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J Infect. 2012 Feb 10. [Epub ahead of print] Presentation, etiology and outcome of pneumonia in younger nursing home residents. Klapdor B, Ewig S, Schaberg T, Rohde G, Pletz MW, Schütte H, Welte T. Source Thoraxzentrum Ruhrgebiet, Department of Respiratory and Infectious Diseases, EVK Herne and Augusta-Kranken-Anstalt Bochum, Germany. Abstract OBJECTIVE: Nursing-home acquired pneumonia comprises a pneumonia entity of elderly and comorbid patients with an increased risk for 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: Around 16% of patients with NHAP (n=100) were aged < 65 years and compared to those aged ≥ 65 years (n=518). 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 presented less severe in the younger. Short and long-term mortality was twice as low in the younger with rates of 12.9% vs 26.6%, and 24.3% vs 43.8%, p 0.014 and 0.002), respectively. Whereas the rate of mechanical ventilation was more than twofold higher (12% vs 5%) (p=0.008), antimicrobial treatment attitudes did not account for different outcomes. CONCLUSIONS: A considerable proportion of younger patients with pneumonia resides in nursing homes. These differ 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. Keywordspneumonia - nursing home - residency - age - outcome.

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