The clinical and microbial characteristics of healthcare-associated pneumonia / 대한내과학회지

BACKGROUND/AIMS: Healthcare-associated pneumonia (HCAP) occurs outside hospitals, but its characteristics are similar to those of hospital-acquired pneumonia (HAP). We evaluated the clinical and microbial characteristics of HCAP in Korea. METHODS: Of 130 subjects with suspected pneumonia, 49 were classified as HCAP and 81 as HAP. We retrospectively examined the clinical presentations, outcomes, pathogens, and drug resistance rates of Pseudomonas aeruginosae in both groups. RESULTS: The clinical presentations, including the symptoms and laboratory findings, at the time of hospitalization were comparable in both groups. The hospital mortalities of HCAP (28.6%) and HAP (34.6%) did not differ significantly; the length of the hospital stay was similar for all of the survivors (14 vs. 17 days, respectively). Of the identified pathogens, methicillin-resistant Staphylococcus aureus was significantly less common in HCAP than in HAP (two vs. 18 cases, respectively, p<0.01), whereas Klebsiella pneumoniae was more common in HCAP (five vs. zero cases, respectively, p<0.01). The frequency of other Gram-negative rods was similar in both groups. The rate of resistance to antibiotics in P. aeruginosae in both groups was substantial, with the highest resistant rate to ciprofloxacin (50% and 61.5% in HCAP and HAP, respectively). CONCLUSIONS: Although the clinical features and outcomes of HCAP were comparable to those of HAP in the study population, the frequency of methicillin-resistant S. aureus was significantly lower in HCAP compared to HAP.

Comparisons of Clinical Characteristics and Outcomes in COPD Patients Hospitalized with Community-acquired Pneumonia and Acute Exacerbation / 결핵및호흡기질환

BACKGROUND: Data comparing the clinical characteristics and outcomes in chronic obstructive pulmonary disease (COPD) patients hospitalized with community-acquired pneumonia (CAP-COPD) and acute exacerbation (AE-COPD) are very limited. METHODS: Eighty episodes of hospitalization in 65 CAP-COPD patients, and 111 episodes of hospitalization in 82 AE-COPD patients were included in this study. The baseline characteristics, clinical presentations, potential bacterial pathogens and clinical outcomes in these patients were retrospectively reviewed and compared. RESULTS: No significant differences were found between the two groups in parameters related to COPD and co-morbidities, except a higher rate of male among CAP-COPD patients. Clinical presentations by symptoms and laboratory findings on admission were significantly more severe in CAP-COPD patients, who showed higher rates of fever and crepitation, but less wheezing than AE-COPD patients. S. pneumoniae and P. aeruginosae were the most common bacterial pathogens in both groups. With no difference in the overall hospital mortality between both groups, the mean length of hospital stay was significantly longer in the CAP-COPD patients than in AE-COPD patients (15.3 vs. 9.8 days, respectively, p<0.01). Additional analysis on CAP-COPD patients showed that systemic steroid use did not influence the length of hospital stay. CONCLUSION: Although there was no significant difference in bacterial pathogens and overall hospital mortality between the two groups, CAP-COPD patients had more severe clinical symptoms and laboratory findings at presentation, and longer hospital stay than AE-COPD patients.

Comparisons of Clinical Characteristics and Outcomes in COPD Patients Hospitalized with Community-acquired Pneumonia and Acute Exacerbation / 결핵및호흡기질환

BACKGROUND: Data comparing the clinical characteristics and outcomes in chronic obstructive pulmonary disease (COPD) patients hospitalized with community-acquired pneumonia (CAP-COPD) and acute exacerbation (AE-COPD) are very limited. METHODS: Eighty episodes of hospitalization in 65 CAP-COPD patients, and 111 episodes of hospitalization in 82 AE-COPD patients were included in this study. The baseline characteristics, clinical presentations, potential bacterial pathogens and clinical outcomes in these patients were retrospectively reviewed and compared. RESULTS: No significant differences were found between the two groups in parameters related to COPD and co-morbidities, except a higher rate of male among CAP-COPD patients. Clinical presentations by symptoms and laboratory findings on admission were significantly more severe in CAP-COPD patients, who showed higher rates of fever and crepitation, but less wheezing than AE-COPD patients. S. pneumoniae and P. aeruginosae were the most common bacterial pathogens in both groups. With no difference in the overall hospital mortality between both groups, the mean length of hospital stay was significantly longer in the CAP-COPD patients than in AE-COPD patients (15.3 vs. 9.8 days, respectively, p<0.01). Additional analysis on CAP-COPD patients showed that systemic steroid use did not influence the length of hospital stay. CONCLUSION: Although there was no significant difference in bacterial pathogens and overall hospital mortality between the two groups, CAP-COPD patients had more severe clinical symptoms and laboratory findings at presentation, and longer hospital stay than AE-COPD patients.

A Case of Hot Tub Lung / 결핵및호흡기질환

Hot tub lung is a lung disorder associated with exposure to hot tub water contaminated with Mycobacterium avium complex (MAC). Although its pathogenesis remains unclear, it may be considered hypersensitivity pneumonitis (HP) rather than an infectious disease. We report a case which fulfilled the current diagnostic criteria of hot tub lung. A patient had worked as a cleaner in the public bath for approximately one year and presented with dyspnea for over one month. The computed tomographic finding of bilateral ground glass attenuation and pathologic finding of granulomatous inflammation were consistent with HP. MAC was isolated from bronchoalveolar lavage fluid and hot tub water. After corticosteroid treatment without antimycobacterial medication, the patient improved and there has been no recurrence. The patient has since discontinued working in the public bath.