Identificador: TDX:524
Autors: Ochoa Gondar, Olga
Resum:
Background: Community-acquired pneumonia (CAP) is generally considered a major cause of morbidity and mortality in the elderly. However, population-based data are very limited and its overall burden is unclear. Objective: This study assessed epidemiology, aetiology, clinical outcomes and risk factors for community-acquired pneumonia (CAP) among Spanish community-dwelling 65 years or older from Tarragona.Methods: Prospective cohort study that included 11,240 individuals aged 65 years or older, who were followed from January 2002 until April 2005. Primary endpoints were all-cause CAP (hospitalised and outpatient) and 30-day mortality after the diagnosis. All cases were radiographically proved and validated by checking clinical records. Results: Incidence rate of overall CAP was 14 cases per 1,000 person-year (10.5 for hospitalised CAP and 3.5 for outpatient CAP). Incidence was almost three-fold higher among immunocompromised patients (30.9 per 1000) than among immunocompetent subjects (11.6 per 1000). Maximum incidences were observed among patients with chronic lung disease and long-term corticosteroid therapy (46.5 and 40.1 cases per 1000 person-year, respectively). Overall 30-days case-fatality rate was 12.7% (2% in cases managed as outpatient and 15% in hospitalised patients). Among 358 patients with an aetiological workup, a total of 142 pathogens were found (single pathogen in 121 cases and mixed pathogens in 10 cases). Streptococcus pneumoniae was the most common pathogen (49%), followed by Pseudomona aeruginosa (15%), Chlamydia pneumoniae (9%) and Haemophillus influenzae (6%). The most common symptoms were respiratory symptoms and fever. The mortality was directly correlated with the Fine score.In multivariable analysis, the variables most strongly associated with increasing risk of CAP were history of hospitalisation for CAP in the previous 2 years and presence of any chronic lung disease.The assesment of clinical effectiveness of the 23-valent pneumococcal polysaccharide vaccine was conducted among 1298 Spanish older adults with chronic respiratory diseases (bronchitis, emphysema or asthma) who were followed between 2002 and 2005. Pneumococcal vaccination did not alter significantly the risk of overall CAP (hazard ratio [HR]: 0.77; 95% confidence interval [CI]: 0.56-1.07) and 30-days mortality from CAP (HR: 0.87; 95% CI: 0.33-2.28). However, a borderline significant reduction of 30% in the risk of all-cause hospitalisation for CAP was observed among vaccinated subjects (HR: 0.70; 95% CI: 0.48-1.00; p=0.052). The effectiveness of the vaccine on the combined endpoint of pneumococcal and unknown organism infections reached 34% (HR: 0.66; 95% CI: 0.43-1.01; p=0.059). Conclusions: CAP remains a major cause of morbidity and mortality in older adults. S. pneumoniae is the cause of about half the cases in which an organism is identified. The presence of chronic obstructive pulmonary disease is the clinical condition that is associated with an increased risk of CAP while receiving the pneumococcal vaccination is associated with a significant lower risk of CAP in the general population over 65 years. In COPD patients, the populations with increased risk of CAP, our findings suggest moderate benefits from the vaccination.
Repositori URV