Pneumonia in nursing homes

Pneumonia in nursing homes is caused by gram-negative bacilli, Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, anaerobes and the influenza virus. Symptoms are similar to those of pneumonia of other species, except that many elderly patients have less pronounced changes in vital signs. The diagnosis is based on clinical manifestations and chest radiography, which is not always available in nursing homes.

In less severe forms of the disease, pneumonia in nursing homes is treated on site with available antibiotics, with a more severe infection, patients are hospitalized. Mortality is moderately high, but may occur as a result of concomitant pathology.

[1], [2], [3], [4], [5]

Causes of the pneumonia in nursing homes

According to etiology and tactics of treatment, pneumonia in nursing homes and institutions is in the middle between community-acquired and hospital pneumonia. Pneumococci and gram-negative bacteria can cause almost the same frequency of most infections, although the question of whether gram-negative bacteria are pathogens or simply saprophytes remains controversial. Further follows N. Influenzae and Moraxella catarrhalis; chlamydia, mycoplasma and legionella are rarely identified.

[6], [7], [8], [9], [10]

Risk factors

Risk factors - often in these patients a weak functional status; reduced mood, mental status and difficulty swallowing; presence of tracheostomy.

[11], [12], [13], [14], [15], [16], [17],

Symptoms of the pneumonia in nursing homes

Symptoms often resemble those of community-acquired or hospital-acquired pneumonia, but may be less pronounced; cough and altered mental status are common, as are uncertain signs of anorexia, weakness, restlessness and fussiness, falls and non-contactness. Subjective dyspnea occurs, but less often. 1 include reduced or absent reactivity, fever, tachycardia, tachypnea, stridor or wheezing and gurgling, wet breathing.

Diagnostics of the pneumonia in nursing homes

Diagnosis is based on clinical manifestations and chest X-ray. X-rays are often difficult to perform in institutions of this type, so hospitalization may be required, at least for the initial examination. In some cases, treatment can be initiated without x-ray confirmation. Patients from a nursing home may not initially be identified by X-ray infiltrates, presumably because of the dehydration that usually accompanies fever in pneumonia in the elderly, and / or a delayed immune response, although the phenomenon has not been proven. Since physical changes can be detected late, and the risk of complications is high, an assessment of hypoxemia with pulse oximetry should be performed, and blood urea nitrogen (AMK) and creatinine tests should be done to detect hypovolemia.

[18], [19], [20]

Treatment of the pneumonia in nursing homes

A little research has been done to find out the need to choose the place where pneumonia should be treated in nursing homes, but in general, patients should be hospitalized if they have two or more unstable vital signs and if they can not be provided with emergency care in a boarding house help. Some patients do not require hospitalization. One dose of an antibiotic active against S. Pneumoniae, H. Influenzae, frequently occurring Gram-negative bacteria and S. Aureus, is necessarily given before the patient is transported; The usual recommendation is oral antipnevmokokkovy fluoroquinolone (for example, levofloxacin 750 mg once a day, moxifloxacin 400 mg once a day or hemifloxacin 320 mg once a day).

Forecast

Mortality in patients requiring hospitalization is 13-41%, whereas in patients receiving pneumonia treatment in nursing homes - 7-19%. Mortality exceeds 30% if there are more than two of the following signs: respiratory rate> 30 per minute, heart rate> 125 beats per minute, acute change in mental status and anamnesis of dementia. An alternative predictive index includes laboratory data. Doctors must follow all medical guidelines, since pneumonia in nursing homes is often a terminal episode in depleted patients from nursing homes.

[21], [22]