The Infections Causing Acute Respiratory Failure in Elderly Patients

  • Giampiero Foccillo


The immune system of older individuals declines with advancing age (“immunosenescence”) increasing susceptibility to infection, as well as to an increased risk of a worse outcome. Severe community-acquired pneumonia and acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are causes of acute respiratory failure (ARF) in elderly patients. Non-invasive mechanical ventilation (NIV) is effective in the treatment of patients with ARF, above all in case of AECOPD.



Acute exacerbations of chronic obstructive pulmonary disease


Acute respiratory distress syndrome


Acute respiratory failure


Community-acquired pneumonia


Chronic obstructive pulmonary disease


Extended-spectrum β-lactamase


Intensive care unit


Methicillin-resistant Staphylococcus aureus


Non-invasive ventilation


  1. 1.
    Murray MA, Chotirmall SH. The impact of immunosenescence on pulmonary disease. Mediators Inflamm. 2015;2015:692546. Published online 2015 Apr 19. Pages 10.CrossRefGoogle Scholar
  2. 2.
    Becquemin H, Beigelman C, Isnard R, et al. Acute respiratory failure in the elderly: etiology, emergency diagnosis and prognosis. Crit Care. 2006;10(3):R82.CrossRefGoogle Scholar
  3. 3.
    Roussos C, Koutsoukou A. Respiratory failure. Eur Respir J Suppl. 2003;47:3s–14s.CrossRefGoogle Scholar
  4. 4.
    Delerme S, Ray P. Acute respiratory failure in the elderly: diagnosis and prognosis. Age Ageing. 2008;37:251–7.CrossRefGoogle Scholar
  5. 5.
    Lee K-Y. Pneumonia, acute respiratory distress syndrome, and early immune-modulator therapy. Int J Mol Sci. 2017;18:388–403.CrossRefGoogle Scholar
  6. 6.
    Ware LB, Matthay MA. The acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1334–49.CrossRefGoogle Scholar
  7. 7.
    Sharma S. Acute respiratory distress syndrome. BMJ Clin Evid. 2010;11:1511.Google Scholar
  8. 8.
    Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307:2526–33.PubMedGoogle Scholar
  9. 9.
    Rothberg MB, Pekow PS, et al. Antibiotic therapy and treatment failure in patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease. JAMA. 2010;303(20):2035–42.CrossRefGoogle Scholar
  10. 10.
    Global Initiative for Chronic Obstructive Lung Diseases. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease (2017 Report).Google Scholar
  11. 11.
    Sethi S, Murphy TF. Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N Engl J Med. 2008;359(22):2355–65.CrossRefGoogle Scholar
  12. 12.
    Eller J, Ede A, Schaberg T, Niederman MS, et al. Infective exacerbations of chronic bronchitis: relation between bacteriologic etiology and lung function. Chest. 1998;113(6):1542–8.CrossRefGoogle Scholar
  13. 13.
    Diederen BM, van der Valk PD, Kluytmans JA, et al. The role of atypical pathogens in exacerbations of chronic obstructive pulmonary disease. Eur Respir J. 2007;30(2):240–4.CrossRefGoogle Scholar
  14. 14.
    Sethi S. Infectious etiology of acute exacerbations of chronic bronchitis. Chest. 2000;117:380S–5S.CrossRefGoogle Scholar
  15. 15.
    Mohan A, Chandra S, Agarwal D, et al. Prevalence of viral infection detected by PCR and RT-PCR in patients with acute exacerbation of COPD: a systematic review. Respirology. 2010;15:536–42.CrossRefGoogle Scholar
  16. 16.
    Miravitles M, Kruesmann F, Haverstock D, et al. Sputum colour and bacteria in chronic bronchitis exacerbations: a pooled analysis. Eur Respir J. 2012;39(6):1354–60.CrossRefGoogle Scholar
  17. 17.
    Black PN, McDonald CF. Pathogen-directed therapy in acute exacerbations of COPD. Proc Am Thorac Soc. 2007;4:647–58.CrossRefGoogle Scholar
  18. 18.
    Janssens J-P, Krause K-H. Pneumonia in the very old. Lancet Infect Dis. 2004;4:112–24.CrossRefGoogle Scholar
  19. 19.
    Fernandez-Sabé N, Carratala J, Roson B, et al. Community-acquired pneumonia in very elderly patients: causative organisms, clinical characteristics, and outcomes. Medicine. 2003;82(3):159–69.PubMedGoogle Scholar
  20. 20.
    Berk SL. Bacterial pneumonia in the elderly: the observations of Sir William Osler in retrospect. J Am Geriatr Soc. 1993;42:683–5.Google Scholar
  21. 21.
    Jain S, Self WH, Wunderink RG, et al. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med. 2015;373(5):415–27.CrossRefGoogle Scholar
  22. 22.
    Chong CP, Street PR. Pneumonia in the elderly: a review of the epidemiology, pathogenesis, microbiology, and clinical features. South Med J. 2008;101(11):1141–5.CrossRefGoogle Scholar
  23. 23.
    Xiaowen H, Lee JS, Pianosi PT, et al. Aspiration-related pulmonary syndromes. Chest. 2015;147(3):815–23.CrossRefGoogle Scholar
  24. 24.
    González-Castillo J, Martín-Sánchez FJ, Linares P, et al. Guidelines for the management of community-acquired pneumonia in the elderly patient. Rev Esp Quimioter. 2014;27(1):69–86.PubMedGoogle Scholar
  25. 25.
    Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(Suppl 2):S27–72.CrossRefGoogle Scholar
  26. 26.
    Lim WS, Baudouin SV, George RC, et al. Guidelines for the management of community-acquired pneumonia in adults: update 2009. Thorax. 2009;64(Suppl 3):1–55.CrossRefGoogle Scholar
  27. 27.
    Woodhead M, Blasi F, Ewig S, et al. Guidelines for the management of adult lower respiratory tract infections. Clin Microbiol Infect. 2011;17(Suppl 6):E1–E59.CrossRefGoogle Scholar
  28. 28.
    Schuetz P, Litke A, Albrich WC, Mueller B. Blood biomarkers for personalized treatment and patient management decisions in community-acquired pneumonia. Curr Opin Infect Dis. 2013;26:159–67.CrossRefGoogle Scholar
  29. 29.
    Weber S, Mawdsley E, Kaye D. Antibacterial agents in the elderly. Infect Dis Clin N Am. 2009;23:881–98.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Giampiero Foccillo
    • 1
  1. 1.Emergency MedicineSan Paolo HospitalNaplesItaly

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