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

J Am Geriatr Soc. 1999 May;47(5):539-46. doi: 10.1111/j.1532-5415.1999.tb02567.x.


Objectives: To compare epidemiological data, etiology, and prognosis of severe community-acquired pneumonia (CAP) in the intensive care unit (ICU) according to age (< or > or = 65 years) and to determine prognostic factors of CAP in older people.

Design: A retrospective (1987-1992) and prospective (1993-95) multicenter study.

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. Prognosis of CAP in older patients was studied by stepwise discriminant analysis.

Results: Two hundred seventy-eight patients (55%) were aged 65 years or older. Comparison of epidemiological data between older and younger patients revealed a higher prevalence of women (38% vs 29%), more severe underlying comorbidities (anticipated death within 5 years: 59% vs 26%), and more frequent chronic respiratory insufficiency (48% vs 33%) in the older patients. In this study group, 224 organisms were isolated from 172 patients (62%); those identified most frequently were Gram-negative bacilli (34%), S. pneumoniae (32%), and Staphylococcus sp. (19%). Compared with younger patients, no significant differences in bacteriological data were observed. However, crude and attributable mortality rates were significantly higher in the older patients (33% vs 21% and 30% vs 19%, respectively). Prognosis analysis identified four independent predictors of mortality in the older patients: initial septic shock (relative risk (RR) = 3), sepsis-related complications (RR = 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 therapy for older patients with severe community-acquired pneumonia. In addition, the inappropriateness of withholding intensive care for reasons of age alone is emphasized.

Publication types

  • Multicenter Study

MeSH terms

  • Age Factors
  • Aged
  • Community-Acquired Infections / mortality
  • Discriminant Analysis
  • Female
  • France
  • Humans
  • Intensive Care Units / statistics & numerical data*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Pneumonia, Bacterial / mortality*
  • Prognosis
  • Prospective Studies
  • Retrospective Studies
  • Survival Analysis