The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지

Community-acquired pneumonia in elderly patients

노인성 폐렴

  • Chang, Hyun-Ha (Department of Internal Medicine, Kyungpook National University School of Medicine)
  • 장현아 (경북대학교 의학전문대학원 내과학교실)
  • Published : 2010.10.01
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Abstract

Pneumonia is the one of the 10 leading causes of overall mortality and the most common cause of infection-related death in Korea, especially in elderly patients. Streptococcus pneumoniae is the most common pathogen causing community-acquired pneumonia (CAP) in elderly patients, and gram-negative bacilli have also been reported as an important pathogen in Korea. Treatment guidelines for community-acquired pneumonia, which were published by the Joint Committee of the Korean Society for Chemotherapy, the Korean Society of Infectious Diseases, and the Korean Academy of Tuberculosis and Respiratory Diseases, are briefly presented in this article. A special consideration should be given to active preventive measures for CAP in elderly patients, especially vaccination using a seasonal influenza and pneumococcal 23-valent polysaccharide vaccine.

Keywords

References

  1. 장래인구추계. 통계청, 2006
  2. 2008년 사망원인통계. 통계청, 2008
  3. Jokinen C, Heiskanen L, Juvonen H, Kallinen S, Karkola K, Korppi M, Kurki S, Ronnberg PR, Seppa A, Soimakallio S, Sten M, Tanska S, Tarkianien A, Tukiainen H, Pyorala K, Makela PH. Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland. Am J Epidemiol 137: 977-988, 1993 https://doi.org/10.1093/oxfordjournals.aje.a116770
  4. Marston BJ, Plouffe JF, File TM Jr, Hackman BA, Salstrom SJ, Lipman HB, Kolczak MS, Breiman RF. Incidence of community-acquired pneumonia requiring hospitalization: results of a population-based active surveillance study in Ohio: the Community- Based Pneumonia Incidence Study Group. Arch Intern Med 157:1709-1718, 1997 https://doi.org/10.1001/archinte.157.15.1709
  5. Jackson ML, Neuzil KM, Thompson WW, Shay DK, Yu O, Hanson CA, Jackson LA. The burden of community-acquired pneumonia in seniors: results of a population-based study. Clin Infect Dis 39:1642-1650, 2004 https://doi.org/10.1086/425615
  6. Riquelme R, Torres A, El-Ebiary M, de la Bellacasa JP, Estruch R, Mensa J, Fernandez-Sola J, Hernandez C, Rodriguez-Roisin R. Community-acquired pneumonia in the elderly: a multivariate analysis of risk and prognostic factors. Am J Respir Crit Care Med 154:1450-1455, 1996 https://doi.org/10.1164/ajrccm.154.5.8912763
  7. Rello J, Rodriguez R, Jubert P, Alvarez B. Severe community-acquired pneumonia in the elderly: epidemiology and prognosis. Study Group for Severe Community-Acquired Pneumonia. Clin Infect Dis 23:723-728, 1996 https://doi.org/10.1093/clinids/23.4.723
  8. El-Solh AA, Sikka P, Ramadan F, Davies J. Etiology of severe pneumonia in the very elderly. Am J Respir Crit Care Med 163:645-651, 2001 https://doi.org/10.1164/ajrccm.163.3.2005075
  9. Kaplan V, Angus DC, Griffin MF, Clermont G, Scott Watson R, Linde-Zwirble WT. Hospitalized community-acquired pneumonia in the elderly: age-and sex-related patterns of care and outcome in the United States. Am J Respir Crit Care Med 165:766-772, 2002 https://doi.org/10.1164/ajrccm.165.6.2103038
  10. Zalacain R, Torres A, Celis R, Blanquer J, Aspa J, Esteban L, Menendez R, Blanquer R, Borderias L. Community-acquired pneumonia in the elderly: Spanish Multicentre Study. Eur Respir J 21:294-302, 2003 https://doi.org/10.1183/09031936.03.00064102
  11. Moon YS, Choi JT, Lee YJ, Yoon BB. Clinical feature of pneumonia in the elderly. J Korean Acad Fam Med 14:17-26, 1993
  12. Yu CW, Park CW, Hwang BY, Song JY, Park O, Sohn JW, Cheong HJ, Kim WJ, Kim MJ, Park SC. Clinical features and prognosis of community-acquired pneumonia in the elderly patients. Korean J Infect Dis 32:212-218, 2000
  13. Jeong HW, Park DW, Kee SY, Jung SJ, Sohn JW, Cheong HJ, Kim WJ, Kim MJ, Park SC. Community-acquired pneumonia in elderly: comparison of clinical manifestations and caudetive organisms before and after the separation of prescription and drug-selling. Infect Chemother 36:148-154, 2004
  14. Song JH, Oh WS, Kang CI, Chung DR, Peck KR, Ko KS, Yeom JS, Kim CK, Kim SW, Chang HH, Kim YS, Jung SI, Tong Z, Wang Q, Huang SG, Liu JW, Lalitha MK, Tan BH, Van PH, Carlos CC, So T. Epidemiology and clinical outcomes of community-acquired pneumonia in adult patients in Asian countries: a prospective study by the Asian network for surveillance of resistant pathogens. Int J Antimicrob Agents 31:107-114, 2008 https://doi.org/10.1016/j.ijantimicag.2007.09.014
  15. Koivula I, Sten M, Makela PH. Risk factors for pneumonia in the elderly. Am J Med 96:313-320, 1994 https://doi.org/10.1016/0002-9343(94)90060-4
  16. Kikawada M, Iwamoto T, Takasaki M. Aspiration and infection in the elderly: epidemiology, diagnosis and management. Drugs Aging 22:115-130, 2005 https://doi.org/10.2165/00002512-200522020-00003
  17. Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest 124:328-336, 2003 https://doi.org/10.1378/chest.124.1.328
  18. Kikuchi R, Watabe N, Konno T, Mishina N, Sekizawa K, Sasaki H. High incidence of silent aspiration in elderly patients with community-acquired pneumonia. Am J Respir Crit Care Med 150:251-253, 1994 https://doi.org/10.1164/ajrccm.150.1.8025758
  19. Terpenning M. Geriatric oral health and pneumonia risk. Clin Infect Dis 40:1807-1810, 2005 https://doi.org/10.1086/430603
  20. Riquelme R, Torres A, el-Ebiary M, Mensa J, Estruch R, Ruiz M, Angrill J, Soler N. Community-acquired pneumonia in the elderly: clinical and nutritional aspects. Am J Respir Crit Care Med 156:1908-1914, 1997 https://doi.org/10.1164/ajrccm.156.6.9702005
  21. Metlay JP, Schulz R, Li YH, Singer DE, Marrie TJ, Coley CM, Hough LJ, Obrosky DS, Kapoor WN, Fine MJ. Kapooluence of age on symHooms atley Centation in patients with community-acquired pneumonia. Arch Intern Med 157:1453-1459, 1997 https://doi.org/10.1001/archinte.157.13.1453
  22. Basi SK, Marrie TJ, Huang JQ, Majumdar SR. Patients admitted to hospital with suspected pneumonia and normal chest radiographs: epidemiology, microbiology, and outcomes. Am J Med 117:305-311, 2004 https://doi.org/10.1016/j.amjmed.2004.03.029
  23. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, Coley CM, Marrie TJ, Kapoor WN. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 336:243-250, 1997 https://doi.org/10.1056/NEJM199701233360402
  24. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, Lewis SA, Macfarlane JT. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 58:377-382, 2003 https://doi.org/10.1136/thorax.58.5.377
  25. Bauer TT, Ewig S, Marre R, Suttorp N, Welte T. CRB-65 predicts death from community-acquired pneumonia. J Intern Med 260: 93-101, 2006 https://doi.org/10.1111/j.1365-2796.2006.01657.x
  26. Espana PP, Capelastegui A, Gorordo I, Esteban C, Oribe M, Ortega M, Bilbao A, Quintana JM. Development and validation of a clinical prediction rule for severe community-acquired pneumonia. Am J Respir Crit Care Med 174:1249-1256, 2006 https://doi.org/10.1164/rccm.200602-177OC
  27. Yandiola PP, Capelastegui A, Quintana J, Diez R, Gorordo I, Bilbao A, Zalacain R, Menendez R, Torres A. Prospective comparison of severity scores for predicting clinically relevant outcomes for patients hospitalized with community-acquired pneumonia. Chest 135:1572-1579, 2009 https://doi.org/10.1378/chest.08-2179
  28. Ewig S, Kleinfeld T, Bauer T, Seifert K, Schafer H, Goke N. Comparative validation of prognostic rules for community-acquired pneumonia in an elderly population. Eur Respir J 14:370-375, 1999
  29. Conte HA, Chen YT, Mehal W, Scinto JD, Quagliarello VJ. A prognostic rule for elderly patients admitted with community-acquired pneumonia. Am J Med 106:20-28, 1999
  30. Lee JR, Jo SE, Choi MN, Lee HR. Factors related to mortality of elderly patients admitted with community-acquired pneumonia. J Korean Acad Fam Med 27:97-103, 2006
  31. Song JH, Jung KS, Kang MW, Kim DJ, Pai H, Suh GY, Shim TS, Ahn JH, Ahn CM, Woo JH, Lee NY, Lee DG, Lee MS, Lee SM, Lee YS, Lee H, Chung DR. Treatment guidelines for community-acquired pneumonia in Korea: an evidence-based approach to appropriate antimicrobial therapy. Infect Chemother 41:133-153, 2009 https://doi.org/10.3947/ic.2009.41.3.133
  32. Mandell LA, Bartlett JG, Dowell SF, File TM Jr, Musher DM, Whitney C. Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Clin Infect Dis 37:1405-1433, 2003 https://doi.org/10.1086/380488
  33. Schmidt-Ioanas M, Lode H. Treatment of pneumonia in elderly patients. Expert Opin Pharmacother 7:499-507, 2006 https://doi.org/10.1517/14656566.7.5.499
  34. Gleason PP, Meehan TP, Fine JM, Galusha DH, Fine MJ. Associations between initial antimicrobial therapy and medical outcomes for hospitalized elderly patients with pneumonia. Arch Intern Med 159:2562-2572, 1999 https://doi.org/10.1001/archinte.159.21.2562
  35. Garcia Vazquez E, Mensa J, Martinez JA, Marcos MA, Puig J, Ortega M, Torres A. Lower mortality among patients with community- acquired pneumonia treated with a macrolide plus a beta-lactam agent versus a beta-lactam agent alone. Eur J Clin Microbiol Infect Dis 24:190-195, 2005 https://doi.org/10.1007/s10096-005-1295-9
  36. Meehan TP, Fine MJ, Krumholz HM, Scinto JD, Galusha DH, Mockalis JT, Weber GF, Petrillo MK, Houck PM, Fine JM. Quality of care, process, and outcomes in elderly patients with pneumonia. JAMA 278:2080-2084, 1997 https://doi.org/10.1001/jama.278.23.2080
  37. Marrie TJ, Lau CY, Wheeler SL, Wont CJ, Feagan BG. Predictors of symptom resolution in patients with community-acquired pneumonia. Clin Infect Dis 31:1362-1367, 2000 https://doi.org/10.1086/317495
  38. El Solh AA, Aquilina AT, Gunen H, Ramadan F. Radiographic resolution of community-acquired bacterial pneumonia in the elderly. J Am Geriatr Soc 52:224-229, 2004 https://doi.org/10.1111/j.1532-5415.2004.52059.x
  39. Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogue S, Ferrer M. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet 354:1851-1858, 1999. https://doi.org/10.1016/S0140-6736(98)12251-1
  40. Gillick MR. Rethinking the role of tube feeding in patients with advanced dementia. N Engl J Med 342:206-210, 2000 https://doi.org/10.1056/NEJM200001203420312
  41. Marik PE, Zaloga GP. Gastric versus post-pyloric feeding: a systematic review. Crit Care 7:R46-R51, 2003 https://doi.org/10.1186/cc2190
  42. Yoneyama T, Yoshida M, Ohrui T, Mukaiyama H, Okamoto H, Hoshiba K, Ihara S, Yanagisawa S, Ariumi S, Morita T, Mizuno Y, Ohsawa T, Akagawa Y, Hashimoto K, Sasaki H. Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc 50:430-433, 2002 https://doi.org/10.1046/j.1532-5415.2002.50106.x
  43. 대한감염학회. 성인예방접종. 1판. p. 8-25, 군자출판사, 2007
  44. 대한감염학회. 성인예방접종. 1판. p. 26-34, 군자출판사, 2007
  45. Nichol KL, Nordin J, Mullooly J, Lask R, Fillbrandt K, Iwane M. Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. N Engl J Med 348:1322-1332, 2003 https://doi.org/10.1056/NEJMoa025028
  46. Nichol KL, Margolis KL, Wuorenma J, Von Sternberg T. The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community. N Engl J Med 331:778-784, 1994 https://doi.org/10.1056/NEJM199409223311206
  47. Nordin J, Mullooly J, Poblete S, Strikas R, Petrucci R, Wei F, Rush B, Safirstein B, Wheeler D, Nichol KL. Influenza vaccine effectiveness in preventing hospitalizations and deaths in persons 65 years or older in Minnesota, New York, and Oregon: data from 3 health plans. J Infect Dis 184:665-670, 2001 https://doi.org/10.1086/323085
  48. Voordouw AC, Sturkenboom MC, Dieleman JP, Stijnen T, Smith DJ, van der Lei J, Stricker BH. Annual revaccination against influenza and mortality risk in community-dwelling elderly persons. JAMA 292:2089-2095, 2004 https://doi.org/10.1001/jama.292.17.2089
  49. Rubins JB, Alter M, Loch J, Janoff EN. Determination of antibody responses of elderly adults to all 23 capsular polysaccharides after pneumococcal vaccination. Infect Immun 67:5979-5984, 1999
  50. Whitney CG, Farley MM, Hadler J, Harrison LH, Bennett NM, Lynfield R, Reingold A, Cieslak PR, Pilishvili T, Jackson D, Facklam RR, Jorgensen JH, Schuchat A. Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N Engl J Med 348:1737-1746, 2003 https://doi.org/10.1056/NEJMoa022823
  51. Christenson B, Hedlund J, Lundberg P, Ortqvist A. Additive preventive effect of influenza and pneumococcal vaccines in elderly persons. Eur Respir J 23:363-368, 2004 https://doi.org/10.1183/09031936.04.00063504
  52. Lim J, Eom CS, Kim S, Ke S, Cho B. Pneumococcal vaccination rate among elderly in South Korea. J Korean Geriatr Soc 14:18-24, 2010 https://doi.org/10.4235/jkgs.2010.14.1.18