Author/Editor		Eržen, Renato; Tomič, Viktorija; Košnik, Mitja; Mušič, Ema
Title		Pljučnica pri bolnikih iz doma za ostarele
Translated title		Pneumonia in nursing home residents
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 71, št. 10
Publication year		2002
Volume		str. 635-8
Language		slo
Abstract		Background. Pneumonia remains one of the leading causes of morbidity and mortality worldwide, especially in advanced age. Prognosis of the disease depends on premorbid condition and immune competence of the patient, severity of the disease and causative microorganism. In our analysis we wanted to establish clinical, x-ray and microbiological characteristics of pneumonia in nursing home residents, estimate suitability of therapeutic measures and find out risk factors for adverse outcome in this group of patients. Material and methods. This retrospective study includes all nursing home residents hospitalised due to CAP in Hospital Golnik in 2000. Clinical data was/were evaluated according to case history. Microbiological data and laboratory results were gathered from the patients files. Chi-square test was used for statistical analysis. Results. 30 patients, 17 women were included, aged 82.5 +- 11.7 years. 60% of patients had at least 2 accompanying diseases, most frequently cardiovascular and neurologic diseases. At admittance 83% of patients presented with severe form of the disease. Dispnea (93%) tachypnea, cough (67%) and confusion (47%) dominate clinical picture. Patients rarely expectorate, are frequently hypoxemic (93%) have leucocytosis (63%), electrolyte disturbances and elevated urea (67%). According to the microbiologic results most frequent causative agents are Enterobacteriae, S. pneumoniae, H. influenzae and also some multiresistant bacteria. Amoxycillin with clavulanic acid was the most frequently used antibiotic, followed by macrolides and 3rd generation cephalosporines. 9 patients died, mortality rate was 30%. Their average age was 83,4 years, 67% of them had more than 2 accompanying diseases, all of them severe form of the disease, 89% severe respiratory insufficiency and 22% positive hemoculture. (Abstract truncated at 2000 characters).
Summary		Izhodišča. Okužbe dihal so eden pogostejših vzrokov obolevnosti in smrtnosti pri starostniku. Z analizo smo želeli ugotoviti klinične, rentgenske in mikrobiološke značilnosti pljučnice pri bolnikih, ki prihajajo iz domov za ostarele, oceniti ustreznost empirične izbire antibiotičnega zdravljenja in ostalih terapevtskih ukrepov ter ugotoviti prognozo bolezni ter vzroke za visoko smrtnost pri tej skupini bolnikov. Material in metode. V retrospektivno analizo smo vključili varovance domov za ostarele, ki so bili v letu 2000 hospitalizirani v Bolnišnici Golnik zaradi zunajbolnišnične pljučnice, in jih primerjali z enako veliko skupino enako starih bolnikov, ki so za pljučnico zboleli doma. Vsi podatki so iz pregledane bolniške dokumentacije. Za statistično analizo smo uporabili test hi-kvadrat Rezultati. Leta 2000 smo med 367 bolniki s pljučnico zdravili 30 bolnikov (17 žensk) iz domov za ostarele. Stari so bili 82,5 +- 11,7 leta. 60% bolnikov je imelo vsaj dve pridruženi kronični bolezni, največkrat bolezni srca in ožilja ter nevrološke bolezni. 83 % bolnikov je imelo ob sprejemu težko klinično sliko. Bolniki so bili najpogosteje dispnoični (93%) kašljali so (67%), imeli povišano telesno temperaturo (67%), neredko so bili zmedeni (47%). Le redki so izkašljevali (27%). Bili so hipoksemični (93%), imeli povišane vnetne parametre, prisotne elektrolitske motnje, povišano sečnino (67%). Osamitev povzročiteja iz kužnin je redko uspela, ker pri teh bolnikih sploh ne uspemo odvzeti sputuma. Izolirane bakterije: S. pneumoniae, H. influenzae, po Gramu negativni bacili, anaerobi, multirezistentne bakterije. Bolnike smo zdravili z dovajanjem kisika (90%), infuzijami glukosaliničnih raztopin (63%) antibiotikom (100%). Med antibiotiki je bil največkrat izbran amoksicilin s klavulansko kislino (70%). Umrlo je 9 bolnikov (30%). (Izvleček prekinjen pri 2000 znakih).
Descriptors		HOMES FOR THE AGED PNEUMONIA, BACTERIAL HOSPITALIZATION AGED RETROSPECTIVE STUDIES