Cost Effectiveness of Different Initial Antimicrobial Regimens for Elderly Community-Acquired Pneumonia Patients in General Ward

Figures & data

Table 1 Comparison of Baseline Characteristics in Hospitalized Elderly Patients with CAP in Different Treatment Schemes (n=511)

Characteristics	Group A (n=292)	Group B (n=146)	Group C (n=73)	p value
Male sex	125(42.8%)	69(47.3%)	30 (41.1%)	0.594
Median age (years, IQR)	78.1(72.0–83.5)	79.0(72.0–83.0)	78.0(72.0–84.0)	0.966
Underlying conditions	266(91.1%)	132(90.4%)	72(98.6%)	0.075
Chronic respiratory disease	91(31.2%)	33(22.6%)	24(32.9%)	0.129
Cardiovascular disease	184(63.0%)	86(58.9%)	52(71.2%)	0.205
Chronic liver disease	5(1.7%)	2(1.4%)	1(1.4%)	0.953
Chronic renal disease	18(6.2%)	6(4.1%)	3 (4.1%)	0.590
Diabetes mellitus	47 (16.1%)	21 (14.4%)	13(17.8%)	0.795
Cerebrovascular disease	82(28.1%)	35(24.0%)	21(28.8%)	0.616
Numbers of comorbidities	2.0±1.2	1.8±1.1	2.3±1.3	0.011
Risk of aspiration	28(9.6%)	10(6.8%)	9(12.3%)	0.392
Long-term bedridden status	34(11.6%)	10(6.8%)	4(5.5%)	0.125
History of CAP within 1 year	27(9.2%)	8(5.5%)	10(13.7%)	0.119
PSI scores	79.0(69.3–96.0)	85.0(70.0–102.0)	88.0(73.5–102.0)	0.123
HCAP	72(24.7%)	17(11.6%)	9(12.3%)	0.001
Risk factors of PA infection^#	110(37.7%)	27(18.5%)	14(19.2%)	<0.001

Note: ^#Details are made available in the study by Han et al.¹⁰

Abbreviations: PSI, pneumonia severity index; CAP, community-acquired pneumonia; HCAP, healthcare-associated pneumonia.

Figure 1 Screening flow chart of the study.

Table 2 Comparison of Clinical Manifestations, Laboratory and Imaging Findings in Hospitalized Elderly Patients with CAP in Different Treatment Schemes (n=511)

Characteristics	Group A (n=292)	Group B (n=146)	Group C (n=73)	p value
Symptoms
Fever	139(47.6%)	70(47.9%)	46(63.0%)	0.053
Cough	268(88.4%)	130(89.0%)	67(91.8%)	0.620
Expectoration	258(86.7%)	114(78.1%)	60(82.2%)	0.016
Chest pain	20(6.8%)	14(9.6%)	7(9.6%)	0.529
Wheezing	122(41.8%)	61(41.8%)	25(34.2%)	0.479
Confusion	22(7.5%)	11 (7.5%)	2(2.7%)	0.324
Cyanosis	47(16.1%)	11(7.5%)	8(11.0%)	0.036
Signs
RR ≥ 24 beats/min	8(2.7)	7(4.8)	2(2.7)	0.504
HR ≥ 125 beats/min	3(1.0)	0(0)	0(0)	0.323
SBP<90 mmHg	2(0.7)	1(0.7)	0(0)	0.778
DBP ≤60 mmHg	50(17.1)	16(11.0)	12(16.4)	0.229
Laboratory findings
WBC > 10000/mm^3	67(23.8%)	38(26.6%)	22(30.6%)	0.472
Lymphocyte <1100/mm^3	114(41.6%)	39(28.5%)	24(33.3%)	0.027
HCT<30%	38(14.0%)	13(9.5%)	11(15.3)	0.353
Albumin<35 g/L	143(52.8)	62(44.3)	41(56.9)	0.144
BUN >7 mmol/L	88(32.1)	37(16.4)	19(26.0)	0.376
Cr >123.76umol/L	30(10.9%)	12(8.6%)	5(6.8)	0.510
Glucose > 14mmol/L	7(2.7%)	4(3.0)	2(2.9)	0.984
Na<130 mmol/L	13(4.7)	6(4.3)	5(6.8)	0.693
PH<7.35	9(4.6)	3(3.4)	3(5.2)	0.847
PaO2/FiO2<250 mmHg	58(30.7)	22(25.0)	8(14.0)	0.041
Lactic acid >2 mmol/L	18(18.2)	6(10.0)	5(10.9)	0.275
ESR	39.0±28.6	34.0±25.2	47.8±27.5	0.009
CRP	34.8±82.9	54.7±197.5	94.8±168.7	0.014
Imaging features
Pleural effusion	75 (25.7)	35(24.0)	18 (24.7)	0.924
Multilobe infiltration	141(48.3%)	66(45.2%)	39(53.4%)	0.516

Abbreviations: RR, respiratory rate; HR, heart rate; SBP, systolic blood pressure; DBP, diastolic blood pressure; WBC, white blood cell; HCT, hematocrit; BUN, blood urea nitrogen; Cr, creatinine; Na, sodium; PaO₂/FiO₂, partial arterial oxygen pressure/fraction of inspired oxygen; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein.

Table 3 Etiology Distribution in Hospitalized Elderly Patients with CAP in Different Treatment Schemes (n=65)

Pathogens	Group A (n=35)	Group B (n=17)	Group C (n=13)	p value
Pseudomonas aeruginosa	7(10.8)	2(3.1)	5(7.7)	0.201
Klebsiella pneumoniae	7(10.8)	0	1(1.5)	0.102
Escherichia coli	4(6.2)	1(1.5)	0(0)	0.397
Acinetobacter	3(4.6)	0	2(3.1)	0.281
Staphylococcus aureus	6(9.2)	2(3.1)	0(0)	0.274
Streptococcus pneumoniae	1(1.5)	1(1.5)	1(1.5)	0.746

Figure 2 Comparison of rate of clinical failure occurrence, in-hospital mortality, 30-day mortality and 60-day mortality among group A, B and C patients. There were no significant differences among the three groups.

Figure 3 Comparison of the median total costs, drug costs and antibiotic costs for one elderly CAP episode among group A, B and C patients. *Compared with group A of median total costs, p=0.001; ^#Compared with group C, p=0.009; ^&Compared with group A of median drug costs, p=0.001; ⋆Compared with group C, p=0.009; ^αCompared with group A of median antibiotic costs, p=0.001; ^βCompared with group C, p<0.001.

Han X, Zhou F, Li H, et al. Effects of age, comorbidity and adherence to current antimicrobial guidelines on mortality in hospitalized elderly patients with community-acquired pneumonia. BMC Infect Dis. 2018;18(1):192. doi:10.1186/s12879-018-3098-529699493

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