• Tuberculosis and Respiratory Diseases
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• 제41권5호
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• pp.537-545
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• 1994

연구배경: 중증 원외폐렴은 1987년 영국흉부학회에서 453명의 원외폐렴환자를 대상으로 전향적조사를 한 이후, 여러 학자들에 의해 조기에 위험군을 찾아내어 치료에 도움을 주려는 노력이 있어 왔다. 외국의 경우 중증 원외폐렴에 관한 많은 보고가 있으나 국내에서는 중증 원외폐렴에 대한 임상양상과 특징이 잘 연구되지 못한 상태이다. 이에 본 관찰에서는 계명대학교 동산병원에 입원하여 중증 원외폐렴으로 중환자실에서 치료중 사망한 환자 10명을 대상으로 임상적 고찰을 하였다. 방법: 1987년 7월 부터 1993년 7월 까지 계명대학교 동산병원에서 면역억제 치료중이거나 폐암으로 인한 이차성 폐렴 그리고 결핵성 폐렴을 제외한 원외폐렴으로 498명이 입원하였다. 중환자실에서 치료를 받은 환자는 77명이었으며 이들중 치료중에 사망한 10예를 대상으로 나이, 성별, 임상소견, 검사실성적, 중환자실 전원이유, 원인균, 항생제치료, 및 입원기간 등을 후향적으로 분석하였다. 결과: 1) 10예중 남자가 7예 여자가 10예로 남자의 발생빈도가 높았고, 연령분포는 20대에서 70대까지의 분포를 보였으나 60대 이상이 7예로 고령에서 가장 많은 분포를 보였으며 평균나이는 56.2세였다. 2) 입원당시 임상양상은 호흡수증가 5예, 저산소혈증 5예, 의식변화 4예, 청색증 4예, 백혈구감소증 4예, 백혈구증가증 4예, 혈청 크레아티닌증가 4예, 저혈압 3예, 저알부민혈증 3예 순으로 관찰되었다. 이학적검사에서 이상소견이 없는 경우가 2예였고 한가지만 이상소견을 가지는 경우가 3예에서 관찰되었다. 검사실성적에서는 모든 환자에서 한가지이상의 이상소견이 관찰되었다. 3) 객담배양 검사에서 E.coli와 Enterobacter species가 각각 한 예씩 검출되었으며, 객담도말검사에서는 그람양성구균만 검출된 경우가 6예, 그람양성구균과 그람음성간균이 함께 검출된 경우가 2예에서 관찰되었다. 4) 중환자실로 전원된 이유로는 저산소혈증 5예, 고탄산혈증 2예, 산혈증 2예, 심장 또는 폐정지 2예, 신부전 2예, 간부전 2예의 순으로 관찰되었다. 5) 사용한 항생제는 aminoglycoside 8예, 1세대 cephalosporin 7예, 3세대 cephalosporin 5예, vancomycin 2예였으며 환자당 평균 2.7종류의 항생제를 사용하였다. 가장 많이 사용한 항생제 조합은 1세대 cephalosporin과 aminoglycoside 였다. 6) 평균 입원일수는 11.2일 이었으며, 7예(70%)에서 5일 이내에 사망하였다. 결론: 대부분의 사망환자는 입원초기에 사망하여 조기 집중치료가 중요할 것으로 생각되며, 고령의 환자는 많은 주의를 요할 것으로 사료된다. 앞으로 조기에 위험군을 확인하기 위한 노력이 필요할 것으로 생각된다.

• Tuberculosis and Respiratory Diseases
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• 제38권1호
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• pp.53-58
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• 1991

Acinetobacter calcoaceticus var anitratus, a non-fermentative gram negative bacillus, has been infrequently reported as a cause of community-acquired pneumonia. Bacteremic community-acquired pneumonia caused by Acinetobacter is a fulminant disease with a high mortality (above 40 per cent in the reported case). The onset of the illness is rapid but nonspecific with fever, productive cough, pleuritic pain and rapid prostration. And the patients frequently present with respiratory distress, severe hypoxemia, leukopenia and septic shock. We experienced a case of community-acquired Acinetobacter pneumonia who underwent respiratory support with mechanical ventilator for about 4 weeks and survived. We report the case with review of literature.

• Tuberculosis and Respiratory Diseases
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• 제70권3호
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• pp.224-234
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• 2011

Background: Little data is available regarding hospitalized patients with nursing home-acquired pneumonia (NHAP). This is unfortunate because there is an increasing number of elderly persons who are living in nursing homes in Korea. The aim of this study was to compare clinical characteristics and treatment responses of NHAP with community-acquired pneumonia (CAP). Methods: Patients with pneumonia who were admitted from eight nursing homes or from their own homes were enrolled between May 2007 and April 2009. Their clinical characteristics and treatment responses were reviewed retrospectively, and differences between the two groups were analyzed. Results: Of 110 Patients with pneumonia, 66 (60%) were from nursing homes and their median age was 84. In the NHAP group, functional performance status was significantly poorer, classical symptoms of pneumonia were less severe, and multi-lobe involvement (on chest radiographs) was more frequent than in the CAP group. Patients with NHAP more frequently showed lymphocytopenia, anemia, hypoalbuminemia, hypoxemia, and elevated blood urea nitrogen on admission. The mean CURB-65 score was 2.2 in the NHAP group, higher than 1.7 in the CAP group (p=0.004), and multi-drug resistant pathogens were also highly identified in NHAP group (39% vs. 10%, p=0.036). The mean duration of antibiotic therapy was greater for the NHAP (12.6 days) than for the CAP group (6.6 days) (p<0.001). The mortality rate was 23% in NHAP group, which was significantly higher than 5% in the CAP group (p=0.014). Conclusion: NHAP should be more intensively investigated because of the higher frequency of multi-drug resistant pathogens and mortality than the CAP.

• 한국임상약학회지
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• 제16권2호
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• pp.81-85
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• 2006

Community acquired pneumonia(CAP) is the most prevalent disease among pneumonia patients and progressed to severe pneumonia. A retrospective study was performed to evaluate antibiotic regimens according to guidelines of Infectious Disease Society of America. From January to October 2005, chart review of 50 patients with CAP was peformed in terms of microbiology and laboratory data of each regimen. Temperature, WBC count, ALT, AST and alkaline phosphatase of each patient were examined for liver toxicity. In three patients received levofloxacin appeared to have normalized temperature and improved cough. The patients who received cefmetazole -aminoglycoside appeared to have worsen LFT(Liver function test). Many patients in flomoxef-aminoglycoside group received mechanical ventilation because of the basis diseases like tuberculosis, diabetes mellitus and hypertension. In conclusion, antibiotic therapy for the treatment of CAP should be selected according to tolerance, bacteria and severity of disease.

• Tuberculosis and Respiratory Diseases
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• 제75권2호
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• pp.75-78
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• 2013

Methcillin-resistant Staphylococcus aureus (MRSA) has emerged as an important cause of community-acquired infections, which has been recently designated as community-associated (CA) MRSA. Panton-Valentine leukocidin (PVL)-negative multilocus sequence type 72 (ST72)-staphylococcal cassette chromosome mec (SCCmec) type IV has been reported as the predominat CA-MRSA strain in Korea and is commonly associated with skin and soft tissue infections in addition to healthcare-associated pneumonia. However, community-acquired pneumonia (CAP) for this strain has not yet been reported. We hereby report two cases of CAP caused by PVL-negative ST72-SCCmec type IV strain in patients who had no risk factors for MRSA acquisition. While CA-MRSA infections are not yet prevalent in Korea, our cases suggest that CA-MRSA should be considered in cases of severe CAP, especially for cases associated with necrotizing pneumonia.

• Tuberculosis and Respiratory Diseases
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• 제44권5호
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• pp.1072-1082
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• 1997

연구배경 : 중증 지역사회획득 폐렴은 진단방법의 향상, 항생제의 개발, 조기진단 및 치료에도 불구하고 여전히 높은 사망률을 보이는 질환으로 알려져 있다. 중증 지역사회획득 폐렴의 임상적 특정을 분석하고 예후에 영향을 미치는 인자를 규명하여 치료 및 예후 판정에 도움을 주고자 한다. 방 법 : 1989년 1월부터 1996년 7월까지 한림대학교 의료원에 내원한 40명의 중증 지역사회획득 폐렴환자를 대상으로 후향적으로 분석하였다. 원인균 동정을 위해 객담배양, 혈액배양, 기관지폐포세척액배양 및 Mycoplasma pneumoniae에 대한 항체검사를 시행하였고, 초치료로 2세대 혹은 3세대 cephalosporin, amoxicillin/clavulanic acid 등이 사용되었으며 aminoglycoside와 macrolide가 상황에 따라 병용 투여되었다. 대상군을 생존군과 사망군으로 분류하여 연령, 흡연 및 알콜중독 유무, 기저질환 유무, 저산소 혈중, 기계적 환기의 필요, 흉부 방사선상 양측성 폐 침윤 소견, 분당 호흡수, 쇼크의 유무, 혈중요소질소 및 알부민 농도 등을 비교 분석하였다. 결 과 : 남자가 2.07 : 1의 비율로 많았고 평균 연령은 $63.1{\pm}17.5$세(범위 : 25~90세)였으며 60세 이상이 65%로 다수를 차지하였다. 흡연자가 62.5%, 알콜중독자가 30%였고, 60%에서 기저질환이 발견되었으며 종류별로는 과거의 폐결핵 병변(12.5%), 만성 폐쇄성 폐질환(7.5%), 기관지 천식(5%), 기관지 확장증(2.5%), 당뇨병(22.5%) 등이었다. 가장 흔한 원인균은 S. Pneumoniae로 17.5%였으며 S. aureus 15%, K. pneumoniae 13.5%, Mycobacterium tuberculosis 7.5%였고 그 외에 coagulase negative staphylococcus, H. influenzae, P. aeruginosa, E. cloaceae, E. coli가 각각 2.5%씩 동정되어 65%의 동정율을 나타내었다. 단독 및 병용요법에서 흔히 사용된 항생제는 aminoglycoside계(75% : 30/40), 2세대 및 3세대 cephalosporin계(40% : 16/40, 27.5% : 11/40), macrolide계(27.5% : 11/4), amoxicillin/clavulanic acid(22.5% : 9/40)의 순이었다. 사망률은 37.5%였으며 사망환자의 50%가 입원후 72시간 내에 사망하였다. 예후에 영향을 미치는 인자로는 기계적 환기의 필요, 흉부 방사선 소견상 양측성 폐침윤, 혈중 알부민 농도의 저하(3.0g/dl 이하) 등이 통계적으로 유의한 차이를 보였다. 결 론 : 본 연구에서 나타난 중중 지역사회획득 폐렴의 임상적 특징과 예후인자를 바탕으로 적절한 항생제의 선택과 초기에 적극적인 진료로 치료성적을 향상시킬 것으로 기대된다.

• Journal of Yeungnam Medical Science
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• 제30권1호
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• pp.58-61
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• 2013

Enterovirus commonly causes neurologic diseases (aseptic meningitis, encephalitis, etc.), hand-foot-mouth disease, herpangina, and acute hemorrhagic conjunctivitis. However, it rarely causes pneumonia in immunocompetent adults. In Korea, no case has been reported about pneumonia caused by enterovirus in healthy adults. We can cite the case of a 20-year-old woman who presented severe community-acquired pneumonia caused by enterovirus. The diagnosis was based on reverse transcriptase polymerase chain reaction (RT-PCR) of a respiratory specimen.

• Tuberculosis and Respiratory Diseases
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• 제80권2호
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• pp.201-209
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• 2017

Background: Methicillin-resistant Staphylococcus aureus (MRSA) infection is a severe and life-threatening disease in patients with community-onset (CO) pneumonia. However, the current guidelines lack specificity for a screening test for MRSA infection. Methods: This study was retrospectively conducted in elderly patients aged ${\geq}65years$, who had contracted CO-pneumonia during hospitalization at the Jeju National University Hospital, between January 2012 and December 2014. We analyzed the risk factors of MRSA in these patients and developed a scoring system to predict MRSA infection. Results: A total of 762 patients were enrolled in this study, including 19 (2.4%) with MRSA infection. Healthcare-associated pneumonia (HCAP) showed more frequent MRSA infection compared to community-acquired pneumonia (4.4% vs. 1.5%, respectively; p=0.016). In a multivariate logistic regression analysis, admissions during the influenza season (odds ratio [OR], 2.896; 95% confidence interval [CI], 1.022-8.202; p=0.045), chronic kidney disease (OR, 3.555; 95% CI, 1.157-10.926; p=0.027), and intensive care unit admission (OR, 3.385; 95% CI, 1.035-11.075; p=0.044) were identified as predictive factors for MRSA infection. However, the presence of HCAP was not significantly associated with MRSA infection (OR, 1.991; 95% CI, 0.720-5.505; p=0.185). The scoring system consisted of three variables based on the multivariate analysis, and showed moderately accurate diagnostic prediction (area under curve, 0.790; 95% CI, 0.680-0.899; p<0.001). Conclusion: MRSA infection would be considered in elderly CO-pneumonia patients, with three risk factors identified herein. When managing elderly patients with pneumonia, clinicians might keep in mind that these risk factors are associated with MRSA infection, which may help in selecting appropriate antibiotics.

• Tuberculosis and Respiratory Diseases
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• 제72권2호
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• pp.149-155
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• 2012

Background: This study is to evaluate the effect of systemic corticosteroid on the clinical outcomes and the occurrence of complications in mechanical ventilated patients with severe community-acquired pneumonia (CAP). Methods: We retrospectively assessed the clinical outcomes and complications in patients with severe CAP admitted to ICU between March 1, 2003 and July 28, 2009. Outcomes were measured by hospital mortality after ICU admission, duration of mechanical ventilation (MV), ICU, and hospital stay. Complications such as ventilator associated pneumonia (VAP), catheter related-blood stream infection (CR-BSI), and upper gastrointestinal (UGI) bleeding during ICU stay were assessed. Results: Of the 93 patients, 36 patients received corticosteroids over 7 days while 57 patients did not receive corticosteroids. Age, underlying disease, APACHE II, PSI score, and use of vasopressor were not different between two groups. In-hospital mortality was 30.5% in the steroid group and 36.8% in the non-steroid group (p>0.05). The major complications such as VAP, CR-BSI and UGI bleeding was significantly higher in the steroid group than in the non-steroid group (19.4% vs. 7%, p<0.05). The use of steroids and the duration of ICU stay were significantly associated with the development of major complications during ones ICU stay (p<0.05). Conclusion: Systemic corticosteroid in patients with severe CAP requiring mechanical ventilation may have no beneficial effect on clinical outcomes like duration of ICU stay and in-hospital mortality but may contribute to the development of ICU acquired complications.

• Tuberculosis and Respiratory Diseases
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• 제74권2호
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• pp.51-55
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• 2013

Acute eosinophilic pneumonia is a severe and rapidly progressive lung disease that can cause fatal respiratory failure. Since this disease exhibits totally different clinical features to other eosinophilic lung diseases (ELD), it is not difficult to distinguish it among other ELDs. However, this can be similar to other diseases causing acute respiratory distress syndrome or severe community-acquired pneumonia, so the diagnosis can be delayed. The cause of this disease in the majority of patients is unknown, even though some cases may be caused by smoke, other patients inhaled dust or drugs. The diagnosis is established by bronchoalveolar lavage. Treatment with corticosteroids shows a rapid and dramatic positive response without recurrence.