Community-acquired pneumonia (CAP) is a common disorder that is potentially life threatening, especially in older adults and in those with comorbid disease. Despite substantial progress in therapeutic options, CAP remains a primary cause of death from infectious disease in the United States. Thus, any new information concerning the outcomes of patients with CAP is welcomed. Included in this issue are 2 original articles that shed light on outcomes in selected patients with CAP.
The paper by Sharma et al1 addresses the important issue of long-term (ie, 6 months) effect of functional decline of elderly patients who have been hospitalized for CAP. Importantly, the authors observed that 60% of the patients had significant decrease in activities of daily living 6 months after discharge. They also suggested that further studies should be done to assess interventions that might improve this effect. I certainly agree with this recommendation. Furthermore, these observations reinforce the need to communicate with patients and their families concerning these effects of CAP, so they can be better prepared for such consequences. It is important to acknowledge that, for patients who require admission to the hospital, mortality rate remains high 1 year after discharge, particularly for the elderly or patients with underlying disease. Brancati et al and Kaplan et al2,3 showed that 1 in 4 hospital survivors of CAP died in the following year, whereas a larger and more recent study reported a 1-year mortality rate of 33% for discharged elderly patients (aged 65 years or older), which was significantly higher than that for hospitalized controls. Studies such as these show that CAP can have long-term consequences in certain populations and may require additional understanding to improve the outcomes of elderly and severely ill patients.
The paper by Daud-Gallotti et al4 importantly describes the potential effect that adverse events (AEs) have in the initial management of patients in the emergency department. This retrospective and matched case-control study evaluated the occurrence of AEs in patients with CAP and their association with in-hospital death. The occurrence of at least 1 adverse event was associated with a higher risk of death (3.25-fold). The authors found that AEs related to nursing and medical performances accounted for more that 80% of all reported events; and they acknowledge that monitoring and improving such events is a valuable process to improve health care and outcomes. Considering the impact of CAP, monitoring and improving AEs are crucial to improve the outcomes of patients in these settings. In a sense, this is a call to arms to develop strategies to reduce these events for the betterment of our patients.
Finally, concerning outcomes of patients with CAP, several guidelines have been published by a number of societies both nationally and internationally. A primary purpose of these guidelines is ultimately to improve the outcomes of patients by promoting appropriate management strategies. It is thus noteworthy that, at the time of this writing, the first collaborative guideline for the management of CAP in immunocompetent adult patients, co-sponsored by the Infectious Diseases Society and the American Thoracic Society, is nearing completion. It is anticipated that this will be available on the Websites of each society soon.
1. Sharma G, Han L, Quagliarello V. Short- and long-term functional outcome of hospitalized older adults with community-acquired pneumonia. Infect Dis Clin Pract
2. Brancati FL, Chow JW, Wagener MM, et al. Is pneumonia really the old man's friend? Two-year prognosis after community-acquired pneumonia. Lancet
3. Kaplan V, Clermont G, Griffin MF, et al. Pneumonia: still the old man's friend? Arch Intern Med
4. Daud-Gallotti R, Novaes HMD, Lorenzi MC, et al. Adverse events in patients with community-acquired pneumonia at an academic tertiary emergency department. Do they contribute to hospital death? Infect Dis Clin Pract