OBJECTIVE: The etiology, presentation, and prognosis of community-acquired pneumonia (CAP) among nursing home residents are believed to differ from those of other groups. However, few Spanish studies have confirmed those assumptions or studied regional differences in CAP etiology. PATIENTS AND METHODS: A prospective study which included all patients over 65 years of age admitted to our hospital with CAP was carried out over a period of 18 months (2002)(2003). We examined clinical, analytical,

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... d radiographic characteristics paying particular attention to functional status-using the Eastern Cooperative Oncology Group (ECOG) scale and Barthel and Karnofsky indicesand comorbidity. Two blood cultures, a Legionella antigen test in urine, and serology for atypical bacteria were used for the etiologic diagnosis; bacterial cultures of respiratory samples were also used in certain cases. RESULTS: Ninety-one patients, 25 of whom were nursing home residents, were enrolled. The nursing home residents were older than the other patients (mean [SD] age of 82 [4] compared with 73 [5]; P=.0001) and had greater comorbidity (P=.0001)-with a significantly greater presence of diabetes mellitus, cerebrovascular disease, congestive heart failure, and dementia. They also had a poorer functional status (ECOG, 2.09 [0.9] compared with 0.93 [1.1], P=.001; Barthel Index, 19 [33] compared with 77 [35], P=.001; Karnofsky Index, 51 [17] compared with 78 [23], P=.001). Regarding clinical characteristics, significant differences were found for respiratory rate (39 [11] compared with 27 [7] breaths/min; P=.001), blood pressure (69.5 [20] compared with 79.2 [18] mm Hg; P=.029), and temperature (36.6 [1.2] compared with 37.7 [1.1] ºC; P=.001). CAP patients from nursing homes presented a greater number of affected lobules in chest x-rays (P=.004), more hypoxemia, acidosis, anemia, hypoalbuminemia, and greater scores of urea and creatinine. Fine Scale scores were also greater (134 [26] compared with 95 [28]; P=.001) as was mortality (7/25 compared with 3/66; P=.005). Few patients had an etiologic diagnosis and no significant differences were observed between the groups. The variable that predicted mortality in elderly patients in this series, according to stepwise logistic regression, was urea (adjusted R 2 =0.452). CONCLUSIONS: In our sample population, nursing home residents were older, had greater comorbidity, and severe functional impairment. Under these circumstances the severity of CAP increases and becomes an important cause of mortality despite the fact that the etiologic agents do not appear to differ from those of the other patients. Document downloaded from http://www.archbronconeumol.org, day 10/08/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. vascular, la insuficiencia cardíaca congestiva crónica y la demencia-y peor estado funcional (ECOG: 2,09 ± 0,9 frente a 0,93 ± 1,1, p = 0,001; índice de Barthel: 19 ± 33 frente a 77 ± 35, p = 0,001; índice de Karnofsky: 51 ± 17 frente a 78 ± 23, p = 0,001). En cuanto a las características clínicas, encontramos diferencias significativas en la frecuencia respiratoria (39 ± 11 frente a 27 ± 7 respiraciones/min; p = 0,001), la presión arterial diastólica (69,5 ± 20 frente a 79,2 ± 18 mmHg; p = 0,029) y en la temperatura (36,6 ± 1,2 frente a 37,7 ± 1,1 °C; p = 0,001). En la radiografía de tórax, la NAC de residencia presentó mayor número de lóbulos afectados (p = 0,004). Además, estos pacientes tenían mayor hipoxemia, acidosis, anemia, hipoalbuminemia y elevación de las cifras de urea y creatinina. Asimismo, la puntuación en la escala de Fine fue superior (134 ± 26 frente a 95 ± 28; p = 0,001) y presentaron mayor mortalidad (7/25 frente a 3/66; p = 0,005). En la mayoría de los pacientes no se pudo encontrar un diagnóstico etiológico, pero no se observaron diferencias significativas entre ambos grupos. La variable predictora de mortalidad de los ancianos de la serie -modelo de regresión (pasos sucesivos)-fue la urea (R 2 corregida = 0,452). CONCLUSIONES: En nuestra población, los ancianos que viven en residencias tienen mayor edad, pluripatología e importante deterioro funcional. En estas circunstancias la NAC adquiere especial gravedad y es una causa importante de mortalidad, pese a que los agentes etiológicos no parecen diferir de los habituales. Palabras clave: Neumonía adquirida en la comunidad. Anciano. Residencia.