Tigecycline Treatment for Infections Caused by Multidrug-Resistant Pathogens / 영남의대학술지

BACKGROUND: Tigecycline (TIG), a new broad-spectrum glycylcycline with anti-multidrug-resistant-(MDR)-pathogen activity, was launched in March 2009 in South Korea, but there are insufficient clinical studies on its use in the country. As such, this study was performed to analyze cases of severe MDR-pathogen-caused infections treated with TIG. METHODS: Patients treated with TIG within the period from May 2009 to June 2010 were enrolled in this study. Their clinical and microbiologic data were reviewed retrospectively. RESULTS: Twenty-one patients were treated with TIG for complicated skin and soft-tissue infections (cSSTIs) (42.9%), complicated intra-abdominal infections (cIAIs) (38.1%), or pneumonia (19.1%) caused by MDR pathogens like carbapenem-resistant Acinetobacter baumannii (76.2%), methicillin-resistant Staphylococcus aureus (61.9%), extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae (38.1%), and penicillin-resistant Enterococcus species (33.3%). Thirteen patients (61.9%) had successful clinical outcomes while five (23.8%) died within 30 days. The rate of clinical success was highest in cSSTI (77.8%), followed by cIAI (50%) and pneumonia (50%), and the mortality rate was highest in pneumonia (50%), followed by cIAI (25%) and cSSTI (11.1%). CONCLUSION: Tigecycline therapy can be an option for the treatment of severe MDR-pathogen-caused infections in South Korea. Due to its high risk of failure and mortality, however, prudence is required in its clinical use for the treatment of severe infections like nosocomial pneumonia.

Erratum: Author's Name Correction / 결핵및호흡기질환

No abstract available.

Usefulness of Serum Cortisol in Assessment for the Severity of Community-Acquired Pneumonia / 결핵및호흡기질환

BACKGROUND: High cortisol levels are frequently observed in patients with severe infections are of prognostic value in sepsis. The aim of this study was to evaluate the clinical usefulness of serum cortisol in assessment for the severity of community-acquired pneumonia (CAP). METHODS: This study analyzed the results of 52 CAP subjects admitted in Changwon Fatima Hospital between July 2008 to May 2010. Total serum cortisol, infection markers such as C-reactive protein (CRP), procalcitonin (PCT) and CURB (Confusion, Uremia, Respiratory rate, Blood pressure)-65 were examined retrospectively. RESULTS: In clinically unstable subjects on admission day 4, baseline serum cortisol, CURB-65, and CRP were elevated significantly compared to those of stable subjects. Area under curve (AUC) of cortisol, CRP, and CURB-65 from ROC curves were 0.847, 0.783, and 0.724 respectively. In the subjects with serum cortisol > or =22.82 microg/dL, CRP, PCT, CURB-65 score, and mortality were significantly elevated. CONCLUSION: These findings suggest that measurement of serum cortisol in early stage may provide helpful information in the assessment of CAP severity.

A Case of Pulmonary and Endobronchial Mycobacterium avium Infection Presenting as an Acute Pneumonia in an Immunocompetent Patient / 결핵및호흡기질환

The global number of Mycobacterium avium complex (MAC) pulmonary infection is increasing. Patients with preexisting lung disease or who are immunodeficient are at the greatest risk for developing MAC infection. Endobronchial lesions with MAC infection are rare in the immunocompetent host. However, there have been an increasing number of reports of an immunocompetent host being afflicted with various manifestations of MAC infection. We report a case of pulmonary and endobronchial MAC infection presenting as an acute pneumonia in a 59-year-old female without preexisting lung disease or immunodeficiency.

Recovery Rate of Nontuberculous Mycobacteria and the Clinical Course of Nontuberculous Mycobacterial Pulmonary Disease at a Secondary Hospital / 결핵및호흡기질환

BACKGROUND: To examine the recovery rate of nontuberculous mycobacteria (NTM) from respiratory specimens and the clinical course of NTM pulmonary disease at a 700-bed secondary hospital. METHODS: This study analyzed the results of 843 acid-fast bacilli (AFB) culture-positive respiratory specimens from 650 subjects collected between May 2003 and April 2008. In addition, the clinical course of NTM pulmonary disease, diagnosed using criteria established by the American Thoracic Society, was examined. RESULTS: There were 67 (7.9%) NTM isolates recovered from 52 (8.0%) subjects. Among the 535 AFB smear-positive specimens, 34 (6.3%) NTM isolates were recovered. There were 33 (10.7%) NTM isolates were recovered from 308 AFB smear-negative specimens. Of 52 subjects with isolated NTM, M. intracellulare was the most common species at 73.1% (n=33), followed by M. kansassi (n=7), M. abscessus (n=2), M. fortuitum (n=2), and M. avium (n=1). Sixteen (30.8%) patients had NTM pulmonary disease and the most common causative organism was M. intracellulare (n=14, 87.5%). Of these, 6 cases attained negative conversion in culture, 4 cases failed to attain negative conversion because of poor cooperation or expiration from complicated underlying lung disease, and 5 cases were transferred to a higher-grade hospital. CONCLUSION: The recovery rate of NTM from respiratory specimens was relatively low and the most common species was M. intracellulare. Patients with NTM pulmonary disease showed variable clinical outcomes.