|Topic:||19. Lung Infection (Non-Mycobacterial, i.e., Bacterial, Viral, Fungal, HIV, etc.) / Adult / Clinical Studies / Microbiology, Tuberculosis and Pulmonary Infections (MTPI)|
|Authors:||A.J. Videla1, I. Palma2, M. Fernandez Acquier2, M. Labato2, T. Wiemken3, S. Furmanek3, P. Peyrani3, J.A. Ramirez3, C.M. Luna2; 1Pilar/AR, 2Buenos Aires/AR, 3Louisville, KY/US|
Introduction: Most patients admitted with community-acquired pneumonia (CAP) are older than 65 years-old and/or have significant comorbidities (>65C+) influencing severity and outcome. Little is known about the characteristics of patients younger than 65 years-old without comorbidities (<65C-). We describe features, etiology and clinical outcome of this group and compare them with >65C+ subjects. Material and Methods: We performed a secondary analysis of the CAPO database comprising hospitalized patients with CAP. Patients were divided into two groups: >65C+ (older and /or with any comorbidity: congestive heart failure, chronic obstructive pulmonary disease, cerebrovascular disease, diabetes, HIV +, liver, renal or neoplastic disease) and <65C- (younger without comorbidities). Cases from the H1N1 2009 pandemic were excluded. Results: 5694 >65C+ CAP cases and 1439 <65C- patients were included, (median age: 74 (19.8) vs. 45 (21), males 61 vs 55%, p < 0.001). Pleural effusion was the only feature more common in the <65C- patients in PSI I/II groups (18 vs. 10%, p <0.001). At admission >65C+ patients had a lower O2 Saturation (93 vs. 95%, p < 0.001), higher frequency of PaO2/FIO2 <300 (68 vs. 48%, p < 0.001) and altered mental status (16 vs. 4%, p <0.001). Legionella and S. aureus were more frequent among >65C+ (p <0.001 for both comparisons). Atypical pathogens were more common in the <65C- (p < 0.001). There were no differences in the frequency of S. pneumoniae. Mortality was lower in <65C- patients (2 vs. 9%, p < 0.001). Among the <65C- who died, 64% were in PSI classes I and II. <65C- patients achieved clinical stability earlier (median of 4 vs. 5 days, p < 0.001) and had a shorter length of stay (median of 8 vs. 6 days, p < 0.001).
|Clinical outcome|| |
>65C+ (n, %)
|Admissions in PSI I group||251 (4)||742 (51)||< 0.001|
|Admissions in PSI II group||937 (16)||509 (35)||< 0.001|
|ICU admissions in PSI I group||28 (5)||55 (41)||< 0.001|
|ICU admissions in PSI II group||81 (14)||49 (36)||< 0.001|
|Died during hospitalization in PSI I group||7 (1)||10 (33)||< 0.001|
|Died during hospitalization in PSI II group||31 (6)||11 (36)||< 0.001|
Conclusion: There were significant differences in the etiology and clinical features of CAP among between groups. <65C- patients had a shorter clinical course with lower mortality. A higher frequency of cases with low PSI risk categories were admitted and died during admission in this group, signaling a potential limitation of the risk score.