title: Growing Antibiotic Resistance in Fatal Cases of Staphylococcal Pneumonia in the Elderly.
abstract: Older people are often especially susceptible to pneumonia and bacteria may develop resistance to antibiotics quicker in the elderly, whose immune systems gradually diminish. This study analyses, retrospectively, resistance to antibiotics in high-risk elderly patients with fatal pneumonia. Records of all patients aged over 65 who did not survive a bout with pneumonia were gathered from the records of the Department of Pneumology of HELIOS Clinic in Wuppertal, Germany from the period of 2004-2014. Susceptibility testing was executed for the study population, whose pneumonia was triggered by various kinds of bacteria. We detected 936 pneumonia patients of the overall mean age of 68.0 ± 13.6 years, with the following pneumonia types: 461 (49.3 %) community-acquired, 354 (37.8 %) nosocomial-acquired, and 121 (12.9 %) aspiration pneumonia. There were 631 (67.4 %) males and 305 (32.6 %) females there. We identified 672 (71.8 %) patients who had a high risk for pneumonia, especially staphylococcal pneumonia (p < 0.0001). The elderly patients had a higher risk of dying from pneumonia (2.9 odds ratio, 95 % confidence interval 1.8-4.6; p < 0.0001); of the 185 pneumonia-related deaths, 163 (88.1 %) were in the elderly. In those with fatal staphylococcal pneumonia, a high antibiotic resistance rate was found for piperacillin-tazobactam (p = 0.044), cefuroxime (p = 0.026), cefazolin (p = 0.043), levofloxacin (p = 0.018), erythromycin (p = 0.004), and clindamycin (p = 0.025). We conclude that elderly patients with staphylococcal pneumonia show resistance to common antibiotics. However, no significant antibiotic resistance could be ascribed for other types of pneumonia in these patients.
authors.affiliation: Department of Internal Medicine, Division of Pulmonary, Allergy and Sleep Medicine, HELIOS Clinic Wuppertal, Witten/Herdecke University, Heusnerstrasse 40, 42283, Wuppertal, Germany. josef.yayan@hotmail.com.
authors.forename: Josef
authors.initials: J
authors.lastname: Yayan
authors.affiliation: Department of Internal Medicine, Division of Pulmonary, Allergy and Sleep Medicine, HELIOS Clinic Wuppertal, Witten/Herdecke University, Heusnerstrasse 40, 42283, Wuppertal, Germany.
authors.forename: Kurt
authors.initials: K
authors.lastname: Rasche
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002437:Cefazolin / Q000494:pharmacology; D002444:Cefuroxime / Q000494:pharmacology; D002981:Clindamycin / Q000494:pharmacology; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D024881:Drug Resistance, Bacterial; D004917:Erythromycin / Q000494:pharmacology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D064704:Levofloxacin / Q000494:pharmacology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016017:Odds Ratio; D010397:Penicillanic Acid / Q000031:analogs & derivatives; D010878:Piperacillin; D000077725:Piperacillin, Tazobactam Drug Combination; D011023:Pneumonia, Staphylococcal / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D012189:Retrospective Studies; D013210:Staphylococcus / Q000187:drug effects*
chemical_list: D000900:Anti-Bacterial Agents; D000077725:Piperacillin, Tazobactam Drug Combination; D002981:Clindamycin; D004917:Erythromycin; D064704:Levofloxacin; D010397:Penicillanic Acid; D002437:Cefazolin; D002444:Cefuroxime; D010878:Piperacillin
keywords: Antibiotics; Elderly; Mortality; Pneumonia; Resistance; Sensitivity