• Title/Summary/Keyword: Community-Acquired Pneumonia

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Reasons and Risk Factors for Readmission Following Hospitalization for Community-acquired Pneumonia in South Korea

  • Jang, Jong Geol;Ahn, June Hong
    • Tuberculosis and Respiratory Diseases
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    • v.83 no.2
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    • pp.147-156
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    • 2020
  • Background: Limited studies have been performed to assess readmission following hospitalization for community-acquired pneumonia (CAP) in an Asian population. We evaluated the rates, reasons, and risk factors for 30-day readmission following hospitalization for CAP in the general adult population of Korea. Methods: We performed a retrospective observational study of 1,021 patients with CAP hospitalized at Yeungnam University from March 2012 to February 2014. The primary end point was all-cause hospital readmission within 30 days following discharge after the initial hospitalization. Hospital readmission was classified as pneumonia-related or pneumonia-unrelated readmission. Results: During the study period, 862 patients who survived to hospital discharge were eligible for inclusion and among them 72 (8.4%) were rehospitalized within 30 days. In the multivariable analysis, pneumonia-related readmission was associated with para/hemiplegia, malignancy, pneumonia severity index class ≥4 and clinical instability ≥1 at hospital discharge. Comorbidities such as chronic lung disease and chronic kidney disease, treatment failure, and decompensation of comorbidities were associated with the pneumonia-unrelated 30-day readmission rate. Conclusion: Rehospitalizations within 30 days following discharge were frequent among patients with CAP. The risk factors for pneumonia-related and -unrelated readmission were different. Aspiration prevention, discharge at the optimal time, and close monitoring of comorbidities may reduce the frequency of readmission among patients with CAP.

Respiratory Review of 2012: Pneumonia

  • Yoon, Young-Soon
    • Tuberculosis and Respiratory Diseases
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    • v.73 no.2
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    • pp.77-83
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    • 2012
  • Pneumonia is the cause of significant morbidity and mortality, despite advances in diagnosis and antibacterial treatment. Pneumonia is often misdiagnosed and mistreated up until recently. Recent classification of pneumonia consists of community-acquired pneumonia, health care-associated pneumonia, hospital-acquired pneumonia, and ventilator-associated pneumonia. The etiology, risk factors, and treatment are different among them. This article briefly introduces new concepts and ideas in biomarkers, diagnosis, treatment, prognosis, and prevention of pneumonia during the past 2 years. One of the most frequent subjects of recent papers was those about pandemic H1N1 in 2009.

Comparison of Antibiotic Regimens for the Treatment of Community Acquired Pneumonia (원외획득 폐렴 환자치료에서 항생제 regimen 별 효능비교)

  • Moon, Hong-Seop;Choe, In;Lee, Seung-Il
    • Korean Journal of Clinical Pharmacy
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    • v.16 no.2
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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.

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Clinical Implications of Drug-Resistant $Streptococcus$ $pneumoniae$ as a Cause of Community Acquired Pneumonia (폐렴원인균으로서 약제내성 폐렴사슬알균 ($Drug-resistant$ $Streptococcus$ $pneumoniae$)의 현황과 임상적 의미)

  • Shin, Kyeong-Cheol
    • Journal of Yeungnam Medical Science
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    • v.28 no.1
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    • pp.13-19
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    • 2011
  • The emergence of antibiotic-resistant pathogens is a Serious clinical problem in the treatment of infectious diseases that increase mortality, morbidity, hospitalization length, and the cost of healthcare. In particular, $Streptococcus$ $pneumoniae$ is a major etiologic pathogen of pneumonia, sinusitis, otitis media, and meningitis. As the definition of penicillin resistance to $S.$ $pneumoniae$ was recently changed, macrolide-resistant $S.$ $pneumoniae$ is a major resistant pathogen in the community. Infections caused by antibiotic-resistant strains are associated with incorrect use of antibiotics and critical clinical outcomes. For the appropriate use of antibiotics to treat infections, physicians always should have up-to-date information on the current epidemiologic status of antibiotic resistance for common pathogens and their susceptibility to antimicrobials. Appropriate selection of antimicrobials, strict control of infection, vaccination, and development of a feasible national policy of infection control are important strategies for the control of antimicrobial resistance. This review article focuses on the current status of antibiotic-resistant $S.$ $pneumoniae$ in community-acquired pneumonia in Korea.

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A study on analysis of factors on in-hospital mortality for community-acquired pneumonia (지역사회획득 폐렴 환자의 퇴원시 사망 요인 분석)

  • Kim, Yoo-Mi
    • Journal of the Korean Data and Information Science Society
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    • v.22 no.3
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    • pp.389-400
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    • 2011
  • This study was carried out to analysis factors related to in-hospital mortality of community-acquired peumonia using administrative database. The subjects were 5,353 community-acquired pneumonia inpatients of the Korean National Hospital Discharge Injury Survey 2004-2006 data. The data were analyzed using chi-squared test and decision tree model in the data mining technique. Among the decision tree model, C4.5 had the best performance. The critical factors on in-hospital mortality of communityacquired pneumonia are admission route, respiratory failure, congenital heart failure including age, comorbidity, and bed size. This study was carried out using the administrative database including patients' characteristics and comorbidity. However further study should be extensively including hospital characteristics, regional medical resources, and patient management practice behavior.

Predictive Factors of Methicillin-Resistant Staphylococcus aureus Infection in Elderly Patients with Community-Onset Pneumonia

  • Jwa, Hyeyoung;Beom, Jong Wook;Lee, Jong Hoo
    • Tuberculosis and Respiratory Diseases
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    • v.80 no.2
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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.

A Study of Mycoplasmal Pneumonia developed around a Chunnam Coastal Area in 1993 (1993년 전남의 한 해안지역에서 발생한 Mycoplasmal 폐렴에 대한 고찰)

  • Byun, Joo-Nam;Yang, Eun-Suck
    • Journal of agricultural medicine and community health
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    • v.18 no.2
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    • pp.161-171
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    • 1993
  • Mycoplasma pneumoniae(M. pneumoniae) is a primary pathogene of the respiratory tract in children. Most studies of such pneumonia involve a group of admitted patients in hospital, usually with major medical illness. We retrospectively studied the epidemiologic and clinical feature of 105 patients with serologically proven M. pneumoigic pneumonia treated at Gwang-Yang Hospital during a epidemic period of Jun. 1993 to Dec. 1993. All cases of pneumonia developed in this period were also reviewed and compared with serologically proven group. The results were as follows. 1. There were 63 males and 42 females, and the male /female ratio was 1.5 : 1. 2. More than half(57%) of cases belonged to 5-9 years of age group, and mean age was 6.5 years old. 3. Mean age was steadily decreased as prevalence of mycoplasmal pneumonia had been subsided. 4. The date of index case was June 26th, and that of median case was 3 months after the index case. 5. A major determinant of the outbreak seemed to be the population density rather than the population size. 6. Recurrence and serious complication were not observed in this period. 7. All cases of pneumonia developed in this period might be attributed to M. pnemoniae. These epidemiologic and clinical characteristics would contribute to the prevention and diagnosis of mycoplasmal pneumonia.

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Usefulness of Procalcitonin in the Assessing the Severity of Community-Acquired Pneumonia Patient (지역사회획득폐렴 환자의 중증도 평가에서 Procalcitonin 유용성)

  • Park, Hun-Pyo;Lee, Jung-Soo;Jang, Ye-Su;Kim, Min-Su
    • Tuberculosis and Respiratory Diseases
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    • v.67 no.5
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    • pp.430-435
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    • 2009
  • Background: Thus far, research studies on community-acquired pneumonia (CAP) have focused on its clinical severity. Recently, it has been determined that procalcitonin (PCT) level is correlated with severity of CAP. A retrospective study conducted at our hospital used risk predictability and PCT to determine whether or no PCT is useful in assessing the severity of CAP. Methods: This study covered 92 CAP cases that were admitted to the respiratory department at Changwon Fatima Hospital between July 1, 2008 and June 30, 2009. All enrolled subjects were measured for infection markers and risk predictability. Results: Based on hospital admission data, enrolled subjects had Pneumonia Severity Index (PSI) scores serving as risk predictors showed that both PCT and white blood cell (WBC) were statistically significant as infection markers (p=0.001, 0.037). Thus, this study used ROC curves in PSI for data analysis. As a result, it was determined that the area under curve (AUC) of PCT and WBC was 0.694 and 0.593 respectively, indicating that PCT has a higher test value for WBC, when PCT was higher than 0.745 ng/mL. In addition, it was found that PCT levels higher than 0.745 ng/mL had higher PSI scores than the group with PCT lower than 0.745 ng/mL (p=0.032). Conclusion: In order to predict risk of pneumonia cases admitted due to symptoms of CAP, it is important to consider PCT as well as PSI, and follow-up monitoring of PCT cases.

A Study on analysis of severity-adjustment length of stay in hospital for community-acquired pneumonia (지역사회획득 폐렴 환자의 중증도 보정 재원일수 분석)

  • Kim, Yoo-Mi;Choi, Yun-Kyoung;Kang, Sung-Hong;Kim, Won-Joong
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.12 no.3
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    • pp.1234-1243
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    • 2011
  • Our study was carried out to develop the severity-adjustment model for length of stay in hospital for community-acquired pneumonia so that we analysed the factors on the variation in length of stay(LOS). The subjects were 5,353 community-acquired pneumonia inpatients of the Korean National Hospital Discharge In-depth Injury Survey data from 2004 through 2006. The data were analyzed using t-test and ANOVA and the severity-adjustment model was developed using data mining technique. There are differences according to gender, age, type of insurance, type of admission, but there is no difference of whether patients died in hospital. After yielding the standardized value of the difference between crude and expected length of stay, we analysed the variation of length of stay for community-acquired pneumonia. There was variation of LOS in regional differences and insurance type, though there was no variation according whether patients receive their care in their residences. The variation of length of stay controlling the case mix or severity of illness can be explained the factors of provider. This supply factors in LOS variations should be more studied for individual practice style or patient management practices and healthcare resources or environment. We expect that the severity-adjustment model using administrative databases should be more adapted in other diseases in practical.

Treatment Guidelines for Community-acquired Pneumonia in Korea: An Evidence-based Approach to Appropriate Antimicrobial Therapy (지역사회획득 폐렴의 치료지침 권고안)

  • Song, Jae-Hoon;Jung, Ki-Suck;Kang, Moon Won;Kim, Do Jin;Pai, Hyunjoo;Suh, Gee Young;Shim, Tae Sun;Ahn, Joong Hyun;Ahn, Chul Min;Woo, Jun Hee;Lee, Nam Yong;Lee, Dong-Gun;Lee, Mi Suk;Lee, Sang Moo;Lee, Yeong Seon;Lee, Hyukmin;Chung, Doo Ryeon
    • Tuberculosis and Respiratory Diseases
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    • v.67 no.4
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    • pp.281-302
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    • 2009
  • The successful treatment of community-acquired pneumonia requires appropriate, empirical antimicrobial therapy. The etiology and antimicrobial susceptibility of major pneumonia pathogens can differ by country. Therefore, the ideal treatment guidelines for community-acquired pneumonia should be based on the studies performed in each country. We developed a treatment guideline for community-acquired pneumonia for immunocompetent adults in Korea. This guideline was developed by the joint committee of the Korean Society for Chemotherapy, the Korean Society of Infectious Diseases, and the Korean Academy of Tuberculosis and Respiratory diseases.