Community-acquired pneumonia in the intensive care unit: Epidemiological and prognosis data in older people

OBJECTIVES: To compare epidemiological data, etiology, and prognosis of sev ere community-acquired pneumonia (CAP) in the intensive care unit (ICU) acc ording to age (< or greater than or equal to 65 years) and to determine pro gnostic factors of CAP in older people. DESIGN: A retrospective (1987-1992) and prospective (1993-95) multicenter s tudy. SETTING: Six ICUs in the north of France. PATIENTS: Five hundred five patients admitted to an ICU for severe CAP. MEASUREMENTS: Patient characteristics were compared with regard to age. Pro gnosis of CAP in older patients was studied by stepwise discriminant analys is. RESULTS: Two hundred seventy-eight patients (55%) were aged 65 years or old er. Comparison of epidemiological data between older and younger patients r evealed a higher prevalence of women (38% vs 29%), more severe underlying c omorbidities (anticipated death within 5 years: 59% vs 26%), and more frequ ent chronic respiratory insufficiency (48% vs 33%) in the older patients. I n this study group, 224 organisms were isolated from 172 patients (62%); th ose identified most frequently were Gram-negative bacilli (34%), S. pneumon iae (32%), and Staphylococcus sp. (19%). Compared with younger patients, no significant differences in bacteriological data were observed. However, cr ude and attributable mortality rates were significantly higher in the older patients (33% vs 21% and 30% vs 19%, respectively). Prognosis analysis ide ntified four independent predictors of mortality in the older patients: ini tial septic shock (relative risk (RR) = 3), sepsis-related complications (R R = 4.3), hospital-acquired lower respiratory tract superinfections (RR = 2 ), and nonspecific pneumonia-related complications (RR = 2.8). CONCLUSION: The bacterial etiology provides some approaches to empirical th erapy for older patients with severe community-acquired pneumonia. In addit ion, the inappropriateness of withholding intensive care for reasons of age alone is emphasized.