Clinical analysis of community-acquired pneumonia in the elderly

Objective To evaluate the clinical features, etiology, and outcome of patie nts over 65 years old hospitalized for community-acquired pneumonia. Patients Eighty-four patients (50 males, 34 females) hospitalized for commu nity-acquired pneumonia in Kawasaki Medical School Kawasaki Hospital betwee n April 1998 and March 2000. Results Most of the patients had respiratory symptoms or signs, but over on e-third also had atypical symptoms of pneumonia such as dyspnea, consciousn ess disturbance, and gastrointestinal symptoms. The causative microorganism s were identified in 48% of these patients. Streptococcus pneumoniae (13%), respiratory viruses (13%), Haemophilus influenzae (8%) and Mycobacterium t uberculosisd (8%) were frequently identified, but Mycoplasma pneumoniae was less frequently noted in the elderly. Double infection was recognized in 1 9% and a combination of some virus and bacteria in 13%. Treatment consisted of the administration of second or third generation cephalosporin antibiot ics intravenously, because antibiotics had already been preadministered in 39%. The prognosis was poor (mortality rate 9%) for the elderly with commun ity-acquired pneumonia despite mechanical ventilation in 8%. Conclusions Although the range of microorganisms causing community-acquired pneumonia differed slightly from that in previous reports; namely, lower f requency of Chlamydia pneumoniae and Legionella pneumophila, it is suggeste d that the initial antibiotic treatment should always cover S. pneumoniae a nd H. influenzae. In addition, since a prevalence of virus infections relat ed to the increase in community-acquired pneumonia in the elderly was found in this study, the routine use of influenza vaccine and pneumococcal vacci nes in the elderly is recommended to reduce the high mortality rate.