H.J. Heppner

Elderly Patients with Community-Acquired Pneumonia

Community-acquired pneumonia (CAP) is a common infectious disease that still causes substantial morbidity and mortality. Elderly people are frequently affected, and several issues related to care of this condition in the elderly have to be considered. This article reviews current recommendations of guidelines with a special focus on aspects of the care of elderly patients with CAP.The most common pathogen in CAP is still Streptococcus pneumoniae, followed by other pathogens such as Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydophila pneumoniae and Legionella species. Antimicrobial resistance is an increasing problem, especially with regard to macrolide-resistant S. pneumoniae and fluoroquinolone-resistant strains. With regard to β-lactam antibacterials, resistance by H. influenzae and Moraxella catarrhalis is important, as is the emergence of multidrug-resistant Staphylococcus aureus. The main management decisions should be guided by the severity of disease, which can be assessed by validated clinical risk scores such as CURB-65, a tool for measuring the severity of pneumonia based on assessment of confusion, serum urea, respiratory rate and blood pressure in patients aged ≥65 years.For the treatment of low-risk pneumonia, an aminopenicillin such as amoxicillin with or without a β-lactamase inhibitor is frequently recommended. Monotherapy with macrolides is also possible, although macrolide resistance is of concern. When predisposing factors for special pathogens are present, a β-lactam antibacterial combined with a β-lactamase inhibitor, or the combination of a β-lactam antibacterial, a β-lactamase inhibitor and a macrolide, may be warranted. If possible, patients who have undergone previous antibacterial therapy should receive drug classes not previously used.For hospitalized patients with non-severe pneumonia, a common recommendation is empirical antibacterial therapy with an aminopenicillin in combination with a β-lactamase inhibitor, or with fluoroquinolone monotherapy. With proven Legionella pneumonia, a combination of β-lactams with a fluoroquinolone or a macrolide is beneficial. In severe pneumonia, ureidopenicillins with β-lactamase inhibitors, broad-spectrum cephalosporins, macrolides and fluoroquinolones are used. A combination of a broad-spectrum β-lactam antibacterial (e.g. cefotaxime or ceftriaxone), piperacillin/tazobactam and a macrolide is mostly recommended. In patients with a predisposition for Pseudomonas aeruginosa, a combination of piperacillin/tazobactam, cefepime, imipenem or meropenem and levofloxacin or ciprofloxacin is frequently used. Treatment duration of more than 7 days is not generally recommended, except for proven infections with P. aeruginosa, for which 15 days of treatment appears to be appropriate. Further care issues in all hospitalized patients are timely administration of antibacterials, oxygen supply in case of hypoxaemia, and fluid management and dose adjustments according to kidney function.The management of elderly patients with CAP is a challenge. Shifts in antimicrobial resistance and the availability of new antibacterials will change future clinical practice. Studies investigating new methods to detect pathogens, determine the optimal antimicrobial regimen and clarify the duration of treatment may assist in further optimizing the management of elderly patients with CAP.

[Pneumonia Severity Index (PSI), CURB-65, and mortality in hospitalized elderly patients with aspiration pneumonia].

ZusammenfassungHintergrundDie Aspirationspneumonie ist beim älteren Patienten mit einer hohen Morbidität und Mortalität assoziiert. Um eine adäquate medizinische Versorgung zu gewährleisten, ist die Etablierung verlässlicher prognostischer Marker notwendig.ZielsetzungDer Pneumonie-Schwere-Index (PSI) und der CURB-65-Score als valide Instrumente zur Prognoseabschätzung der ambulant erworbenen Pneumonie (CAP) werden daraufhin untersucht, ob damit auch die Prognose von hospitalisierten älteren Patienten mit Aspirationspneumonie vorhersagbar ist.Material und MethodenDie Daten von insgesamt 209xa0Patienten eines Zentrums, die zwischen 2001 und 2005 wegen Aspirationspneumonie stationär behandelt worden waren, wurden anhand des PSI und CURB-65-Scores ausgewertet. Zum Vergleich der Morbidität und Mortalität wurde eine gleich große Gruppe stationärer Patienten mit CAP herangezogen.ErgebnisseDer Altersdurchschnitt der Patienten mit Aspirationspneumonie betrug 76,7±13,4xa0Jahre, 104 (49,8%) Patienten waren weiblich. Im Vergleich zu Patienten mit CAP fanden sich bei denen mit Aspirationspneumonie signifikant häufiger eine positive Tumoranamnese sowie Hypotonie und Hyponatriämie. Die Mortalität lag im Vergleich zur CAP-Gruppe deutlich höher (39,2% vs. 16,3%). Bei der Aspirationspneumonie lag die Odds Ratio (OR) bezüglich Mortalität für einen CURB-65-Score von 3–5xa0Punkten im Vergleich zu 0–2 Punkten bei 1,03 (95%-Konfidenzintervall 0,59; 1,79). Bei Patienten mit CAP weist die OR für einen CURB-65-Score von 3–5 Punkten gegenüber 0–2xa0Punkten statistisch signifikante Risikoerhöhungen auf (OR 2,50; 95%-Konfidenzintervall 1,04; 6,06). Der PSI zeigt bei Aspirationspneumonie tendenziell eine Erhöhung der Mortalität mit steigender Risikoklasse an.SchlussfolgerungenAnders als bei der CAP sind weder der PSI noch der CURB-65-Score geeignet, die Prognose bei hospitalisierten geriatrischen Patienten mit Aspirationspneumonie vorherzusagen.AbstractBackgroundAspiration pneumonia is associated with a high morbidity and mortality in elderly patients. In order to provide risk-adapted medical care, it is necessary to establish valid prognostic tools for these patients.ObjectiveThe value of two well-established scores to assess prognosis in community-acquired pneumonia (CAP), i.e., CURB-65 and the Pneumonia Severity Index (PSI), was evaluated in elderly patients hospitalized for aspiration pneumonia.Material and methodsA total of 209 patients hospitalized with aspiration pneumonia between 2001 and 2005 in a single center were evaluated using PSI and CURB-65. For comparison of morbidity and mortality, an equally large group of inpatients with CAP was analyzed.ResultsThe mean age of patients with aspiration pneumonia was 76.7±13.4 years, and 104 (49.8xa0%) were female. Patients with aspiration pneumonia more frequently showed a history of cancer, hypotension, and hyponatriemia on admission. Mortality was clearly higher in comparison to patients with CAP (39.2% vs. 16.3%). The Odds Ratio (OR) for mortality was 1.03 (95% CI 0.59; 1.79) for a CURB-65 score of 3–5 points compared to 0–2 points. In cases of CAP, OR showed a statistically significant increase of risk (OR 2.50; 95% CI 1.04; 6.06), for CURB-65 scores of 3–5 points vs. 0–2 points). In aspiration pneumonia, the PSI showed a trend towards increasing mortality within higher risk class.ConclusionsIn geriatric patients hospitalized with aspiration pneumonia, CURB-65 and PSI have no prognostic value.BACKGROUNDnAspiration pneumonia is associated with a high morbidity and mortality in elderly patients. In order to provide risk-adapted medical care, it is necessary to establish valid prognostic tools for these patients.nnnOBJECTIVEnThe value of two well-established scores to assess prognosis in community-acquired pneumonia (CAP), i.e., CURB-65 and the Pneumonia Severity Index (PSI), was evaluated in elderly patients hospitalized for aspiration pneumonia.nnnMATERIAL AND METHODSnA total of 209 patients hospitalized with aspiration pneumonia between 2001 and 2005 in a single center were evaluated using PSI and CURB-65. For comparison of morbidity and mortality, an equally large group of inpatients with CAP was analyzed.nnnRESULTSnThe mean age of patients with aspiration pneumonia was 76.7 ± 13.4 years, and 104 (49.8 %) were female. Patients with aspiration pneumonia more frequently showed a history of cancer, hypotension, and hyponatriemia on admission. Mortality was clearly higher in comparison to patients with CAP (39.2% vs. 16.3%). The Odds Ratio (OR) for mortality was 1.03 (95% CI 0.59; 1.79) for a CURB-65 score of 3-5 points compared to 0-2 points. In cases of CAP, OR showed a statistically significant increase of risk (OR 2.50; 95% CI 1.04; 6.06), for CURB-65 scores of 3-5 points vs. 0-2 points). In aspiration pneumonia, the PSI showed a trend towards increasing mortality within higher risk class.nnnCONCLUSIONSnIn geriatric patients hospitalized with aspiration pneumonia, CURB-65 and PSI have no prognostic value.

Pneumonie-Schwere-Index (PSI), CURB-65 und Mortalität bei hospitalisierten geriatrischen Patienten mit Aspirationspneumonie

ZusammenfassungHintergrundDie Aspirationspneumonie ist beim älteren Patienten mit einer hohen Morbidität und Mortalität assoziiert. Um eine adäquate medizinische Versorgung zu gewährleisten, ist die Etablierung verlässlicher prognostischer Marker notwendig.ZielsetzungDer Pneumonie-Schwere-Index (PSI) und der CURB-65-Score als valide Instrumente zur Prognoseabschätzung der ambulant erworbenen Pneumonie (CAP) werden daraufhin untersucht, ob damit auch die Prognose von hospitalisierten älteren Patienten mit Aspirationspneumonie vorhersagbar ist.Material und MethodenDie Daten von insgesamt 209xa0Patienten eines Zentrums, die zwischen 2001 und 2005 wegen Aspirationspneumonie stationär behandelt worden waren, wurden anhand des PSI und CURB-65-Scores ausgewertet. Zum Vergleich der Morbidität und Mortalität wurde eine gleich große Gruppe stationärer Patienten mit CAP herangezogen.ErgebnisseDer Altersdurchschnitt der Patienten mit Aspirationspneumonie betrug 76,7±13,4xa0Jahre, 104 (49,8%) Patienten waren weiblich. Im Vergleich zu Patienten mit CAP fanden sich bei denen mit Aspirationspneumonie signifikant häufiger eine positive Tumoranamnese sowie Hypotonie und Hyponatriämie. Die Mortalität lag im Vergleich zur CAP-Gruppe deutlich höher (39,2% vs. 16,3%). Bei der Aspirationspneumonie lag die Odds Ratio (OR) bezüglich Mortalität für einen CURB-65-Score von 3–5xa0Punkten im Vergleich zu 0–2 Punkten bei 1,03 (95%-Konfidenzintervall 0,59; 1,79). Bei Patienten mit CAP weist die OR für einen CURB-65-Score von 3–5 Punkten gegenüber 0–2xa0Punkten statistisch signifikante Risikoerhöhungen auf (OR 2,50; 95%-Konfidenzintervall 1,04; 6,06). Der PSI zeigt bei Aspirationspneumonie tendenziell eine Erhöhung der Mortalität mit steigender Risikoklasse an.SchlussfolgerungenAnders als bei der CAP sind weder der PSI noch der CURB-65-Score geeignet, die Prognose bei hospitalisierten geriatrischen Patienten mit Aspirationspneumonie vorherzusagen.AbstractBackgroundAspiration pneumonia is associated with a high morbidity and mortality in elderly patients. In order to provide risk-adapted medical care, it is necessary to establish valid prognostic tools for these patients.ObjectiveThe value of two well-established scores to assess prognosis in community-acquired pneumonia (CAP), i.e., CURB-65 and the Pneumonia Severity Index (PSI), was evaluated in elderly patients hospitalized for aspiration pneumonia.Material and methodsA total of 209 patients hospitalized with aspiration pneumonia between 2001 and 2005 in a single center were evaluated using PSI and CURB-65. For comparison of morbidity and mortality, an equally large group of inpatients with CAP was analyzed.ResultsThe mean age of patients with aspiration pneumonia was 76.7±13.4 years, and 104 (49.8xa0%) were female. Patients with aspiration pneumonia more frequently showed a history of cancer, hypotension, and hyponatriemia on admission. Mortality was clearly higher in comparison to patients with CAP (39.2% vs. 16.3%). The Odds Ratio (OR) for mortality was 1.03 (95% CI 0.59; 1.79) for a CURB-65 score of 3–5 points compared to 0–2 points. In cases of CAP, OR showed a statistically significant increase of risk (OR 2.50; 95% CI 1.04; 6.06), for CURB-65 scores of 3–5 points vs. 0–2 points). In aspiration pneumonia, the PSI showed a trend towards increasing mortality within higher risk class.ConclusionsIn geriatric patients hospitalized with aspiration pneumonia, CURB-65 and PSI have no prognostic value.BACKGROUNDnAspiration pneumonia is associated with a high morbidity and mortality in elderly patients. In order to provide risk-adapted medical care, it is necessary to establish valid prognostic tools for these patients.nnnOBJECTIVEnThe value of two well-established scores to assess prognosis in community-acquired pneumonia (CAP), i.e., CURB-65 and the Pneumonia Severity Index (PSI), was evaluated in elderly patients hospitalized for aspiration pneumonia.nnnMATERIAL AND METHODSnA total of 209 patients hospitalized with aspiration pneumonia between 2001 and 2005 in a single center were evaluated using PSI and CURB-65. For comparison of morbidity and mortality, an equally large group of inpatients with CAP was analyzed.nnnRESULTSnThe mean age of patients with aspiration pneumonia was 76.7 ± 13.4 years, and 104 (49.8 %) were female. Patients with aspiration pneumonia more frequently showed a history of cancer, hypotension, and hyponatriemia on admission. Mortality was clearly higher in comparison to patients with CAP (39.2% vs. 16.3%). The Odds Ratio (OR) for mortality was 1.03 (95% CI 0.59; 1.79) for a CURB-65 score of 3-5 points compared to 0-2 points. In cases of CAP, OR showed a statistically significant increase of risk (OR 2.50; 95% CI 1.04; 6.06), for CURB-65 scores of 3-5 points vs. 0-2 points). In aspiration pneumonia, the PSI showed a trend towards increasing mortality within higher risk class.nnnCONCLUSIONSnIn geriatric patients hospitalized with aspiration pneumonia, CURB-65 and PSI have no prognostic value.

External validation of the CURSI criteria (confusion, urea, respiratory rate and shock index) in adults hospitalised for community-acquired pneumonia

BackgroundFor patients hospitalised due to community-acquired pneumonia (CAP), mortality risk is usually estimated with prognostic scores such as CRB-65 or CURB-65. For elderly patients, a new score referred to as CURSI has been proposed which uses shock index (SI) instead of the blood pressure (B) and age (65) criteria. The new score has not been externally validated to date.MethodsWe used data from a hospital-based CAP registry to compare the ability of CURSI, CURB-65 and CRB-65 to predict mortality at day 30 after hospital admission. Patients were stratified by score points as well as score-point-based risk categories, and mortality for each group was assessed. To compare test performance, receiver-operating characteristic (ROC) curves were constructed, and the areas under the curve (AUROC) were calculated with 95% confidence intervals (CI).ResultsWe analysed 553 inpatients (45% females, median age 78 years) hospitalised between 2005 and 2009 for CAP. Overall, mortality at day 30 was 11% (59/553). The study sample was characterised by advanced comorbidity (chronic heart failure: 22%, chronic kidney failure: 27%) and functional impairment (nursing home residency: 26%, dementia: 31%). All risk scores were significantly associated with 30-day mortality. The AUROC values with 95% CI using score points for risk prediction were as follows: 0.63 [0.56-0.71] for CRB-65, 0.68 [0.61-0.75] for CURB-65 and 0.68 [0.61-0.75] for CURSI. The CURSI-defined low-risk group (0 or 1 score point) had a higher mortality (8%) than the low-risk groups defined by CURB-65 and CRB-65 (4% and 3%, respectively). Lowering the cut-off for the CURSI-defined low-risk group (0 point only) would lower the mortality to 4%, making it comparable to the CURB-65-defined low-risk group.ConclusionsIn our study, the CURSI-defined low-risk group had a higher 30-day mortality than the low-risk groups defined by CURB-65 and CRB-65. Lowering the cut-off value for the CURSI low-risk group would result in a mortality comparable to the CURB-65-defined low risk group. Even then, however, CURSI does not perform better than the established risk scores.

[Prevention of catheter-related infections: minimizing secondary complications in geriatric patients].

The use of intravascular or intraluminal catheters is common in geriatric medicine. Blood stream infections due to intravascular catheterization, peritoneal catheters for dialysis, suprapubic or transurethral catheters, or percutaneous endoscopic gastrostomy are a major source of nosocomial infections. Therefore, the prevention of catheter-associated infections is an important issue for physicians and nursing staff working in hospitals or in outpatient settings. The risk can be minimized by diligent checking of the indications, hygienic measures, using the correct materials, thorough follow-up, and education of the medical and nursing staff. Thus, it is possible to avoid individual suffering of patients and to reduce costs in the healthcare system.ZusammenfassungDie Anlage von intravasalen bzw. intraluminalen Kathetern ist ein häufig angewendetes Verfahren beim geriatrischen Patienten. Katheterassoziierte Infektionen zählen zu den häufigsten nosokomial erworbenen Infektionen, die mit der Anlage intravasaler Gefäßzugänge, peritonealer Dialysezugänge, perkutaner Ernährungssonden und suprapubischer bzw. transurethraler Harnblasenkatheter einhergehen können. Eine wichtige Aufgabe für Ärzte und nichtärztliche Mitarbeiter ist die Vermeidung und deutliche Reduktion dieser Infektionen durch die Kenntnis des korrekten Umgangs mit Kathetern im häuslichen und stationären Umfeld. Die angemessene Indikationsstellung, aseptische Arbeitsweise, Auswahl des richtigen Materials und optimale Nachsorge sowie die regelmäßige Schulung des mit der Katheteranlage oder Nachsorge und Pflege betrauten Personals können die Inzidenz der katheterassoziierten Infektionen auf ein Minimum reduzieren. Auf diese Weise werden sowohl das individuelle Leid der Betroffenen als auch die Kosten für das Gesundheitssystem minimiert.AbstractThe use of intravascular or intraluminal catheters is common in geriatric medicine. Blood stream infections due to intravascular catheterization, peritoneal catheters for dialysis, suprapubic or transurethral catheters, or percutaneous endoscopic gastrostomy are a major source of nosocomial infections. Therefore, the prevention of catheter-associated infections is an important issue for physicians and nursing staff working in hospitals or in outpatient settings. The risk can be minimized by diligent checking of the indications, hygienic measures, using the correct materials, thorough follow-up, and education of the medical and nursing staff. Thus, it is possible to avoid individual suffering of patients and to reduce costs in the healthcare system.

Vermeidung katheterassoziierter Infektionen

The use of intravascular or intraluminal catheters is common in geriatric medicine. Blood stream infections due to intravascular catheterization, peritoneal catheters for dialysis, suprapubic or transurethral catheters, or percutaneous endoscopic gastrostomy are a major source of nosocomial infections. Therefore, the prevention of catheter-associated infections is an important issue for physicians and nursing staff working in hospitals or in outpatient settings. The risk can be minimized by diligent checking of the indications, hygienic measures, using the correct materials, thorough follow-up, and education of the medical and nursing staff. Thus, it is possible to avoid individual suffering of patients and to reduce costs in the healthcare system.ZusammenfassungDie Anlage von intravasalen bzw. intraluminalen Kathetern ist ein häufig angewendetes Verfahren beim geriatrischen Patienten. Katheterassoziierte Infektionen zählen zu den häufigsten nosokomial erworbenen Infektionen, die mit der Anlage intravasaler Gefäßzugänge, peritonealer Dialysezugänge, perkutaner Ernährungssonden und suprapubischer bzw. transurethraler Harnblasenkatheter einhergehen können. Eine wichtige Aufgabe für Ärzte und nichtärztliche Mitarbeiter ist die Vermeidung und deutliche Reduktion dieser Infektionen durch die Kenntnis des korrekten Umgangs mit Kathetern im häuslichen und stationären Umfeld. Die angemessene Indikationsstellung, aseptische Arbeitsweise, Auswahl des richtigen Materials und optimale Nachsorge sowie die regelmäßige Schulung des mit der Katheteranlage oder Nachsorge und Pflege betrauten Personals können die Inzidenz der katheterassoziierten Infektionen auf ein Minimum reduzieren. Auf diese Weise werden sowohl das individuelle Leid der Betroffenen als auch die Kosten für das Gesundheitssystem minimiert.AbstractThe use of intravascular or intraluminal catheters is common in geriatric medicine. Blood stream infections due to intravascular catheterization, peritoneal catheters for dialysis, suprapubic or transurethral catheters, or percutaneous endoscopic gastrostomy are a major source of nosocomial infections. Therefore, the prevention of catheter-associated infections is an important issue for physicians and nursing staff working in hospitals or in outpatient settings. The risk can be minimized by diligent checking of the indications, hygienic measures, using the correct materials, thorough follow-up, and education of the medical and nursing staff. Thus, it is possible to avoid individual suffering of patients and to reduce costs in the healthcare system.

Risiko-Scores zur ambulant erworbenen Pneumonie bei älteren und geriatrischen Patienten

ZusammenfassungHintergrundDie ambulant erworbene Pneumonie („community-acquired pneumonia“, CAP) ist weiterhin eine bedeutsame sowie für ältere und geriatrische Patienten gefährliche Erkrankung.Ziel der ArbeitAus epidemiologischen und klinischen Gründen ist es wichtig, die Häufigkeit der verschiedenen Schwergrade bei CAP zu erfassen sowie Erkenntnisse über die Verbreitung und die Gefährdung verschiedener Risikogruppen durch eine CAP zu bekommen. In der ambulanten Versorgung kann ein einfach durchzuführender Prognose-Score die Beurteilung des klinischen Zustands eines Patienten objektivieren und therapeutische Entscheidungen unterstützen. Hierzu soll dem potenziellen Anwender die Kenntnis entsprechender Instrumente vermittelt werden.Material und MethodenSeit den 1990er Jahren sind verschiedene Risiko-Scores zur Risikostratifizierung bei CAP entwickelt und evaluiert worden. Der vorliegende Beitrag stellt die Inhalte und Aussagekraft der verfügbaren Risiko-Scores vor. Hierbei werden die Vor- und Nachteile der einzelnen Scores einander kritisch gegenübergestellt. Besonderes Augenmerk wird auf die Bedeutung der Risiko-Scores für geriatrische Patienten gelegt.ErgebnisseDer momentan in Deutschland führende Wegweiser für die Entscheidung über eine ambulante oder stationäre Behandlung ist der Risiko-Score CRB-65. Zur Entscheidung über eine primär intensivmedizinische Behandlung können u.xa0a. die modifizierten Kriterien der „American Thoracic Society“ (ATS) verwendet werden. Grundsätzlich gilt, dass Risiko-Scores bei CAP für ältere und geriatrische Patienten weniger verlässlich sind als allgemein für Erwachsene.SchlussfolgerungFür Therapieentscheidungen müssen neben den behandelten Risiko-Scores weitere, auch funktionelle Aspekte des geriatrischen Patienten berücksichtigt werden. Speziell die Entscheidung über eine stationäre Einweisung sollte für ältere und geriatrische Patienten entsprechend der Nutzen-Risiko-Relation individuell gefällt werden.AbstractBackgroundCommunity-acquired pneumonia (CAP) is still an important and serious disease for elderly and geriatric patients.AimsFor epidemiological and clinical reasons it is important to collate the frequencies of the various degrees of severity of CAP and to obtain information on the spread and degree of the threat to the various risk groups by CAP. In outpatient treatment a simple to execute prognosis score can be used to objectify the assessment of the clinical status of a patient and to support therapeutic decision-making. For this purpose knowledge of the appropriate instruments should be available to potential users.Material and methodsSince the 1990s a variety of risk scores for stratification of CAP have been developed and evaluated. This article presents the content and value of the available risk scores whereby the advantages and disadvantages of the individual scores are critically compared. Special emphasis is placed on the importance of the risk scores for geriatric patients.ResultsAt present the decision about outpatient or inpatient treatment is primarily based on the risk score CRB-65. Criteria for intensive care unit admissions are provided by the modified American Thoracic Society (ATS) set of criteria. Overall, risk scores are less reliable for elderly patients than for younger adults.ConclusionFor treatment decisions for the elderly, functional aspects should also be considered in addition to the aspects of risk scores discussed here. In particular, the decision about inpatient admission for elderly, geriatric CAP patients should be made on an individual basis taking the benefit-risk relationship into consideration.BACKGROUNDnCommunity-acquired pneumonia (CAP) is still an important and serious disease for elderly and geriatric patients.nnnAIMSnFor epidemiological and clinical reasons it is important to collate the frequencies of the various degrees of severity of CAP and to obtain information on the spread and degree of the threat to the various risk groups by CAP. In outpatient treatment a simple to execute prognosis score can be used to objectify the assessment of the clinical status of a patient and to support therapeutic decision-making. For this purpose knowledge of the appropriate instruments should be available to potential users.nnnMATERIAL AND METHODSnSince the 1990s a variety of risk scores for stratification of CAP have been developed and evaluated. This article presents the content and value of the available risk scores whereby the advantages and disadvantages of the individual scores are critically compared. Special emphasis is placed on the importance of the risk scores for geriatric patients.nnnRESULTSnAt present the decision about outpatient or inpatient treatment is primarily based on the risk score CRB-65. Criteria for intensive care unit admissions are provided by the modified American Thoracic Society (ATS) set of criteria. Overall, risk scores are less reliable for elderly patients than for younger adults.nnnCONCLUSIONnFor treatment decisions for the elderly, functional aspects should also be considered in addition to the aspects of risk scores discussed here. In particular, the decision about inpatient admission for elderly, geriatric CAP patients should be made on an individual basis taking the benefit-risk relationship into consideration.

Risiko-Scores zur ambulant erworbenen Pneumonie bei älteren und geriatrischen Patienten@@@Risk scores for community acquired pneumonia in elderly and geriatric patients

ZusammenfassungHintergrundDie ambulant erworbene Pneumonie („community-acquired pneumonia“, CAP) ist weiterhin eine bedeutsame sowie für ältere und geriatrische Patienten gefährliche Erkrankung.Ziel der ArbeitAus epidemiologischen und klinischen Gründen ist es wichtig, die Häufigkeit der verschiedenen Schwergrade bei CAP zu erfassen sowie Erkenntnisse über die Verbreitung und die Gefährdung verschiedener Risikogruppen durch eine CAP zu bekommen. In der ambulanten Versorgung kann ein einfach durchzuführender Prognose-Score die Beurteilung des klinischen Zustands eines Patienten objektivieren und therapeutische Entscheidungen unterstützen. Hierzu soll dem potenziellen Anwender die Kenntnis entsprechender Instrumente vermittelt werden.Material und MethodenSeit den 1990er Jahren sind verschiedene Risiko-Scores zur Risikostratifizierung bei CAP entwickelt und evaluiert worden. Der vorliegende Beitrag stellt die Inhalte und Aussagekraft der verfügbaren Risiko-Scores vor. Hierbei werden die Vor- und Nachteile der einzelnen Scores einander kritisch gegenübergestellt. Besonderes Augenmerk wird auf die Bedeutung der Risiko-Scores für geriatrische Patienten gelegt.ErgebnisseDer momentan in Deutschland führende Wegweiser für die Entscheidung über eine ambulante oder stationäre Behandlung ist der Risiko-Score CRB-65. Zur Entscheidung über eine primär intensivmedizinische Behandlung können u.xa0a. die modifizierten Kriterien der „American Thoracic Society“ (ATS) verwendet werden. Grundsätzlich gilt, dass Risiko-Scores bei CAP für ältere und geriatrische Patienten weniger verlässlich sind als allgemein für Erwachsene.SchlussfolgerungFür Therapieentscheidungen müssen neben den behandelten Risiko-Scores weitere, auch funktionelle Aspekte des geriatrischen Patienten berücksichtigt werden. Speziell die Entscheidung über eine stationäre Einweisung sollte für ältere und geriatrische Patienten entsprechend der Nutzen-Risiko-Relation individuell gefällt werden.AbstractBackgroundCommunity-acquired pneumonia (CAP) is still an important and serious disease for elderly and geriatric patients.AimsFor epidemiological and clinical reasons it is important to collate the frequencies of the various degrees of severity of CAP and to obtain information on the spread and degree of the threat to the various risk groups by CAP. In outpatient treatment a simple to execute prognosis score can be used to objectify the assessment of the clinical status of a patient and to support therapeutic decision-making. For this purpose knowledge of the appropriate instruments should be available to potential users.Material and methodsSince the 1990s a variety of risk scores for stratification of CAP have been developed and evaluated. This article presents the content and value of the available risk scores whereby the advantages and disadvantages of the individual scores are critically compared. Special emphasis is placed on the importance of the risk scores for geriatric patients.ResultsAt present the decision about outpatient or inpatient treatment is primarily based on the risk score CRB-65. Criteria for intensive care unit admissions are provided by the modified American Thoracic Society (ATS) set of criteria. Overall, risk scores are less reliable for elderly patients than for younger adults.ConclusionFor treatment decisions for the elderly, functional aspects should also be considered in addition to the aspects of risk scores discussed here. In particular, the decision about inpatient admission for elderly, geriatric CAP patients should be made on an individual basis taking the benefit-risk relationship into consideration.BACKGROUNDnCommunity-acquired pneumonia (CAP) is still an important and serious disease for elderly and geriatric patients.nnnAIMSnFor epidemiological and clinical reasons it is important to collate the frequencies of the various degrees of severity of CAP and to obtain information on the spread and degree of the threat to the various risk groups by CAP. In outpatient treatment a simple to execute prognosis score can be used to objectify the assessment of the clinical status of a patient and to support therapeutic decision-making. For this purpose knowledge of the appropriate instruments should be available to potential users.nnnMATERIAL AND METHODSnSince the 1990s a variety of risk scores for stratification of CAP have been developed and evaluated. This article presents the content and value of the available risk scores whereby the advantages and disadvantages of the individual scores are critically compared. Special emphasis is placed on the importance of the risk scores for geriatric patients.nnnRESULTSnAt present the decision about outpatient or inpatient treatment is primarily based on the risk score CRB-65. Criteria for intensive care unit admissions are provided by the modified American Thoracic Society (ATS) set of criteria. Overall, risk scores are less reliable for elderly patients than for younger adults.nnnCONCLUSIONnFor treatment decisions for the elderly, functional aspects should also be considered in addition to the aspects of risk scores discussed here. In particular, the decision about inpatient admission for elderly, geriatric CAP patients should be made on an individual basis taking the benefit-risk relationship into consideration.

Risk scores for community acquired pneumonia in elderly and geriatric patients

ZusammenfassungHintergrundDie ambulant erworbene Pneumonie („community-acquired pneumonia“, CAP) ist weiterhin eine bedeutsame sowie für ältere und geriatrische Patienten gefährliche Erkrankung.Ziel der ArbeitAus epidemiologischen und klinischen Gründen ist es wichtig, die Häufigkeit der verschiedenen Schwergrade bei CAP zu erfassen sowie Erkenntnisse über die Verbreitung und die Gefährdung verschiedener Risikogruppen durch eine CAP zu bekommen. In der ambulanten Versorgung kann ein einfach durchzuführender Prognose-Score die Beurteilung des klinischen Zustands eines Patienten objektivieren und therapeutische Entscheidungen unterstützen. Hierzu soll dem potenziellen Anwender die Kenntnis entsprechender Instrumente vermittelt werden.Material und MethodenSeit den 1990er Jahren sind verschiedene Risiko-Scores zur Risikostratifizierung bei CAP entwickelt und evaluiert worden. Der vorliegende Beitrag stellt die Inhalte und Aussagekraft der verfügbaren Risiko-Scores vor. Hierbei werden die Vor- und Nachteile der einzelnen Scores einander kritisch gegenübergestellt. Besonderes Augenmerk wird auf die Bedeutung der Risiko-Scores für geriatrische Patienten gelegt.ErgebnisseDer momentan in Deutschland führende Wegweiser für die Entscheidung über eine ambulante oder stationäre Behandlung ist der Risiko-Score CRB-65. Zur Entscheidung über eine primär intensivmedizinische Behandlung können u.xa0a. die modifizierten Kriterien der „American Thoracic Society“ (ATS) verwendet werden. Grundsätzlich gilt, dass Risiko-Scores bei CAP für ältere und geriatrische Patienten weniger verlässlich sind als allgemein für Erwachsene.SchlussfolgerungFür Therapieentscheidungen müssen neben den behandelten Risiko-Scores weitere, auch funktionelle Aspekte des geriatrischen Patienten berücksichtigt werden. Speziell die Entscheidung über eine stationäre Einweisung sollte für ältere und geriatrische Patienten entsprechend der Nutzen-Risiko-Relation individuell gefällt werden.AbstractBackgroundCommunity-acquired pneumonia (CAP) is still an important and serious disease for elderly and geriatric patients.AimsFor epidemiological and clinical reasons it is important to collate the frequencies of the various degrees of severity of CAP and to obtain information on the spread and degree of the threat to the various risk groups by CAP. In outpatient treatment a simple to execute prognosis score can be used to objectify the assessment of the clinical status of a patient and to support therapeutic decision-making. For this purpose knowledge of the appropriate instruments should be available to potential users.Material and methodsSince the 1990s a variety of risk scores for stratification of CAP have been developed and evaluated. This article presents the content and value of the available risk scores whereby the advantages and disadvantages of the individual scores are critically compared. Special emphasis is placed on the importance of the risk scores for geriatric patients.ResultsAt present the decision about outpatient or inpatient treatment is primarily based on the risk score CRB-65. Criteria for intensive care unit admissions are provided by the modified American Thoracic Society (ATS) set of criteria. Overall, risk scores are less reliable for elderly patients than for younger adults.ConclusionFor treatment decisions for the elderly, functional aspects should also be considered in addition to the aspects of risk scores discussed here. In particular, the decision about inpatient admission for elderly, geriatric CAP patients should be made on an individual basis taking the benefit-risk relationship into consideration.BACKGROUNDnCommunity-acquired pneumonia (CAP) is still an important and serious disease for elderly and geriatric patients.nnnAIMSnFor epidemiological and clinical reasons it is important to collate the frequencies of the various degrees of severity of CAP and to obtain information on the spread and degree of the threat to the various risk groups by CAP. In outpatient treatment a simple to execute prognosis score can be used to objectify the assessment of the clinical status of a patient and to support therapeutic decision-making. For this purpose knowledge of the appropriate instruments should be available to potential users.nnnMATERIAL AND METHODSnSince the 1990s a variety of risk scores for stratification of CAP have been developed and evaluated. This article presents the content and value of the available risk scores whereby the advantages and disadvantages of the individual scores are critically compared. Special emphasis is placed on the importance of the risk scores for geriatric patients.nnnRESULTSnAt present the decision about outpatient or inpatient treatment is primarily based on the risk score CRB-65. Criteria for intensive care unit admissions are provided by the modified American Thoracic Society (ATS) set of criteria. Overall, risk scores are less reliable for elderly patients than for younger adults.nnnCONCLUSIONnFor treatment decisions for the elderly, functional aspects should also be considered in addition to the aspects of risk scores discussed here. In particular, the decision about inpatient admission for elderly, geriatric CAP patients should be made on an individual basis taking the benefit-risk relationship into consideration.

Vermeidung katheterassoziierter Infektionen@@@Prevention of catheter-related infections: Verringerung von Sekundärkomplikationen beim geriatrischen Patienten@@@Minimizing secondary complications in geriatric patients

The use of intravascular or intraluminal catheters is common in geriatric medicine. Blood stream infections due to intravascular catheterization, peritoneal catheters for dialysis, suprapubic or transurethral catheters, or percutaneous endoscopic gastrostomy are a major source of nosocomial infections. Therefore, the prevention of catheter-associated infections is an important issue for physicians and nursing staff working in hospitals or in outpatient settings. The risk can be minimized by diligent checking of the indications, hygienic measures, using the correct materials, thorough follow-up, and education of the medical and nursing staff. Thus, it is possible to avoid individual suffering of patients and to reduce costs in the healthcare system.ZusammenfassungDie Anlage von intravasalen bzw. intraluminalen Kathetern ist ein häufig angewendetes Verfahren beim geriatrischen Patienten. Katheterassoziierte Infektionen zählen zu den häufigsten nosokomial erworbenen Infektionen, die mit der Anlage intravasaler Gefäßzugänge, peritonealer Dialysezugänge, perkutaner Ernährungssonden und suprapubischer bzw. transurethraler Harnblasenkatheter einhergehen können. Eine wichtige Aufgabe für Ärzte und nichtärztliche Mitarbeiter ist die Vermeidung und deutliche Reduktion dieser Infektionen durch die Kenntnis des korrekten Umgangs mit Kathetern im häuslichen und stationären Umfeld. Die angemessene Indikationsstellung, aseptische Arbeitsweise, Auswahl des richtigen Materials und optimale Nachsorge sowie die regelmäßige Schulung des mit der Katheteranlage oder Nachsorge und Pflege betrauten Personals können die Inzidenz der katheterassoziierten Infektionen auf ein Minimum reduzieren. Auf diese Weise werden sowohl das individuelle Leid der Betroffenen als auch die Kosten für das Gesundheitssystem minimiert.AbstractThe use of intravascular or intraluminal catheters is common in geriatric medicine. Blood stream infections due to intravascular catheterization, peritoneal catheters for dialysis, suprapubic or transurethral catheters, or percutaneous endoscopic gastrostomy are a major source of nosocomial infections. Therefore, the prevention of catheter-associated infections is an important issue for physicians and nursing staff working in hospitals or in outpatient settings. The risk can be minimized by diligent checking of the indications, hygienic measures, using the correct materials, thorough follow-up, and education of the medical and nursing staff. Thus, it is possible to avoid individual suffering of patients and to reduce costs in the healthcare system.