International Journal of Gerontology
Volume 2, Issue 4 , Pages 183-195, December 2008

An Update on the Management Of Hospital-Acquired Pneumonia in the Elderly

  • Chao-Hsien Lee

      Affiliations

    • Division of Chest and Critical Care Medicine, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
    • Mackay Medicine, Nursing and Management College, Taipei, Taiwan
    • ,
  • Chien-Liang Wu

      Affiliations

    • Division of Chest and Critical Care Medicine, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
    • Mackay Medicine, Nursing and Management College, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Chien-Liang Wu, Division of Chest and Critical Care Medicine, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Section 2, Chung Shan North Road, Taipei, Taiwan

Accepted 15 October 2008.

Article Outline

SUMMARY 

Pneumonia is the leading cause of infection-related death and represents the fifth cause of mortality in the elderly. There are several reported risk factors for acquiring pneumonia at an older age, such as alcoholism, lung and heart diseases, nursing home residence, and swallowing disorders. Hospital-acquired pneumonia (HAP) is reviewed, with an emphasis on multidrug-resistant (MDR) bacterial pathogens, such as Pseudomonas aeruginosa, Acinetobacter species, and methicillin-resistant Staphylococcus aureus. The clinical characteristics of pneumonia in the elderly differ substantially compared with younger patients, and the severity of the disease is strongly associated with increased age and age-related comorbid disorders. Streptococcus pneumoniae is the pathogen most frequently responsible for pneumonia in the elderly with early HAP without risk factors for MDR; enteric Gram-negative rods should be considered in nursing home-associated pneumonia, as well as anaerobes in patients with aspiration pneumonia. Special attention should be given to preventive measures such as vaccination, oral care, and nutrition. The management of HAP should be instituted early with: appropriate use of antibiotics in adequate doses; avoidance of excessive use of antibiotics by de-escalation of initial antibiotic therapy, based on microbiologic cultures and the clinical response of the patient; and reduction of the duration of treatment to the minimum effective period.

Key Words:  aged , aging , cross infection , pneumonia

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PII: S1873-9598(09)70007-9

doi:10.1016/S1873-9598(09)70007-9

International Journal of Gerontology
Volume 2, Issue 4 , Pages 183-195, December 2008

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