Abstract:Objective To investigate the current diagnosis and treatment status of elderly patients with community acquired pneumonia (CAP) in an upper first-class hospital in Beijing, and compare the obtained data with Chinese 2016 CAP Diagnosis and Treatment Guidelines in order to explore the problems existing in the process of diagnosis and treatment. Methods A total of 295 elderly patients suffering from CAP admitted in our hospital from January to December 2020 were recruited in this study. According to their CURB-65(confusion, urea, respiratory rate, blood pressure, and age≥65 years) score for pneumonia severity assessment and pneumonia severity index (PSI), they were divided into outpatient and inpatient groups. The general information, admission site, pathogenic bacteria and initial antibiotic use were analyzed and compared between the two groups. SPSS statistics 23.0 was used to perform the statistical analysis. Student′s t test, Rank sum test or Chi-square test was employed for intergroup comparison based on different data types. Results For the 295 elderly CAP patients, there were 34 cases meeting the criteria for hospitalization according to the CURB-65 score (3-5 points), and 147 cases meeting the criteria based on the PSI score (grade Ⅳ-Ⅴ). The patients from the inpatient group were mostly of advanced age and admitted from emergencies, and had longer length of hospital stay and worse prognosis when compared with those from the outpatient group. There were 94.6% (279/295) receiving pathogenic test after admission, and the results indicated the positive rate of sputum smear was 79.9% (155/194), with Gram-positive cocci taking the top[29.7% (46/155)], the positive rate of sputum culture was 32.1% (70/218), with Fungi accounting for 20.0% (14/70), and positive rate of mycoplasma was 28.4% (21/74). On the basis of CURB-65 score, the proportions of third-generation cephalosporin usage [21.8%(57/261)]and quinolone usage [21.5% (56/261)] were quite high in the outpatient treatment group. The proportions of carbapenems [35.3% (12/34)] and carbapenems combined with other antibiotics [23.5% (8/34)] were significantly higher in inpatient group than outpatient group (P<0.05). Conclusion More than half of the elderly patients with CAP have low admission score and mild conditions, and did not meet the criteria for hospitalization recommended by the guidelines. Therefore, we need to further strengthen compliance with the guidelines. The CURB-65 scale has some limitations in the assessment of CAP severity in the elderly, and PSI has a higher value in evaluation of mortality risk of these patients. For the CAP elderly patients who meet the criteria for hospitalization, the type of their initial antibiotic use basically meet the requirements of the guidelines.