Affiliated Qilu Hospital (Qingdao)Department of Respiratory Medicine, The 2nd Hospital of Beijing Corps, Chinese Armed Police ForcesDepartment of Infectious Disease, Qingdao University Medical College Affiliated Yantaiyuhuangding HospitalDepartment of Respiratory Medicine, Rizhao Chinese Medical Hospital Affiliated to Shandong Chinese Medical UniversityDepartment of Respiratory Medicine, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical UniversityDepartment of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical UniversityDepartment of Respiratory Medicine, Linzi District People’s HospitalDepartment of Occupational Medicine and Toxicology, Beijing Chao-Yang Hospital, Capital Medical UniversityDepartment of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical UniversityDepartment of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical UniversityNational Clinical Research Center of Respiratory Diseases, Center for Respiratory Diseases, China-Japan Friendship HospitalNational Clinical Research Center of Respiratory Diseases, Center for Respiratory Diseases, China-Japan Friendship HospitalSenior Director, Anti-infectives, Pfizer IncNational Clinical Research Center of Respiratory Diseases, Center for Respiratory Diseases, China-Japan Friendship HospitalAbstract Background Limited information exists on the clinical characteristics predictive of mortality in patients aged ≥65 years in many countries. The impact of adherence to current antimicrobial guidelines on the mortality of hospitalized elderly patients with community-acquired pneumonia (CAP) has never been assessed. Methods A total of 3131 patients aged ≥65 years were enrolled from a multi-center, retrospective, observational study initiated by the CAP-China network. Risk factors for death were screened with multivariable logistic regression analysis, with emphasis on the evaluation of age, comorbidities and antimicrobial treatment regimen with regard to the current Chinese CAP guidelines. Results The mean age of the study population was 77.4 ± 7.4 years. Overall in-hospital and 60-day mortality were 5.7% and 7.6%, respectively; these rates were three-fold higher in those aged ≥85 years than in the 65–74 group (11.9% versus 3.2% for in-hospital mortality and 14.1% versus 4.7% for 60-day mortality, respectively). The mortality was significantly higher among patients with comorbidities compared with those who were otherwise healthy. According to the 2016 Chinese CAP guidelines, 62.1% of patients (1907/3073) received non-adherent treatment. For general-ward patients without risk factors for Pseudomonas aeruginosa (PA) infection (n = 2258), 52.3% (1094/2090) were over-treated, characterized by monotherapy with an anti-pseudomonal β-lactam or combination with fluoroquinolone + β-lactam; while 71.4% of intensive care unit (ICU) patients (120/168) were undertreated, without coverage of atypical bacteria. Among patients with risk factors for PA infection (n = 815), 22.9% (165/722) of those in the general ward and 74.2% of those in the ICU (69/93) were undertreated, using regimens without anti-pseudomonal activity. The independent predictors of 60-day mortality were age, long-term bedridden status, congestive heart failure, CURB-65, glucose, heart rate, arterial oxygen saturation (SaO2) and albumin levels. Conclusions Overtreatment in general-ward patients and undertreatment in ICU patients were critical problems. Compliance with Chinese guidelines will require fundamental changes in standard-of-care treatment patterns. The data included herein may facilitate early identification of patients at increased risk of mortality. Trial registration The study was registered at ClinicalTrials.gov (NCT02489578).http://link.springer.com/article/10.1186/s12879-018-3098-5Community-acquired pneumoniaOvertreatmentAdherence to guidelinesElderly |