The Study On The Clinical Characteristics Of Elderly Patients With Healthcare Associated Pneumonia In Emergency Department

Objective:The purpose of this study was to investigate the clinical characteristics and the outcome of the elderly patients with healthcare associated pneumonia(HCAP) in emergency department. The current project may facilitate a profound understanding of the pathogenesis of HCAP and the targeting clinical treatment.Methods:1. The 202 patients diagnosed between January 2013 and December 2014, with age over 80 years, were equally assigned into HCAP and CAP groups. The clinical characteristics, including age, hospitalization days, outcomes, clinical manifestation, complication, pneumonia severity index(PSI) and pathogen were compared between both groups.2. The clinical data of elderly patients with HCAP in emergency department wards of Shanghai Ruijin hospital from January 2007 to December 2008 were analyzed retrospectively. 92 cases of clinical diagnosed HCAP during 2007~2008 were compared with the 100 cases of HCAP during 2013~2014. Results:1. The compare between the HCAP and CAP from 2013~2014: The average hospital stay length of HCAP was longer than that of CAP significantly(20.56 d vs. 14.28 d). The mortality of HCAP(24.00%)was also significantly higher than that of CAP(7.84%). The proportion of hydrothorax were higher than that of CAP(67.00% vs. 40.20%).But the proportion of fever were lower than that of CAP(48.00% vs. 62.75%).The nutrition indicators of HCAP were lower than that of CAP including hemoglobin and blood albumin(108.3 g/L vs. 113.7 g/L and 27.60 g/L vs. 29.46 g/L). However, the counts of leukocyte in the blood between HCAP and CAP groups were close. The PSI and the proportion of Class V of HCAP were higher than that of CAP significantly(125.7 vs. 114.8 and 44.00% vs. 19.61%). The frequently isolated pathogens of G- were A. baumannii and P. aeruginosa in HCAP, and K. pneumoniae in CAP. The frequently isolated pathogens of G+ was S. aureus in two groups.2. The compare of HCAP between 2013~2014 and 2007~2008: The proportion of HCAP in elderly pneumonia on 2013~2014 was significantly higher than the period on 2007~2008(40.0% vs. 31.1%). Cough was the most common symptom on 2007~2008, pleural effusion is the second. And the fever is the less common symptom. The frequently isolated pathogens of G- were A. baumannii on 2007~2008. S. aureus was the frequently isolated pathogens of G+ on 2013~2014, and it was significantly higher than that of on2013~2014. Conclusions: The characteristics of HCAP in elderly were commonly recognized as longer hospitalization days, higher mortality rate, malnutrition, and untypical clinical feature. The proportion of HCAP in elderly was increase in this two years. Therefore, all clinicians should deepen the understanding of HCAP. The early diagnosis and treatment had important clinical impacts.