PDF herunterladen
Semin Respir Crit Care Med 2005; 26(6): 650-656
DOI: 10.1055/s-2005-925529
Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Pneumonia in Nursing Homes and Long-Term Care Facilities

Mark B. Loeb1 , 2
  • 1Departments of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
  • 2Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
30. Dezember 2005 (online)

    Lizenzen und Reprints

ABSTRACT

This article reviews the epidemiology of pneumonia in residents of nursing homes and other long-term care facilities (LTCFs). Streptococcus pneumoniae is the most important cause of pneumonia in residents of nursing homes and LTCFs. Factors suggestive of aspiration are the most important risk factors for pneumonia in this population. The clinical presentation of pneumonia among long-term care facility residents is challenging; residents tend to be older and more debilitated than their elderly community-dwelling counterparts. Data on optimal antimicrobial therapy in this setting is sparse. Functional status is an important predictor of outcome in this population. There are key management issues, such as site of care, which remain unresolved. Immunization with influenza and pneumococcal vaccines remains the mainstay of prevention.

KEYWORDS

Pneumonia - aging - respiratory - long-term care facilities - nursing homes

REFERENCES

  • 1 Muder R. Pneumonia in residents of long-term care facilities: epidemiology, etiology, management, and prevention.  Am J Med. 1998;  105 319-330
    CrossrefPubMedGoogle Scholar
  • 2 Spillman B C, Lubitz J. The effect of longevity on spending for acute and long-term care.  N Engl J Med. 2000;  342 1409-1415
    CrossrefPubMedGoogle Scholar
  • 3 Valenti W M, Trudell R G, Bentley D W. Factors predisposing to oropharyngeal colonization with gram-negative bacilli in the aged.  N Engl J Med. 1978;  298 1108-1111
    PubMedGoogle Scholar
  • 4 Jokinen C, Heiskanen L, Juvonen H et al.. Microbial etiology of community-acquired pneumonia in the adult population of 4 municipalities in eastern Finland.  Clin Infect Dis. 2001;  32 1141-1154
    CrossrefPubMedGoogle Scholar
  • 5 Kupronis B A, Richards C L, Whitney C G. Invasive pneumococcal disease in older adults residing in long-term care facilities and in the community.  J Am Geriatr Soc. 2003;  51 1520-1525
    CrossrefPubMedGoogle Scholar
  • 6 Nuorti J P, Butler J C, Crutcher J M et al.. An outbreak of multidrug-resistant pneumococcal pneumonia and bacteremia among unvaccinated nursing home residents.  N Engl J Med. 1998;  338 1861-1868
    CrossrefPubMedGoogle Scholar
  • 7 Ruiz M, Ewig S, Marcos M et al.. Etiology of community-acquired pneumonia: impact of age, comorbidity, and severity.  Am J Respir Crit Care Med. 1999;  160 397-405
    PubMedGoogle Scholar
  • 8 Terpenning M S, Taylor G W, Lopatin D, Kerr C, Dominguez B L, Loesche W J. Aspiration pneumonia: dental and oral risk factors in an older veteran population.  J Am Geriatr Soc. 2001;  49 557-563
    CrossrefPubMedGoogle Scholar
  • 9 Loeb M, Simor A E, Krueger P et al.. Two nursing home outbreaks of respiratory infection with Legionella sainthelensi .  J Am Geriatr Soc. 1999;  47 547-552
    PubMedGoogle Scholar
  • 10 Maesaki S, Kohno S, Kog H et al.. An outbreak of legionnaires' pneumonia in a nursing home.  Intern Med. 1992;  31 508-512
    PubMedGoogle Scholar
  • 11 Troy C J, Peeling R W, Ellis A G et al.. Chlamydia pneumoniae as a new source of infectious outbreaks in nursing homes.  JAMA. 1997;  277 1214-1218
    CrossrefPubMedGoogle Scholar
  • 12 Orr P H, Peeling R W, Fast M et al.. Serological study of responses to selected pathogens causing respiratory tract infection in the institutionalized elderly.  Clin Infect Dis. 1996;  23 1240-1245
    PubMedGoogle Scholar
  • 13 Seenivasan M, Yu V, Muder R. Legionnaires' disease in long-term care facilities: overview and proposed solutions.  J Am Geriatr Soc. 2005;  53 875-880
    CrossrefPubMedGoogle Scholar
  • 14 Mills G D, Oehley M, Arrol B. Effectiveness of beta-lactam antibiotics compared with antibiotics active against atypical pathogens in non-severe community acquired pneumonia: meta-analysis.  BMJ. 2005;  330 456
    CrossrefPubMedGoogle Scholar
  • 15 Loeb M, McGeer A, McArthur M et al.. Risk factors for pneumonia and other lower respiratory tract infections in elderly residents of long-term care facilities.  Arch Intern Med. 1999;  159 2058-2064
    CrossrefPubMedGoogle Scholar
  • 16 Quagliarello V, Ginter S, Han L, Van Ness P, Allore H, Tinetti M. Modifiable risk factors for nursing home-acquired pneumonia.  Clin Infect Dis. 2005;  40 1-6
    CrossrefPubMedGoogle Scholar
  • 17 Vergis E N, Brennen C, Wagener M et al.. Pneumonia in long-term care: a prospective case-control study of risk factors and impact on survival.  Arch Intern Med. 2001;  161 2378-2381
    CrossrefPubMedGoogle Scholar
  • 18 Koivula I, Sten M, Makela P H. Risk factors for pneumonia in the elderly.  Am J Med. 1994;  96 313-320
    CrossrefPubMedGoogle Scholar
  • 19 Meehan T P, Chua-Reyes J M, Tate J et al.. Process of care performance, patient characteristics, and outcomes in elderly patients hospitalized with community-acquired or nursing home-acquired pneumonia.  Chest. 2000;  117 1378-1385
    CrossrefPubMedGoogle Scholar
  • 20 Marrie T J, Blanchard W. A comparison of nursing home-acquired pneumonia patients with patients with community-acquired pneumonia and nursing home patients without pneumonia.  J Am Geriatr Soc. 1997;  45 50-55
    PubMedGoogle Scholar
  • 21 Lim W S, Macfarlane J T. A prospective comparison of nursing home acquired pneumonia with community acquired pneumonia.  Eur Respir J. 2001;  18 362-368
    CrossrefPubMedGoogle Scholar
  • 22 Mylotte J M, Goodnough S, Naughton B J. Pneumonia versus aspiration pneumonitis in nursing home residents: diagnosis and management.  J Am Geriatr Soc. 2003;  51 17-23
    CrossrefPubMedGoogle Scholar
  • 23 Phillips S L, Branaman-Phillips J. The use of intramuscular cefoperazone versus intramuscular ceftriaxone in patients with nursing home-acquired pneumonia.  J Am Geriatr Soc. 1993;  41 1071-1074
    PubMedGoogle Scholar
  • 24 Hirata-Dulas C A, Stein D J, Guay D R, Gruninger R P, Peterson P K. A randomized study of ciprofloxacin versus ceftriaxone in the treatment of nursing home-acquired lower respiratory tract infections.  J Am Geriatr Soc. 1991;  39 979-985
    PubMedGoogle Scholar
  • 25 Peterson P K, Stein D, Guay D RP et al.. Prospective study of lower respiratory tract infections in an extended-care nursing home program: potential role of oral ciprofloxacin.  Am J Med. 1988;  85 164-171
    PubMedGoogle Scholar
  • 26 Naughton B J, Mylotte J M. Antibiotic use, hospital admissions, and mortality before and after implementing guidelines for nursing home-acquired pneumonia.  J Am Geriatr Soc. 2001;  49 1020-1024
    CrossrefPubMedGoogle Scholar
  • 27 Muder R R, Brennen C, Swenson D L, Wagener M. Pneumonia in a long-term care facility: a prospective study of outcome.  Arch Intern Med. 1996;  156 2365-2370
    CrossrefPubMedGoogle Scholar
  • 28 Mehr D R, Binder E F, Kruse R L et al.. Predicting mortality in nursing home residents with lower respiratory tract infection: The Missouri LRI Study.  JAMA. 2001;  286 2427-2436
    CrossrefPubMedGoogle Scholar
  • 29 Mylotte J M, Naughton B, Saludades C, Maszarovics Z. Validation and application of the pneumonia prognosis index to nursing home residents with pneumonia.  J Am Geriatr Soc. 1998;  46 1538-1544
    PubMedGoogle Scholar
  • 30 Bula C J, Ghilardi G, Wietlisbach V, Petignat C, Francioli P. Infections and functional impairment in nursing home residents: a reciprocal relationship.  J Am Geriatr Soc. 2004;  2 700-706
    PubMedGoogle Scholar
  • 31 Degelau J, Guay D, Straub K, Luxenberg M G. Effectiveness of oral antibiotic treatment in nursing home-acquired pneumonia.  J Am Geriatr Soc. 1995;  43 245-251
    PubMedGoogle Scholar
  • 32 Thompson R S, Hall N K, Szpiech M, Reisenberg L A. Treatments and outcomes of nursing-home acquired pneumonia.  J Am Board Fam Pract. 1997;  10 82-87
    PubMedGoogle Scholar
  • 33 Fried T R, Gillick M R, Lipsitz L A. Whether to transfer? Factors associated with hospitalization and outcome of elderly long-term care patients with pneumonia.  J Gen Intern Med. 1995;  10 246-250
    PubMedGoogle Scholar
  • 34 Fried T R, Gillick M R, Lipsitz L A. Short-term functional outcomes of long-term care residents with pneumonia treated with and without hospital transfer.  J Am Geriatr Soc. 1997;  45 302-306
    PubMedGoogle Scholar
  • 35 Kruse R L, Mehr D R, Boles K E et al.. Does hospitalization impact survival after lower respiratory infection in nursing home residents?.  Med Care. 2004;  42 860-870
    PubMedGoogle Scholar
  • 36 Konetzka R T, Spector W, Shaffer T. Effects of nursing home ownership type and resident payer source on hospitalization for suspected pneumonia.  Med Care. 2004;  42 1001-1008
    PubMedGoogle Scholar
  • 37 Gross P A, Hermogenes A W, Sacks H S, Lau J, Levandowski R A. The efficacy of influenza vaccine in elderly persons: a meta-analysis and review of the literature.  Ann Intern Med. 1995;  123 518-527
    PubMedGoogle Scholar
  • 38 Simonsen L, Reichert T A, Viboud C, Blackwelder W C, Taylor R J, Miller M A. Impact of influenza vaccination on seasonal mortality in the US elderly population.  Arch Intern Med. 2005;  165 265-272
    CrossrefPubMedGoogle Scholar
  • 39 Nichol K L, Wuorenma J, von Sternberg T. Benefits of influenza vaccination for low-, intermediate-, and high-risk senior citizens.  Arch Intern Med. 1998;  158 1769-1776
    CrossrefPubMedGoogle Scholar
  • 40 Nordin J, Mullooly J, Poblete S et al.. Influenza vaccine effectiveness in preventing hospitalizations and deaths in persons 65 years or older in Minnesota, New York and Oregon: data from 3 health plans.  J Infect Dis. 2001;  184 665-670
    CrossrefPubMedGoogle Scholar
  • 41 Nichol K L, Nordin J, Mullooly J, Lask R, Fillbrandt K, Iwane M. Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly.  N Engl J Med. 2003;  348 1322-1332
    CrossrefPubMedGoogle Scholar
  • 42 Potter J, Stott D J, Roberts M A et al.. Influenza vaccination of health care workers in long-term-care hospitals reduces the mortality of elderly patients.  J Infect Dis. 1997;  175 1-6
    PubMedGoogle Scholar
  • 43 Carman W F, Elder A G, Wallace L A et al.. Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial.  Lancet. 2000;  355 93-97
    CrossrefPubMedGoogle Scholar
  • 44 Fine M, Smith M A, Carson C A et al.. Efficacy of pneumococcal vaccination in adults: a meta-analysis of randomized controlled trials.  Arch Intern Med. 1994;  154 2666-2677
    PubMedGoogle Scholar
  • 45 Hutchison B G, Oxman A D, Shannon H S, Lloyd S, Altmayer C A, Thomas K. Clinical effectiveness of pneumococcal vaccine.  Can Fam Physician. 1999;  45 2381-2393
    PubMedGoogle Scholar
  • 46 Moore R A, Wiffen P J, Lipsky B A. Are the pneumococcal polysaccharide vaccines effective? Meta-analysis of the prospective trials.  BMC Family Practise. 2000;  1 1
    CrossrefPubMedGoogle Scholar
  • 47 Cornu C. Efficacy of pneumococcal polysaccharide vaccine in immunocompetent adults: a meta-analysis of randomized trials.  Vaccine. 2001;  19 4780-4790
    CrossrefPubMedGoogle Scholar
  • 48 Bardenheier B, Shefer A, McKibben L, Roberts H, Bratzler D. Characteristics of long-term-care facility residents associated with receipt of influenza and pneumococcal vaccinations.  Infect Control Hosp Epidemiol. 2004;  25 946-954
    PubMedGoogle Scholar
  • 49 Dehart M P, Salinas S K, Barnette Jr L J et al.. Project Protect: pneumococcal vaccination in Washington State nursing homes.  J Am Med Dir Assoc. 2005;  6 91-96
    CrossrefPubMedGoogle Scholar

Mark B LoebM.D. 

Department of Pathology and Molecular Medicine, McMaster University, MDCL 3200, 1200 Main St. W., Hamilton, ON, L8N 3Z5 Canada

eMail: loebm@mcmaster.ca

      >