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김덕희,구현경,박혜경,정훈,이성순,강형구 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-
Object: The use of appropriate antibiotics in patients admitted to intensive care units (ICUs) is the cornerstone of treatment of pneumonia. Although the Infectious Disease Society of America (IDSA) and the American Thoracic Society (ATS) guidelines recommend that empirical treatment regimens be based on the local distribution of pathogens in patients with suspected hospital acquired pneumonia (HAP), there are no known studies about clinical significance of patients admitted to ICUs with pneumonia in long term care hospitals (LTCHs). Methods: We performed a retrospective cohort study of 74 patients with pneumonia admitted to a ICU via emergency department between February 2015 and March 2016. 40 patients (54%) with HAP in LTCHs and 24 patients (32.4%) with community acquired pneumonia were evaluated. Results: Among 40 patients with HAP in LTCHs, 27 patents (67.5%) were successfully treated. In patients with HAP in LTCH compared with CAP, the use of antibiotics within 3 months was not significantly different. (35% vs 16.7%, p = 0.155). However, Methicillin-resistant staphylococcus aureus (MRSA) (32.5% vs 8.3%, p = 0.04) and multidrug-resist (MDR) organism including MRSA were found more frequently in patients with HAP in LTCH. (70% vs 20.8%, p = 0,02) Conclusion: MDR pathogens including MRSA should be considered for using empirical antibiotics in patients admitted to ICUs with HAP in LTCH
Prognostic Value of Procalcitonin in Pneumonia among Patients Admitted to Intensive Care Unit.
김덕희,정해원,강형구 고신대학교(의대) 고신대학교 의과대학 학술지 2019 고신대학교 의과대학 학술지 Vol.34 No.1
Objectives: Pneumonia is one of the leading causes of death in the intensive care unit (ICU). Many biomarkers for predicted prognosis have been suggested; among these, procalcitonin (PCT) is known to increase in cases of bacterial infection. However, there have been many debates regarding whether PCT is an appropriate prognostic marker for pneumonia. Therefore, we investigated whether PCT can serve as a biomarker for pneumonia, and compared it with CURB-65, which is a known tool for predicting the prognosis of pneumonia. Methods: Levels of PCT and CURB-65 scores were compared between 30-day non-survival (n = 30) and survival (n = 101) patients. Relationships between PCT and CURB-65 were determined by using linear regression analysis, as well as by using receiver operating characteristic (ROC) curve analysis and calculation of the area under the curve (AUC). High and low PCT groups were compared. Results: High PCT and high CURB-65 score were positively associated with 30-day mortality. For the prediction of 30-day mortality, initial PCT and CURB-65 exhibited AUCs of 0.63 and 0.66; these were not significantly different ( P = 0.132). We found that the high PCT group had a higher rate of initial treatment failure (91%, P = 0.004). Conclusions: Initial PCT can be a prognostic biomarker for mortality in severe pneumonia, similar to the CURB-65 score. Initial high PCT was positively associated with initial treatment failure.