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Age, functional status associated with CAP recurrence
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Among adults hospitalized with community-associated pneumonia, older patients and those with impaired functional status had the highest risk for recurrence, according to researchers from the University of Nova Scotia and the University of Alberta in Canada.
“We believe that recurrent pneumonia is sufficiently common (and) that better attention should be paid to preventive strategies at the time of discharge, closer follow-up of patients with signs of frailty, and perhaps a lower threshold to diagnose and treat pneumonia over the longer-term in those who have survived a previous episode,” the researchers wrote in Clinical Infectious Diseases.
The researchers conducted a population-based, prospective study of a cohort of 2,709 patients with community-associated pneumonia (CAP) who survived the initial hospital admission. Among those patients, 43% were aged at least 75 years, 51% were men, 34% were not fully independent and 56% had severe pneumonia.
During 5 years of follow up, 245 patients (9%) developed recurrent pneumonia, and of those, 156 (64%) required hospitalization. The rate of recurrence was three per 100 person-years. The median time to recurrence was 317 days. The 30-day case fatality rate for recurrent pneumonia was 10.2%. Overall, the patients with recurrent pneumonia were older, frailer, had more comorbidities and had more severe pneumonia at presentation.
In a multivariable analysis, only older age and functional status were associated with an increased risk for recurrent pneumonia. The researchers found that 12% of patients with any impairment in functional status recurred vs. 7% of patients who were fully independent.
Previous studies had identified nonclinical factors such as smoking, chronic alcoholism and functional status as factors related to recurrence, as well as comorbidities such as chronic obstructive pulmonary disorder, neurological disease, heart failure and diabetes, according to the researchers.
“Surprisingly (except for older age and impairments in functional status) none of these risk factors were independently associated with an increased risk of recurrent pneumonia in our study,” the researchers wrote. “Given our study sample is larger than [most previous studies] and the comprehensiveness of our data collection and the completeness and duration of our follow-up, we do not believe that we were examining an atypical population or over-adjusting our analyses.”
Disclosure: The researchers report no relevant financial disclosures.
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