Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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The Etiologic Agents and Clinical Outcomes of Adult Community-acquired Pneumonia in Jeju

제주지역 성인 지역사회획득 폐렴의 원인균 및 임상양상

  • Jeon, Bong-Hee (School of Medicine, Jeju National University) ;
  • Kim, Miok (Department of Internal Medicine, Jeju National University) ;
  • Kim, Jeong Hong (Department of Otorhinolaryngology, Jeju National University) ;
  • Shin, Sang Yop (Department of Internal Medicine, Jeju National University) ;
  • Lee, Jaechun (Department of Internal Medicine, Jeju National University)
  • 전봉희 (제주대학교 의학전문대학원) ;
  • 김미옥 (제주대학교 내과학교실) ;
  • 김정홍 (제주대학교 이비인후과학교실) ;
  • 신상엽 (제주대학교 내과학교실) ;
  • 이재천 (제주대학교 내과학교실)
  • Received : 2008.10.13
  • Accepted : 2008.11.11
  • Published : 2009.05.30
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Abstract

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.

연구배경: 폐렴의 치료는 해당 지역사회의 역학 자료, 항생제에 대한 감수성, 임상양상 등에 따라 적절한 항생제를 선택하는 것이 중요하다. 한반도 남단의 섬지역인 제주지역에서 이와 같은 연구가 시행된 바가 없다. 제주 지역에서 발생한 지역사회 획득 폐렴의 임상양상과 원인균을 전향적으로 조사하여, 향후 적절한 항생제를 선택할 수 있는 자료로 활용하고자 연구를 시행하였다. 방 법: 임상양상으로 지역사회획득폐렴을 진단 받은 환자를 대상으로 전향적으로 원인균 동정을 위해 객담 도말 및 배양검사, Streptococcus pneumoniae, Legionella 등 항원검사, Mycoplasma, Chlamydia 등에 대한 항체검사를 시행하였다. 진단 당시의 임상 양상, 검사실 자료, 초기 경험적 항생제 치료의 실패 여부 등을 분석하였다. 결 과: 203명(평균 64세)의 지역사회 획득 폐렴 환자로부터 10균주의 원인균(90명, 동정률 44.3%)이 동정되었다. 30명(33.3%)에서 두 개 이상의 세균이 동정된 다세균 감염이었다. S. pneumoniae, M. pneumoniae, C. pneumoniae, S. aureus, P. aeruginosa 등의 순으로 동정되었다. 초기 치료 실패로 항균제를 변경한 예가 약 1/4이었으며, 다세균 감염, 흉수, 높은 염증반응수치 등이 초기 치료실패의 위험요인이었다. 환자들로부터 분리된 30균주의 S. pneumoniae에서 penicillin (53.3%), macrolides (66.3%) 등에 대해 항생제 비감수성을 보였으며, levofloxacin과 ceftriaxone에 대해서는 항생제 감수성을 보였다. 결 론: 제주지역 지역사회획득 폐렴의 원인균은 S. pneumoniae이 가장 흔하고, M. pneumoniae, C. pneumoniae, S. aureus, 그람음성간균 등의 순이다. 초기 항생제 치료시 항생제 내성을 고려하여 약제를 선택해야 하며, 초기 치료 실패가 높은 임상양상에 주의를 요한다. 제주지역 지역사회획득 폐렴의 치료로 2-3세대 세팔로스포린 또는 호흡기계 퀴놀론 등을 초기 경험적 항생제로 추천한다.

Keywords

References

  1. Chung MH, Shin WS, Kim YR, Kang MW, Kim MJ, Jung HJ, et al. Etiology of community-acquired pneumonia surveyed by 7 university hospitals. Korean J Infect Dis 1997;29:339-59
  2. Woo JH, Kang JM, Kim YS, Shin WS, Ryu JH, Choi JH, et al. A prospective multicenter study of community-acquired pneumonia in adults with emphasis on bacterial etiology. Korean J Infect Dis 2001;33:1-7
  3. Yoon JH, Lee DC, Lee HS, Lee CH, Kim BH, Kim JW. A clinical investigation of community-acquired pneumonia in Mokpo area. Tuberc Respir Dis 2001;51:17-24 https://doi.org/10.4046/trd.2001.51.1.17
  4. Song JH, Oh WS, Kang CI, Chung DR, Peck KR, Ko KS, et al. Epidemiology and clinical outcomes of community- acquired pneumonia in adult patients in Asian countries: a prospective study by the Asian network for surveillance of resistant pathogens. Int J Antimicrob Agents 2008;31:107-14 https://doi.org/10.1016/j.ijantimicag.2007.09.014
  5. Sohn JW, Park SC, Choi YH, Woo HJ, Cho YK, Lee JS, et al. Atypical pathogens as etiologic agents in hospitalized patients with community-acquired pneumonia in Korea: a prospective multi-center study. J Korean Med Sci 2006;21:602-7 https://doi.org/10.3346/jkms.2006.21.4.602
  6. Lionel AM, Richard W. Chapter 251. Pneumonia. In: Anthony SF, Eugene B, Dennis LK, Stephen LH, Dan LL, Larry J, Joseph L, editors. Harrison's principles of internal medicine. 17th ed. New York: McGraw-Hill Co, Inc.; 2007. p. 1620
  7. Hyun JC, Yoon HJ, Nam JH, Moon MS, Cho YK, Woo JH, et al. A prospective multicenter study on the etiological analysis of community-acquired pneumonia in adult patients in Korea: detection of Mycoplasma pneumoniae and Chlamydia pneumoniae Infections. Korean J Infect Dis 2001;33:15-24
  8. Lee SJ, Lee MG, Jeon MJ, Jung KS, Lee HK, Kishimoto T. Atypical pathogens in adult patients admitted with community-acquired pneumonia in Korea. Jpn J Infect Dis 2002;55:157-9
  9. Kim JH, Kwak YH, Na BK, Lee JY, Shin GC, Jung HS, et al. Viral etiology of community-acquired pneumonia in Korean adults. Korean J Infect Dis 2001;33:8-14
  10. Kim MJ, Cheong HJ, Sohn JW, Shim HS, Park DW, Park SC, et al. A prospective multicenter study of the etiological analysis in adults with community-acquired pneumonia: Legionella, Leptospira, Hantaan virus and Orientia tsutsugamushi. Korean J Infect Dis 2001;33:24-31
  11. Porath A, Schlaeffer F, Lieberman D. The epidemiology of community-acquired pneumonia among hospitalized adults. J Infect 1997;34:41-8 https://doi.org/10.1016/S0163-4453(97)80008-4
  12. Falguera M, Nogues A, Ruiz-Gonzalez A, Garcia M, Puig T. Detection of Mycoplasma pneumoniae by polymerase chain reaction in lung aspirates from patients with community-acquired pneumonia. Chest 1996;110:972-6 https://doi.org/10.1378/chest.110.4.972
  13. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44 Suppl 2:S27-72 https://doi.org/10.1086/511159

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