Vol.53 No.12 December 2005

Clinical characteristics of aspiration pneumonia in advanced aged peoples at care-mixed hospital

Hiromi Ono¹⁾, Takeshi Ishizaki²⁾, Atsuko Nagai¹⁾, Tetsuro Ohtaki¹⁾, Moriyoshi Hashimoto¹⁾, Kazuki Kanamori¹⁾, Maiko Kadowaki³⁾, Daisuke Uesaka³⁾, Siro Mizuno³⁾, Yoshiki Demura³⁾, Shingo Ameshima³⁾ and Hideho Ohtaki¹⁾

¹⁾Department of Internal Medicine, Ohtaki Hospital
²⁾Department of Fundamental Nursing, University of Fukui, 23-3, Shimoaizuki, Matsuoka-cho, Yoshida, Fukui, Japan
³⁾Department of Internal Medicine, University of Fukui

Abstract

Background: Japan's nursing-home population is mushrooming. The mortality of residents is usually related to pulmonary infection, including aspiration pneumonia.
Objective: We clarified the impacts of initial antibiotic therapy in the elderly with aspiration pneumonia institutionalized in nursing homes.
Patients and Methods: Subjects were 104 patients (114 episodes) with a mean aging of 85.8 years old, with aspiration pneumonia and transferred from nursing homes to a care mixed hospital. Aspiration pneumonia was diagnosed based on the diagnostic criteria of the Japanese Aspiration Pneumonia Research Conference.
Results: Among patients 59.6% and 35.1% were transferred from nursing home and own house, respectively. Only 32.5% of patients have had more than 37.5°C, and 33.3% did have more than 9,000/μL of peripheral white blood cell. A positive bacterial culture was found in 54 of 114 episodes in sputa or tracheobronchial secretion. A Gram-negative bacterium was found in 25 cases (46.3%) and MRSA in 21 cases (38.9%). The initial antibiotic was chosen from piperacillin (PIPC), meropenem (MEPM) and cefazolin (CEZ). Response to PIPC was 50%, 80.0% to MEPM and 61.9%, to CEZ. In 27 cases, initial antibiotic therapy was changed, but 22 of 27 died.
Risk factors for poor outcome appear to be comorbidity, the degree of pulmonary involvement, slight fever, increased CRP, hypoalbuminemia, and lowered arterial blood oxygen saturation.
Conclusion: Although prospective validation is required, we were able to clarify the clinical characteristics and prognostic indices in advanced aged people with aspiration pneumonia.

Key word

elderly, nursing home, prognostic factors

Received

April 1, 2005

Accepted

October 25, 2005

Jpn. J. Chemother. 53 (12): 741-747, 2005