The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 437
Slide Session
OS-100 Critical Care
Prevalence of Multi-Drug Resistant Organism
Colonization with Pulmonary Tuberculosis in Critically Ill Patients
Eun Sun Kim1, Eun Young Heo2, Deog Kyeom Kim2, Hee Soon Chung2, Sung Soo Park2 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Korea1, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Korea2 Background: Pulmonary tuberculosis (TB) is different from bacterial pneumonia in terms of patient demographic characteristics, use of antimicrobial agents, and treat- ment environment such as air-borne precaution and isolation. We hypothesized that the prevalence of multi-drug resistant organisms (MDRO) might be different in patients with TB from that of community acquired pneumonia (CAP) among critically ill patients.
Methods: All TB or CAP patients admitted to the intensive care unit (ICU) of the hos- pital in Korea from January 2009 to July 2014 were included. Patients were excluded from the study if there was a prior history of MDRO, hospitalization for =2 days in the preceding 90 days, or antimicrobial therapy in the preceding 30 days. The patients ad- mitted ICU due to other than respiratory failure were also excluded.
Results: 26 TB patients and 43 CAP patients were included in the study. Compared with CAP group, the TB group was younger and had less comorbidities. Duration of delay to ICU admission and/or initiation of effective medication were longer in patients with TB.
The prevalence of MDRO colonization was not different in both groups (26.9% in TB group and 27.9% in CAP group) and multi-drug resistant Acinetobacter baumanii was the most frequently isolated MDRO (21.7%). The rate of ventilator associated pneu- monia (VAP) in TB group (23.1%) was also similar to that of CAP group (16.3%). The proportion of ARDS and multi-organ failure were higher in patients with TB. 18 (69.2%) and 15 (34.9%) patients were dead in TB and CAP group, respectively.
Conclusions: The prognosis of patients with TB requiring intensive care was worse than the patients with severe CAP in ICU. However, the prevalence of MDRO colonization and rate of VAP were not different in both group of patients.
OS-101 Critical Care
Comparison of Clinical Outcomes Between Patients Initiated with Peramivir and those with Osteltamivir Hospitalized to Intensive Care Unit Due to Severe Infl uenza Infection
Jung-Wan Yoo1, Sang-Ho Choi2, Jin Won Huh1, Chae-Man Lim1, Younsuck Koh1, Sang- Bum Hong1
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, Korea1, Department of Infectious Diseases, Asan Medical Center, Korea2
Background: Peramivir, intravenous neuraminidase inhibitor, is available to treat in- fl uenza in hospitalized patients in South Korea. Whether it provides clinical benefi ts to the critically ill patients with severe infl uenza infection admitted to intensitve care unit (ICU)compared to oral oseltamivir remains unclear.
Methods: From August 2009 through March 2014, Patients = 18 confi rmed with lab- oratory evidence of infl uenza infection and hospitalized to medical ICU more than 24 hours were enrolled at Asan Medical Center. Study was performed retrospectively Results: Ninety six patients were enrolled; 38 and 58 received peramivir and oseltam- ivir initially, respectively. SOFA score was higher in patients initiated with peramivir.
More clinical complications including shock (68.4 vs 44.8%), acute kidney injury (44.7 vs 22.4%) and hospital acquired pneumonia (47.4 vs 27.6%) developed in patients receiving peramivir initially. There was no difference of median duration of use of an- tiviral agents between two groups (10 days in both groups). More triple combination antiviral agents were prescribed in patients initiated with oseltamivir (36.2 vs 7.9%, P=0.002) while more vasopressors (78.9 vs 44.8%, P=0.001) was used in those initi- ated with peramivir. There were no signifi cant differences including median length of ICU (20.5 in peramivir vs 17 days in oseltamivir, P=0.284) and 28-day mortality (36.8%
[14/38] in peramivir vs 34.5% [20/58] in oseltamivir, P=0.813). Acute heart failure (Odds ratio [OR] 3.668, 95% Confi dence Interval [CI], 1.134-11.870, P=0.03), hospital ac- quired pneumonia (OR 4.197, 95% CI, 1.578-11.161, P=0.004) and use of corticosteroid (OR 3.022, 95% CI, 1.169-7.812, P=0.022) were associated with 28-day mortality.
Conclusions: Peramivir may be an optional antiviral agent to treat the critically ill pa- tients with severe infl uenza infection and hospitalized to ICU.
OS-102 Critical Care
Factors Infl uencing Medical ICU Admission of Elderly Patients
Junghyun Kim1,2, Sun Mi Choi1,2, Young Sik Park1,2, Chang-Hoon Lee1,2, Sang-Min Lee1,2, Jae-Joon Yim1,2, Chul-Gyu Yoo1,2, Young Whan Kim1,2, Sung Koo Han1,2, Jin-Woo Lee1,2 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Korea1, Department of Internal Medicine, Seoul National University College of Medicine, Korea2 Background: The number of elderly patients admitted to the ICU is growing, along with the increasing proportion of the elderly in the general population. However, de- termining appropriate levels of care in these populations remains a challenge. The aim of this study to identify factors which infl uence the decision whether or not to receive intensive care in elderly patients.
Methods: Elderly patients over 80 year-old who were admitted to general internal medicine wards and referred for ICU admission between January 2013 and April 2014 were retrospectively reviewed.
Results: Among the 84 referred patients, 32 patients were fi nally admitted to ICU.
About 64.3% of the patients were female and the mean age was 85.9 years. Baseline characteristics at the time of ICU referral were not different between the intensive care group and no intensive care group. None of the patients in both groups had advance directives before ICU referral. Factors including self-reported economic sta- tus, comorbidity of chronic lung diseases, cognition impairment, and the number of participants of DNR decision showed signifi cant difference in univariate analysis. After multivariate analysis, cognitive impairment was associated with decreased risk of ICU admission (OR 0.08; 95% CI 0.02-0.41) and increased number of family members participating in the decision making process was associated with increased risk of ICU admission (OR 3.16, 95% CI 1.03-9.66). Mean duration of hospital stay was longer in intensive care group (38.0 days) compared with no intensive care group (20.6 days) (p=0.02). However, there was no difference in hospital deaths (intensive care group 86.5% vs. no intensive care group 68.8%).
Conclusions: This study showed that in elders, patients with intact cognition or large number of family members participating in the decision making process, were more likely to be admitted to the ICU from general ward.
OS-103 Critical Care
Clinical Characteristics and Outcomes of Very Elderly Critically Ill Patients in a Medical Intensive Care Unit of a Single Tertiary Hospital in Korea
Seung Hun Lee1, Tae Won Lee1, Wan Chul Kim1, Sunmi Ju1, Seung Jun Lee1, Yu Ju Cho1, Yi Yeong Jeong1, Jong Doeg Lee1, Young Sil Hwang1, Ho Cheol Kim1
Gyeongsang National University Hospital, Korea1
Background: This study evaluated clinical characteristics and outcomes in very elderly (=80 years of age) critically ill patients admitted to a medical intensive care unit (ICU) in a regional single tertiary hospital.
Method: We retrospectively evaluated prospectively collected data in the medical ICU of Gyeongsang University Hospital in Korea for the period of December 2011 to May 2014. Patients were divided into =80 and <80 years of age and clinical characteristics and outcomes were compared among these patients.
Results: A total of 468 patients were evaluated and 102 patients (21.7%) were =80 years of age. Overall mortality was 38.5% in the ICU and 44.7% in the hospital. There was no signifi cant difference in ICU and in-hospital mortalities between those =80 years and those <80 years (34.9% vs. 39.5% for ICU mortality, 40.6% vs. 45.9% for in-hospital mortality). In addition, early (<48 h) ICU mortality was not signifi cantly dif- ferent between patients =80 years and patients <80 years (39.4% vs. 53.9%). Lengths of ICU and hospital stays were signifi cantly longer in patients <80 years compared to patients =80 years (10.57 ± 19.96 days vs. 8.19 ± 8.78 days for ICU stay; 27.95 ± 39.62 vs. 18.17 ± 15.44 days for hospital stay). The extubation failure rate was not signifi cantly higher in the =80 years group compared to the <80 years group (28.4%
vs. 24.5%). The rate of withholding intensive care was signifi cantly higher in patients
=80 years compared to patients <80 years (22.9% vs. 11.8%).
Conclusion: Clinical outcomes were not signifi cantly different for very elderly critically ill patients compared to those of their younger counterparts in the medical ICU in this study.
