title: Presentation, etiology and outcome of pneumonia in younger nursing home residents.
abstract: OBJECTIVE
  Nursing home-acquired pneumonia characteristically affects elderly patients with multiple comorbidities; it is associated with multidrug-resistant (MDR) pathogens and a high mortality. We studied the specific impact of age on the presentation, etiology and outcome of patients with NHAP.
  
  
  METHODS
  Data from the prospective multicenter CAPNETZ database were used for a comparison of the hospitalized younger nursing home residents with pneumonia to those aged ≥ 65 years as regards clinical presentation, comorbidity, severity at presentation, etiology, and outcome.
  
  
  RESULTS
  Amongst 618 patients with NHAP, 16% of patients (n = 100) were aged; 65 years. Comorbidity was present in most patients with NHAP but the pattern of comorbidity differed significantly. The rate of potential MDR pathogens was low among both age groups (together around 5%). According to the CRB-65 score, NHAP presentation was less severe in the younger patients. Short- and long-term mortality was twice as low in the younger patients with rates of 12.9% vs 26.6%, and 24.3% vs 43.8%, p = 0.014 and 0.002), respectively. In contrast, the usage of mechanical ventilation was more than two-fold higher (12% vs 5%) (p = 0.008) in younger patients. Antimicrobial treatment strategies did not account for different outcomes.
  
  
  CONCLUSIONS
  A considerable proportion of patients with NHAP are: 65 years of age. They differ from older patients in terms of clinical presentation, frequency and type of comorbidity, as well as outcome. NHAP is a heterogeneous entity, with age and comorbidity as the main determinant of NHAP characteristics.
authors.affiliation: Thoraxzentrum Ruhrgebiet, Department of Respiratory and Infectious Diseases, EVK Herne and Augusta-Kranken-Anstalt Bochum, Bergstrasse 26, 44791 Bochum, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Klapdor
authors.forename: Santiago
authors.initials: S
authors.lastname: Ewig
authors.forename: Tom
authors.initials: T
authors.lastname: Schaberg
authors.forename: Gernot
authors.initials: G
authors.lastname: Rohde
authors.forename: Mathias W
authors.initials: MW
authors.lastname: Pletz
authors.forename: Hartwig
authors.initials: H
authors.lastname: Schütte
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D011014:Pneumonia / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome