• Journal of the Korean Data and Information Science Society
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• v.22 no.3
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• pp.389-400
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• 2011

This study was carried out to analysis factors related to in-hospital mortality of community-acquired peumonia using administrative database. The subjects were 5,353 community-acquired pneumonia inpatients of the Korean National Hospital Discharge Injury Survey 2004-2006 data. The data were analyzed using chi-squared test and decision tree model in the data mining technique. Among the decision tree model, C4.5 had the best performance. The critical factors on in-hospital mortality of communityacquired pneumonia are admission route, respiratory failure, congenital heart failure including age, comorbidity, and bed size. This study was carried out using the administrative database including patients' characteristics and comorbidity. However further study should be extensively including hospital characteristics, regional medical resources, and patient management practice behavior.

• Tuberculosis and Respiratory Diseases
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• v.63 no.3
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• pp.273-277
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• 2007

70세 남자가 내원 7일전 발생한 우측 흉부 통증, 고열 및 가래를 동반한 기침으로 입원하였다. 백혈구와 CRP(C reactive protein)의 상승, 흉부 방사선 소견상 우하엽에 폐렴을 시사하는 소견이 관찰되어 지역 사회 획득성 폐렴에 준한 경험적 항생제를 투여하였다. 처음 두 번의 연속적인 가래 배양 검사에서 항생제 감수성이 있는 Acinetobacter baumannii균이 동정 되었으며 항생제 치료 후 임상 증상 및 방사선 소견이 점차 호전되었다. Acinetobacter baumannii는 중환자실에서 주로 발생하는 병원 획득성 폐렴의 주요 균으로 알려져 있으며 지역 사회 획득성 폐렴의 흔한 원인균은 아니다.

• Tuberculosis and Respiratory Diseases
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• v.66 no.5
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• pp.358-364
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• 2009

Background: The appropriate empirical antimicrobial choice in the treatment of community-acquired pneumonia (CAP) should be advocated by community-based information on the etiologic pathogens, their susceptibility to antimicrobials, clinical characteristics and outcomes. Jeju is a geographically isolated and identical region in Korea. However, there is no regional reference on adult CAP available. This study investigated the etiologic agents and clinical outcomes of adult patients diagnosed with CAP in Jeju, Korea, to help guide the empirical antimicrobial choice. Methods: A prospective observational study for one year in a referral hospital in Jeju, Korea. Patients diagnosed with CAP were enrolled with their clinical characteristics. Microbiological evaluations to identify the etiologic agents in the adult patients with CAP were performed with blood culture, expectorated sputum smear and culture, antibody tests for mycoplasma, chlamydophila, and antigen tests for legionella and pneumococcus. The clinical outcomes of the initial empirical treatment were analyzed. Results: Two hundred and three patients with mean age of 64 and 79 females were enrolled. Ten microbials from 90 cases (44.3%) were isolated and multiple isolates were confirmed in 30. Among the microbial isolates, S. pneumoniae (36.3%) was the most common, followed by M. pneumoniae (23.0%), C. pneumoniae (17.0%), S. aureus (9.6%) and P. aeruginosa (5.9%). The initial treatment failure (23.8%) was related to the isolation of polymicrobial pathogens, elevated inflammatory markers, and the presence of pleural effusion. Among the 30 isolates of S. pneumoniae, 16 (53.3%) were not susceptible to penicillin, and 19 isolates (63.3%) to erythromycin and clarithromycin. However, 29 isolates (96.7%) were susceptible to levofloxacin and ceftriaxone. Conclusion: S. pneumoniae, M. pneumoniae, S. aureus, and P. aeruginosa are frequent etiologic agents of adult CAP in Jeju, Korea. The clinical characteristics and antibiotic resistance should be considered when determining the initial empirical antimicrobial choice. Respiratory quinolone or ceftriaxone is recommended as an empirical antimicrobiotic in the treatment of adult CAP in Jeju, Korea.

• Tuberculosis and Respiratory Diseases
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• v.58 no.6
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• pp.607-613
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• 2005

Background : Early death is an important problem associated with the management of community-acquired pneumonia. However, there is little information on the risk factors associated with it. The aim of this study was to identify the factors associated with early death in community-acquired pneumonia patients. Methods : From January 1999 to July 2004, 1,487 adult patients with community-acquired pneumonia who were admitted to the pulmonary department via emergency center were examined. Early death was defined as those who died within 2 days of hospitalization. The clinical and laboratory aspects of the patients who died early (n = 30) were compared with those of an age and gender matched control population (n = 60). Results : In the early death group, respiratory rate, heart rate, and blood urea nitrogen (BUN) were significant higher (p < 0.05 for all), while the arterial pH, systolic pressure, and $PaO_2$ were significant lower (p < 0.05 for all) than the control. The independent factor significantly associated with early death was tachypnea (OR, 7.049). Conclusion : The importance of an early clinical assessment in emergency center with community-acquired pneumonia needs to be emphasized in order to recognize patients at risk of early death.

• Tuberculosis and Respiratory Diseases
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• v.60 no.4
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• pp.419-425
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• 2006

Background : Severe community-acquired pneumonia (CAP) can develop into respiratory failure that requires mechanical ventilation (MV), which is associated with a higher rate of mortality. It was recently reported that a hydrocortisone infusion in severe CAP patients was associated with a significant reduction in the length of the hospital stay and mortality. This study evaluated efficacy of a hydrocortisone infusion for patients with severe CAP requiring MV. Methods : From February 2005 to July 2005, 13 patients (M : F = 10 : 3, mean age: $68.6{\pm}14.1years$), who were diagnosed with severe CAP and required MV, were enrolled in this study. Hydrocortisone was administered as an intravenous 200mg loading bolus, which was followed by an infusion at a rate of 10mg/hour for 7 days. The control group was comprised of patients with severe CAP requiring MV but in whom corticosteroid was not used before study period. The clinical and physiologic parameters on or by day 8 and the outcome in the hydrocortisone infusion group were compared with those in the control group. Results : 1) There was no significant difference in age, gender ratio, SAPS II, SOFA score, temperature, leukocyte count, PaO2/FiO2 (P/F) ratio, the number of patients with P/F ratio < 200, chest radiograph score, lung injury score and catecholamine-dependent septic shock between the hydrocortisone infusion group and control group at day 1. 2) At day 8, the proportion of patients with an improvement in the P/F ratio ${\geq}100$ and the chest radiograph score was significantly higher in the hydrocortisone infusion group than in the control group (61.5% vs. 15.4%, 76.9% vs. 23.1%, p< 0.05). However, there was no significant difference in the other clinical and physiologic parameters. 3). There was no significant difference in the duration of the MV, ICU stay, hospital stay and 10th and 30th day mortality between the two groups. Conclusion : Hydrocortisone infusion for patients with severe CAP requiring invasive mechanical ventilation may be effective in improving the level of oxygenation and the chest radiograph score.

• Clinical and Experimental Pediatrics
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• v.45 no.6
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• pp.685-690
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• 2002

• Tuberculosis and Respiratory Diseases
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• v.58 no.1
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• pp.59-63
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• 2005

A-67-year-old man was hospitalized due to fever, cough and dyspnea upon exertion, and was treated with intravenous antibiotics. During the hospital course he presented with weakness in his low extremities. The laboratory tests showed an elevated CK level and myoglobinuria. He was diagnosed with rhabdomyolysis with community-acquired pneumonia and treated accordingly. Subsequently, his symptoms and signs of rhabdomyolysis improved.

• Tuberculosis and Respiratory Diseases
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• v.47 no.4
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• pp.460-470
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• 1999

Background : In 1993, American Thoracic Society (ATS) recommended a guideline for the initial management of adults with community-acquired pneumonia(CAP). However, etiologic organisms and medical system in Korea seem to be different from those in Western countries. Retrospective analysis was done to evaluate the efficacy of antibiotics chosen by ATS guideline in the treatment of Korean patients with CAP admitted to a tertiary university medical center. Methods : Hospitalized patients with CAP at Samsung Medical Center from April 1997 through March 1998 were retrospectively reviewed. Patients who fulfilled all of the following criteria were included in this study : (1) fever ${\geq}38^{\circ}C$ (2) purulent sputum (3) pulmonary infiltrates on chest X-ray. Patients were classified as : 1) ATS group ; patients whose initial antibiotics were chosen by ATS guideline 2) Non-ATS overuse group ; additional antibiotics administered more than those of ATS guideline, and 3) Non-ATS underuse group ; initial antibiotics were insufficient to ATS guideline. Response of empirical antibiotics and etiologic organisms of 3 groups were identified. Results : Sixty-four patients were enrolled. Thirty-six patients were classified into ATS group, 10 patients Non-ATS overuse group, and 18 patients Non-ATS underuse group. Thirty-three patients of 36 ATS group, 9 patients of 10 Non-ATS overuse group, and 14 patients of 18 Non-ATS underuse group showed improvement by initial empirical antibiotics. There was no statistical difference in antibiotic response between 3 groups (p>0.05). S. pneumoniae (12.5%), K. pneumoniae (9.4%), and P. aeruginosa (4.7%), Mycoplasma (3.1%) were the most commonly isolated organisms. In 18 patients with severe CAP, P. aeruginosa was isolated only in 1 patient and Legionella organism not isolated. Conclusion : Initial empirical antibiotics chosen by ATS guideline were effective in the management of Korean patients with CAP admitted to a tertiary hospital. However, well-designed large-scale prospective study is needed to identify etiologic organisms and choose an adequate initial empirical antibiotics in Korean adults patient with severe CAP.

• Korean Journal of Clinical Pharmacy
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• v.21 no.4
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• pp.394-399
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• 2011

이 증례는 알코올 중독증을 앓은 병력을 가졌으나 간 기능에 특이한 증후가 없던 환자가, 지역 사회 획득성 폐렴으로부터 유발된 중증 패혈증 치료를 받기 위해서 linezolid, moxifloxacin 과 함께 aztreonam을 초회 정맥주사 맞은 후, 아주 높은 수치의 alanine aminotransferase (ALT), aspartate aminotransferase (AST) 혈중 농도가 검출된 경우이다. 후속 치료에서 상기 3가지 항생제 대신 vancomycin과 ceftazidime을 주사했더니, ALT/AST가 빠르게 정상화됨이 관찰되었다. 이 증례 보고는 linzolid, moxifloxacin과 aztreonam을 함께 사용할 경우, 각별한 주의 관찰이 필요하며, 알코올 중독증을 앓은 병력을 가진 환자에게 투여 시 특별한 주의와 함께 AST/ALT혈중 수치를 검사토록 권하기 위한 것이다.

• Tuberculosis and Respiratory Diseases
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• v.50 no.4
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• pp.409-414
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• 2001

Background : Legionella pneumophila has been recognized as an important cause of community-acquired pneumonia(CAP) requiring hospitalization. However, epidemiological data on the occurrence of legionella-related pneumonia is unavailable in Korea. The purpose of this study was to evaluate the etiological importance of legionella pneumophila serogroup 1 in patients hospitalized with CAP. Method : The CAP patients over 16 year-old were recruited from July 1999 to June 2000 at the Chunchon Sacred Heart Hospital. Fifty four patients (male 29, female 25, average age $63.8{\pm}15.3$) were included in this study. A diagnosis of a legionella pneumophila infection was based on a urinary antigen test using the Binax Company enzyme immunoassay. The severity of pneumonia was assessed using the Fine's PORT scoring system. Result : The average Fine's PORT score was 99.7(${\pm}44.9$). According to the risk classification proposed by the Infectious Disease Society of America, the number of patients in each class(from class I to class V) were 6(11.1%), 13(24.1%), 9(16.7%), 14(25.8%), and 12(22.2%), respectively. Thirty two patients(59.3%) were initially admitted to the intensive care unit. The mortality rate was 16.7%(9 in 54). In all patients, urinary antigens to Legionella pnewnophila serogroup 1 were not detected. Conclusion : Legionella pnewnophila may play little role in causing adult CAP in Korea. Therefore, the routine use of macrolide in the empirical treatment of the CAP patients based upon the ATS guidelines(1993) in Korea should be reevaluated.