Skip to main content
SpringerLink
Log in

Epidemiology of patients hospitalised for pneumonia in 2011: a prospective multicentre cohort study

Epidemiologie stationärer Pneumoniepatienten 2011 – Eine prospektive multizentrische Kohortenstudie

  • Original Article
  • Published:
Wiener klinische Wochenschrift Aims and scope Submit manuscript

Summary

This study was conducted to investigate the age dependent epidemiology of pneumonia and risk factors for mortality.

The data were derived from the Austrian Pneumonia Network (APNET), comprising nine Departments for Internal Medicine with a total of 1,011 hospital beds. All inpatients diagnosed with pneumonia during 2011 were followed until discharge. Identification of microorganisms was performed according to local standard methods. Data of patients < 65 years and ≥ 65 years were compared by Mann–Whitney and the Chi-square tests. Risk factors for hospital mortality were evaluated by univariate and multivariate analyses.

Overall, 1,956 patients were included. The hospital mortality was 10.4 %, and was higher in patients ≥ 65 (12.7 %) than in patients < 65 years of age (5.0 %; p < 0.001). Streptococcus (S.) pneumoniae was the most important pathogen. Enterobacteriacaeae were revealed significantly more often in patients ≥ 65 years. Age ≥ 65 years, chronic heart failure (CHF) and neurological disease increased the risk of hospital mortality 1.96 (95 % CI 1.19–3.20), 1.59 (95 % CI 1.10–2.29), and 1.7 (95 % CI 1.19–2.41)-fold, respectively.

In conclusion, pneumonia patients with CHF, neurological disease and age ≥ 65 years could benefit from intensified care due to increased risk of in-hospital death.

Zusammenfassung

Grundlagen

Prävalenz und Mortalität der Pneumonie sind vor allem bei älteren Menschen hoch und werden angesichts der alternden Bevölkerung in Österreich noch weiter ansteigen. Da kaum aktuelle Daten zur Epidemiologie der Pneumonie in Österreich verfügbar sind, wurde ein Pneumonie-Netzwerk bestehend aus 9 Abteilungen für Innere Medizin (Wien: 2, NÖ: 2, Burgenland, Steiermark, Salzburg, OÖ, Tirol: jeweils 1) gegründet (Gesamtbettenzahl n = 1011). Ziel war es, alle Patienten, die im Jahr 2011 mit einer Pneumonie stationär betreut wurden, prospektiv zu erfassen und hinsichtlich Erregerverteilung, Risikofaktoren und Mortalität auszuwerten.

Methodik

Erregernachweis und Therapie wurden wie an den jeweiligen Abteilungen im Routinebetrieb üblich durchgeführt. Demographische Daten wurden aus den Krankenakten erhoben und in eine Datenbank aufgenommen. Der Vergleich der Daten von Patienten < 65 und ≥ 65 Jahre erfolgte mittels Mann–Whitney und Chi-square Tests. Risikofaktoren für die Spitalssterblichkeit wurden mittels univariater und multivariater Analyse ausgewertet.

Ergebnisse

Insgesamt konnten Daten von 1956 hospitalisierten Pneumoniepatienten erfasst werden. Die durchschnittliche Spitalsmortalität lag bei 10,4 % und war bei Patienten ≥ 65 deutlich höher (12,7 %) als bei Patienten < 65 Jahre (5,0 %; p < 0,001). Streptococcus (S.) pneumoniae war der am häufigsten nachgewiesene Erreger. Enterobacteriaceae wurden signifikant häufiger bei Patienten ≥ 65 Jahren detektiert. Alter ≥ 65 Jahre, Herzinsuffizienz und neurologische Grunderkrankungen erhöhten das Risiko im Spital zu versterben 1,96 (95 % CI 1,19–3,20), 1,59 (95 % CI 1,10–2,29), und 1,7 (95 % CI 1,19–2,41) fach.

Schlussfolgerungen

Patienten mit Herzinsuffizienz, neurologischer Grunderkrankung bzw. fortgeschrittenem Lebensalter haben im Falle einer Pneumonie ein erhöhtes Mortalitätsrisiko und könnten daher besonders von einer intensivierten Therapie bzw. von einer Prophylaxe mittels Pneumokokkenimpfung gemäß den geltenden Empfehlungen profitieren.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Marrie TJ, Huang JQ. Epidemiology of community-acquired pneumonia in Edmonton, Alberta: an emergency department-based study. Can Respir J. 2005 Apr;12(3):139–42.

    PubMed  Google Scholar 

  2. Jokinen C, Heiskanen L, Juvonen H, Kallinen S, Karkola K, Korppi M, et al. Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland. Am J Epidemiol. 1993 May 1;137(9):977–88.

    PubMed  CAS  Google Scholar 

  3. Almirall J, Bolibar I, Vidal J, Sauca G, Coll P, Niklasson B, et al. Epidemiology of community-acquired pneumonia in adults: a population-based study. Eur Respir J. 2000 Apr;15(4):757–63.

    Article  PubMed  CAS  Google Scholar 

  4. Garibaldi RA. Epidemiology of community-acquired respiratory tract infections in adults. Incidence, etiology, and impact. Am J Med. 1985 Jun 28;78(6B):32–7.

    Article  PubMed  CAS  Google Scholar 

  5. Restrepo MI, Mortensen EM, Velez JA, Frei C, Anzueto A. A comparative study of community-acquired pneumonia patients admitted to the ward and the ICU. Chest. 2008 Mar;133(3):610–7.

    Article  PubMed  Google Scholar 

  6. Cilloniz C, Ewig S, Polverino E, Marcos MA, Esquinas C, Gabarrus A, et al. Microbial aetiology of community-acquired pneumonia and its relation to severity. Thorax. 2011 Apr;66(4):340–6.

    Article  PubMed  Google Scholar 

  7. Song JH, WS Oh, Kang CI, Chung DR, Peck KR, Ko KS, et al. Epidemiology and clinical outcomes of community-acquired pneumonia in adult patients in Asian countries: a prospective study by the Asian network for surveillance of resistant pathogens. Int J Antimicrob Agents. 2008 Feb;31(2):107–14.

    Article  PubMed  CAS  Google Scholar 

  8. Fine MJ, Smith MA, Carson CA, Mutha SS, Sankey SS, Weissfeld LA, et al. Prognosis and outcomes of patients with community-acquired pneumonia. A meta-analysis. JAMA. 1996 Jan 10;275(2):134–41.

    Article  PubMed  CAS  Google Scholar 

  9. Barrett-Connor E. The nonvalue of sputum culture in the diagnosis of pneumococcal pneumonia. Am Rev Respir Dis. 1971 Jun;103(6):845–8.

    PubMed  CAS  Google Scholar 

  10. Johansson N, Kalin M, Tiveljung-Lindell A, Giske CG, Hedlund J. Etiology of community-acquired pneumonia: increased microbiological yield with new diagnostic methods. Clin Infect Dis. 2010 Jan 15;50(2):202–9.

    Article  PubMed  Google Scholar 

  11. Pilishvili T, Lexau C, Farley MM, Hadler J, Harrison LH, Bennett NM, et al. Sustained reductions in invasive pneumococcal disease in the era of conjugate vaccine. J Infect Dis. 2010 Jan 1;201(1):32–41.

    Article  PubMed  Google Scholar 

  12. Grijalva CG, Nuorti JP, Arbogast PG, Martin SW, Edwards KM, Griffin MR. Decline in pneumonia admissions after routine childhood immunisation with pneumococcal conjugate vaccine in the USA: a time-series analysis. Lancet. 2007 Apr 7;369(9568):1179–86.

    Article  PubMed  CAS  Google Scholar 

  13. Kyaw MH, Lynfield R, Schaffner W, Craig AS, Hadler J, Reingold A, et al. Effect of introduction of the pneumococcal conjugate vaccine on drug-resistant Streptococcus pneumoniae. N Engl J Med. 2006 Apr 6;354(14):1455–63.

    Article  PubMed  CAS  Google Scholar 

  14. Whitney CG, Farley MM, Hadler J, Harrison LH, Bennett NM, Lynfield R, et al. Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N Engl J Med. 2003 May 1;348(18):1737–46.

    Article  PubMed  Google Scholar 

  15. Lexau CA, Lynfield R, Danila R, Pilishvili T, Facklam R, Farley MM, et al. Changing epidemiology of invasive pneumococcal disease among older adults in the era of pediatric pneumococcal conjugate vaccine. JAMA. 2005 Oct 26;294(16):2043–51.

    Article  PubMed  CAS  Google Scholar 

  16. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992 Jun;101(6):1644–55.

    Article  PubMed  CAS  Google Scholar 

  17. Spitalskompass. http://www.spitalskompass.at/Spitaeler/Listenansicht. Last access 20 August 2013.

  18. Gavazzi G, Krause KH. Ageing and infection. Lancet Infect Dis. 2002 Nov;2(11):659–66.

    Article  PubMed  Google Scholar 

  19. Effros RB. Roy Walford and the immunologic 2 of aging. Immun Ageing. 2005 Apr 25;2(1):7.

    Article  PubMed  Google Scholar 

  20. Heppner HJ, Sieber C, Muhlberg W, Esslinger AS. [Fever in the elderly patient]. MMW Fortschr Med. 2006 Jan 26;148(4):39–42.

    PubMed  CAS  Google Scholar 

  21. Maarel-Wierink CD van der, Vanobbergen JN, Bronkhorst EM, Schols JM, Baat C de. Meta-analysis of dysphagia and aspiration pneumonia in frail elders. J Dent Res. 2011 Dec;90(12):1398–404.

    Article  PubMed  Google Scholar 

  22. Easterling CS, Robbins E. Dementia and dysphagia. Geriatr Nurs. 2008 Jul-Aug;29(4):275–85.

    Article  PubMed  Google Scholar 

  23. Lieu PK, Chong MS, Seshadri R. The impact of swallowing disorders in the elderly. Ann Acad Med Singapore. 2001 Mar;30(2):148–54.

    PubMed  CAS  Google Scholar 

  24. Shay K. Infectious complications of dental and periodontal diseases in the elderly population. Clin Infect Dis. 2002 May 1;34(9):1215–23.

    Article  PubMed  Google Scholar 

  25. Sumi Y, Miura H, Michiwaki Y, Nagaosa S, Nagaya M. Colonization of dental plaque by respiratory pathogens in dependent elderly. Arch Gerontol Geriatr. 2007 Mar–Apr;44(2):119–24.

    Article  PubMed  Google Scholar 

  26. Hochberg I, Abassi Z, Azzam ZS. Patterns of alveolar fluid clearance in heart failure. Int J Cardiol. 2008 Nov 12;130(2):125–30.

    Article  PubMed  Google Scholar 

  27. Kaestle SM, Reich CA, Yin N, Habazettl H, Weimann J, Kuebler WM. Nitric oxide-dependent inhibition of alveolar fluid clearance in hydrostatic lung edema. Am J Physiol Lung Cell Mol Physiol. 2007 Oct;293(4):L859–69.

    Article  PubMed  CAS  Google Scholar 

  28. Corrales-Medina VF, Musher DM, Wells GA, Chirinos JA, Chen L, Fine MJ. Cardiac complications in patients with community-acquired pneumonia: incidence, timing, risk factors, and association with short-term mortality. Circulation. 2012 Feb 14;125(6):773–81.

    Article  PubMed  Google Scholar 

  29. Torres A, Dorca J, Zalacain R, Bello S, El-Ebiary M, Molinos L, et al. Community-acquired pneumonia in chronic obstructive pulmonary disease: a Spanish multicenter study. Am J Respir Crit Care Med. 1996 Nov;154(5):1456–61.

    Article  PubMed  CAS  Google Scholar 

  30. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997 Jan 23;336(4):243–50.

    Article  PubMed  CAS  Google Scholar 

  31. Kothe H, Bauer T, Marre R, Suttorp N, Welte T, Dalhoff K. Outcome of community-acquired pneumonia: influence of age, residence status and antimicrobial treatment. Eur Respir J. 2008 Jul;32(1):139–46.

    Article  PubMed  CAS  Google Scholar 

  32. Ewig S, Welte T, Chastre J, Torres A. Rethinking the concepts of community-acquired and health-care-associated pneumonia. Lancet Infect Dis. 2010 Apr;10(4):279–87 (Review).

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

Christoph Wenisch received an unrestricted grant from Pfizer, Inc. On behalf of all authors, the corresponding author states that there is no conflict of interest among the other authors.

Author information

Authors and Affiliations

  1. 4. Medizinische Abteilung mit Infektions und Tropenmedizin, Kaiser Franz Josef Spital, Kundratstrasse 3, 1100, Vienna, Austria

    Christoph Wenisch & Nina Muzatko

  2. Universitätsklinik für Innere Medizin I (Stoffwechselerkrankungen, Pulmologie, Infektiologie, Endokrinologie, Rheumatologie und Angiologie), Medizinische Universität Innsbruck, Innsbruck, Austria

    Günter Weiss & Rosa Bellmann-Weiler

  3. Universitätsinstitut für Medizinische Mikrobiologie, Hygiene und Infektiologie – SALK Labor GmbH Landeskrankenhaus Salzburg, Salzburg, Austria

    Arno Lechner

  4. Universitätsklinik für Innere Medizin, Klinische Abteilung für Pulmologie, Medizinische Universität Graz, Graz, Austria

    Michael Meilinger

  5. Abteilung für Innere Medizin, Landeskrankenhaus Thermenregion Mödling, Mödling, Austria

    Karl Rittler

  6. Abteilung für Innere Medizin, Krankenhaus Oberwart, Oberwart, Austria

    Beate Pomogyi

  7. 2. Medizinische Abteilung, Landesklinikum St. Pölten, St. Pölten, Austria

    Mathilde Kutilek

  8. Abteilung für Innere Medizin, Krankenhaus der Barmherzigen Brüder, Salzburg, Austria

    Ursula-Maria Fürst

  9. Abteilung für Innere Medizin, Krankenhaus der Barmherzigen Schwestern, Ried im Innkreis, Austria

    Alexander Andorfer

  10. Krankenhaushygiene, Wilheminenspital, Vienna, Austria

    Judith Maria Wenisch

Authors
  1. Christoph Wenisch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Günter Weiss
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Arno Lechner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael Meilinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Karl Rittler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nina Muzatko
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Beate Pomogyi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mathilde Kutilek
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Rosa Bellmann-Weiler
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ursula-Maria Fürst
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Alexander Andorfer
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Judith Maria Wenisch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christoph Wenisch.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wenisch, C., Weiss, G., Lechner, A. et al. Epidemiology of patients hospitalised for pneumonia in 2011: a prospective multicentre cohort study. Wien Klin Wochenschr 125, 621–628 (2013). https://doi.org/10.1007/s00508-013-0419-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00508-013-0419-y

Keywords

Schlüsselwörter

Search

Navigation