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Risk score-guided treatment for hospitalized pneumonia in older patients

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Abstract

Background

Initial intravenous antibiotic treatment strategy for pneumonia is debated in older people living in nursing homes. Guidelines of the American Thoracic Society identified American Health-Care Associated Pneumonia (HCAP) which covered Nursing Home-Acquired Pneumonia (NHAP) and can be used as a score. The Complicated Pathogen Risk Assessment Score (CPRS) focuses on comorbidities and clinical past history.

Aim

This study assesses the usefulness of HCAP score and CPRS in choosing initial empiric therapy while comparing their predictive value for a required change in initial antibiotic regimen and for mortality in hospitalized older patients.

Methods

This is a retrospective analysis of 175 patients aged 75 years or more hospitalized for pneumonia from 2014 to 2015. They were treated according to the French guidelines as community-acquired pneumonia. The HCAP score and the CPRS were analyzed retrospectively. They were matched to in-hospital mortality and to change in initial antibiotic regimen rates.

Results

Therapy as recommended for CAP was started in all 175 patients. A change in antibiotic regimen was noted in 17% of patients: 30% of those with a CPR score > 2 and 20% of those with an HCAP score ≥ 1. The global mortality rated 11% for all patients, 20.5% for those with a CPRS score > 2, and 16.5% for those with an HCAP score ≥ 1. Both changes for antibiotic regimen (p < 0.001) and mortality ( p< 0.001) rates were more closely associated with a CPRS  > 2 than with an HCAP score ≥ 1.

Conclusion

Multidrug-resistant risk scores are useful in optimizing initial empirical therapy for NHAP in the elderly.

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Authors and Affiliations

  1. Department of Geriatric Medicine, Hôpitaux Universitaires de Paris Seine Saint Denis, Service de Médecine Gériatrique Hôpital René Muret, 93270, Sevran, France

    Véronique François-Fasille & Géraud Varennes

  2. Department of Cardiology, Hôpitaux Universitaires de Paris Seine Saint Denis, Hôpital René Muret, 93270, Sevran, France

    Jean Jacques Monsuez

  3. SAMU 93, UF Recherche-Enseignement-Qualité, Université Paris 13, Sorbonne Paris Cité, Inserm U942, Hôpital Avicenne, 125, rue de Stalingrad, 93009, Bobigny, France

    Paul-Georges Reuter & Frédéric Lapostolle

Authors
  1. Véronique François-Fasille
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  2. Jean Jacques Monsuez
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  3. Géraud Varennes
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  4. Paul-Georges Reuter
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  5. Frédéric Lapostolle
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Correspondence to Véronique François-Fasille.

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There are no conflicts of interest with regard to this study or funding from any company.

Ethical approval

The study was approved by the local committee for Ethics . All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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For this type of study formal consent is not required.

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François-Fasille, V., Monsuez, J.J., Varennes, G. et al. Risk score-guided treatment for hospitalized pneumonia in older patients. Eur Geriatr Med 9, 509–513 (2018). https://doi.org/10.1007/s41999-018-0069-8

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  • DOI: https://doi.org/10.1007/s41999-018-0069-8

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