Pneumonia in nursing homes

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

With less severe forms of the disease, the treatment of pneumonia in nursing homes is carried out at the site of the existing antibiotics, with a more severe infection, patients are hospitalized. The mortality is moderately high, but can occur due to concomitant pathology.

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

Causes of the pneumonia in nursing homes

According to the etiology and tactics of treatment of pneumonia in the nursing homes and institutions, it is located in the middle between the community and hospital pneumonia. pneumococci and gram-negative bacteria can cause most infections with the same frequency, although the question of whether gram-negative bacteria are pathogenic organisms or simply saprophytes remains controversial. The following are N. influenzae and moraxella catarrhalis; Chlamydia, mycoplasmas and legionella are rarely identified.

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

Risk factors

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

[11], [12], [13], [14], [15], -]. [17]

Symptoms of the pneumonia in nursing homes

Symptoms often resemble such with community-acquired or hospital pneumonia, but can be less pronounced; A cough and a modified mental status are often found, as well as the uncertain symptoms of anorexia, weakness, immaturity and fussiness, falling and non-contact. Subject short shortness of breath is found, but less often. 1 include reduced or missing reactivity, fever, tachycardia, tachypnee, striper or wheezing and gurgling, wet breathing.

Diagnostics of the pneumonia in nursing homes

Diagnosis is based on clinical manifestations and radiography of the chest. X-ray is often difficult to do in institutions of this type, so that hospitalization may require, at least for the initial examination. In some cases, treatment can be started without radiological confirmation. In patients, radiographically infiltrates may not be determined from the nursing home, apparently due to dehydration, which usually accompanies fever during pneumonia in old age, and/or slowed immune reaction, although the phenomenon has not been proven. Since physical changes can be detected with delay, and the risk of complications is high, hypoxemia should be assessed using pulsoximetry, as well as tests for the nitrogen of blood urea (AMC) and creatinine to detect hypovolemia.

[18], [19]

Treatment of the pneumonia in nursing homes

A few studies have been conducted to find out the need to choose a place where pneumonia should be treated in nursing homes, but, in general, patients should be hospitalized if they have two or more unstable indicators of vital functions and if urgent assistance cannot be provided in the boarding house. Some patients do not need hospitalization. One dose of the antibiotic active in relation to S. pneumoniae, N. influenzae, often found gram-negative bacteria and S. aureus, is necessarily given before the patient’s transportation; The usual recommendation is oral antipnexococcal fluoroquinolon (for example, levofloxacin 750 mg once a day, moxifloxacin 400 mg 1 time per day or hemifloxacin 320 mg once a day).

Forecast

Mortality in patients who require hospitalization is 13-41 %, while in patients receiving pneumonia in nursing homes-7-19 %. Mortality exceeds 30 % in the presence of more than two of the following signs: Frequency of respiratory movements & gt; 30 per minute, heart rate & gt; 125 beats per minute, acute change in mental status and anamnesis of dementia. An alternative forecasting index includes laboratory data. Doctors must follow all medical instructions, since pneumonia in nursing homes is often a terminal episode in exhausted patients from nursing homes.

[20], [21]