한국임상약학회지 (Korean Journal of Clinical Pharmacy)

  • 제21권2호
  • /
  • Pages.170-181
  • /
  • 2011
  • /
  • 1226-6051(pISSN)
  • /
  • 2508-786X(eISSN)
한국임상약학회 (Korean College Of Clinical Pharmacy)
권호 표지

Pneumonia Severity Index에 따른 원외획득폐렴 환자의 치료 현황 및 성과

Current Treatment and Clinical Outcomes of Community Acquired Pneumonia According to Pneumonia Severity Index

  • Park, Hyun-Hee (Graduate School of Clinical Pharmacy, Sookmyung Women's University) ;
  • Ji, Eun-Hee (College of Pharmacy, Seoul National University) ;
  • Lee, Young-Sok (College of Pharmacy, Institute of Pharmaceutical Research and Development, Wonkwang University)
  • 투고 : 2011.02.15
  • 심사 : 2011.03.17
  • 발행 : 2011.06.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: There is considerable variability in rates of hospitalization for patients with community-acquired pneumonia (CAP) in part because of physicians' uncertainty in assessing the severity of illness at presentation. The purpose of the study was to examine the current treatment patterns and factors influencing the Pneumonia Severity Index (PSI) and clinical outcomes in the patient with CAP. Method: The retrospective data collection of the patients with CAP was conducted and the data were reviewed. The collected data included demographic, clinical, laboratory and microbiological medical information. All patients were stratified into three risk groups according to PSI: low risk (PSI score I-II), moderate risk (III) and high risk (IV-V) groups. The examined treatment patterns were the appropriateness of admissions, category of antibiotics used. The prognostic factors associated with PSI and clinical outcomes were examined. Results: One hundred and six patients' medical data were reviewed. The overall appropriateness of admissions was low presenting many of patients were admitted or intensely treated in the hospital despite of lower risk of prognosis and treated with intravenous antibiotics instead of oral fluoroquinolones. Primary pneumonia pathogens were Klebsiella pneumoniae (27%) and Streptococcus pneumoniae (21.6%). Mean LOS was 8.5 days and was significantly longer (10.0days) (p<0.001) in high risk group. The patients with age >65 (p<0.001), diabetes mellitus (p<0.001), mental alteration (p<0.001), and/or $PaO_2$ <60 mmHg (p<0.001) had a tendency to have higher PSI. The prognostic factors associated with longer LOS were age >65 years (p=0.008), mental status alteration (p<0.001), dyspnea (p=0.002) and PSI score (p=0.001). The prognostic factors associated with mortality were congestive heart failure (p=0.038), systolic blood pressure <90 mmHg (p=0.002) and arterial pH <7.35 (p=0.013). Conclusion: Most of patients were found to over-utilize medical service according to appropriateness of admissions. The elderly, mentally altered patients with low $PaO_2$ had higher PSI score with increased risk of LOS. The mortality could be increased in the patient with disease state of congestive heart failure, high blood pressure, and/or acidosis.

키워드

참고문헌

  1. Liam CK, Lim KH, Wong CMM. Community-acquired pneumonia in patients requiring hospitalization. Respirology. 2001; 6: 259-264. https://doi.org/10.1046/j.1440-1843.2001.00336.x
  2. American Thoracic Society. Guidelines for the management of adults with community-acquired pneumonia. Am J Respir Crit Care Med. 2001; 163: 1730-1754. https://doi.org/10.1164/ajrccm.163.7.at1010
  3. Carlos M, Angela, Alejandro J, et al., Community -acquired pneumonia. Chest. 2000; 118: 1344-1354. https://doi.org/10.1378/chest.118.5.1344
  4. Sopena N, Sabri M, Pedro-Botet ML, et al., Prospective study of community-acquired pneumonia of bacterial etiology in adults. Eur J Clin M icrobiol Infect Dis. 1999; 18: 852-858. https://doi.org/10.1007/s100960050419
  5. Friedrich, Medizinische, Kliniken, et al., Intrevenous/Oral sequential therapy in patients hospitalised with communityacquired pneumonia. Drugs. 2002; 62: 303-317.
  6. Bartlett JG, Dowell SF, Mandell LA, File Jr TM, Musher DM, Fine MJ. Practice guidelines for the management of community-acquired pneumonia in adults. Infectious Diseases Society of America. Clin Infect Dis. 2000; 31: 347-82 https://doi.org/10.1086/313954
  7. Fine MJ, Auble TE, Yealy DM, et al., A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997; 336: 243-50 https://doi.org/10.1056/NEJM199701233360402
  8. 유철웅, 박정원, 황병연 등. 노인환자에서의 원외폐렴. 대한 감염학회지. 2000; 32: 212-218.
  9. 정문현, 신완식, 김양리 등. 7개 대학 병원에서 조사한 지역 사회 폐렴의 원인균. 대한감염학회지. 1997; 29: 339-359.
  10. Fine MJ, Stone RA, Singer DE, et al., Processes and outcomes of care with community-acquired pneumonia: results from the pneumonia patient outcomes research team (PORT) cohort study. Arch Intern Med. 1999; 159: 970-980. https://doi.org/10.1001/archinte.159.9.970
  11. Johnson PD, Irving LB, Turnidge JD. 3: Communityacquired pneumonia. Med J Aust. 2002; 176: 341-347.
  12. Cantrill SV, Dalsey WC, Decker WW, et al., Clinical policy for the management and risk stratification of community-acquired pneumonia in adults in the emergency department. Ann Emerg Med. 2001; 38: 107-113. https://doi.org/10.1067/mem.2001.115880
  13. Marrie TJ, Lau CY, Wheeler SL, Wong CJ, Vandevoot MK, Feagan BG. A controlled trial of a critical pathway for treatment of community-acquired pneumonia. CAPITAL Study Investigators. Community-Acquired Pneumonia Intervention Trial Assessing Levofloxacin. JAMA. 2000; 283: 749-755. https://doi.org/10.1001/jama.283.6.749
  14. 배중훈, 이미진, 오동렬 등. 폐렴중증지수를 이용한 폐렴환자의 중증도 분류의 제안. 대한응급의학회지. 2002; 13: 129-134.
  15. Flanders WD, Tucker G, Krishnadasan A, et al., Validation of the pneumonia severity index. Importance of studyspecific recalibration. Gen Intern Med. 1999; 14: 333-340. https://doi.org/10.1046/j.1525-1497.1999.00351.x
  16. 윤지호, 이동채, 이한슬 등. 목포지역에서의 지역사회 획득 폐렴의 임상적 연구. 결핵 및 호흡기질환. 2001; 51: 17-24.
  17. Ruiz M, Arosio C, Salman P, Bauer TT, Torres A. Diagnosis of pneumonia and monitoring of infection eradication. Drugs 2000; 60: 1289-1302. https://doi.org/10.2165/00003495-200060060-00004
  18. Kaplan V, Angus DC, Griffin MF, Clermont G, Scott Watson R, Linde-Zwirble WT. Hospitalized communityacquired pneumonia in the elderly: age- and sex-related patterns of care and outcome in the United States. Am J Respir Crit Care Med. 2002; 165: 766-772. https://doi.org/10.1164/ajrccm.165.6.2103038
  19. Stuble SP, Reichlin S, Dieterle T, Leimenstoll B, Schoenenberger R, Martina B. Community-acquired pneumonia--which patients are hospitalised? Swiss Med Wkly. 2001; 131: 188-192.
  20. Halm EA, Switzer GE, Mittman BS, Walsh MB, Chang CC, Fine MJ. What factors influence physicians' decisions to switch from intravenous to oral antibiotics for community-acquired pneumonia? J Gen Intern Med. 2001; 16: 599-605. https://doi.org/10.1046/j.1525-1497.2001.016009599.x
  21. Fine MJ, Pratt HM, Obrosky DS, et al., Relation between length of hospital stay and costs of care for patients with community-acquired pneumonia. Am J Med. 2000; 109: 378-385. https://doi.org/10.1016/S0002-9343(00)00500-3
  22. Ruiz M, Ewig S, Torres A, et al., Severe communityacquired pneumonia. Risk factors and follow-up epidemiology. Am J Respir Crit Care Med. 19991; 160: 923-929. https://doi.org/10.1164/ajrccm.160.3.9901107
  23. Hoe LK, Keang LT. Hospitalized low-risk communityacquired pneumonia: Outcome and potential for costsavings. Respirology. 1999; 4: 307-309. https://doi.org/10.1046/j.1440-1843.1999.00197.x
  24. Leroy O, Devos P, Guery B, et al., Simplified prediction rule for prognosis of patients with severe communityacquired pneumonia in ICUs. Chest. 1999; 116: 157-165. https://doi.org/10.1378/chest.116.1.157
  25. Lovering AM, MacGowan AP, Anderson P, Irwin D. Epidemiology and resource utilization for patients hospitalized for lower respiratory tract infection. Clin Microbiol Infect. 2001; 7: 666-670. https://doi.org/10.1046/j.1469-0691.2001.00350.x
  26. Lim WS, Macfarlane JT, Boswell TC, et al., Study of community acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: implications for management guidelines. Thorax. 2001; 56: 296-301. https://doi.org/10.1136/thorax.56.4.296
  27. Marras TK, Gutierrea C, Chan CK. Applying a prediction rule to identify low-risk patients with community-acquired pneumonia. Chest. 2000; 118: 1339-1343. https://doi.org/10.1378/chest.118.5.1339
  28. Ruiz M, Ewig S, Marcos MA, et al., Etiology of communityacquired pneumonia: Impact of age, comorbidity, and severity. Am J Respir Crit Care Med. 1999; 160: 397-405. https://doi.org/10.1164/ajrccm.160.2.9808045
  29. Feagan BG, Marrie TJ, Lau CY, et al., Treatment and outcomes of community-acquired pneumonia at Canadian hospitals. CMAJ. 2000; 162: 1415-1420.
  30. Feldman C, Viljoen E, Morar R, et al., Prognostic factors in severe community-acquired pneumonia in patients without co-morbid illness. Respirology. 2001; 6: 323-330. https://doi.org/10.1046/j.1440-1843.2001.00352.x