The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 323
Poster Session
PS 1287 Pulmonology
Clinical Characteristics of Pleural Effusion of Scrub Typhus Patient : An 8-Year Single Center Experience in South Korea
Hoe-Soo Jang1, Hyung-Ho Kim1 Chosun University Hospital, Korea1
Background: The aim of this study is to investigate the characteristics of pleural effu- sion and to identify the factors associated with the occurrence of pleural effusion of adult scrub typhus patients which are currently unclear.
Methods: We conducted a retrospective analysis of the medical records of the con- firmed adult scrub typhus patients between January 2004 and December 2011 at Chosun University Hospital in South Korea. 445 confi rmed adult scrub typhus patients were divided into two groups for comparison: the patients group without pleural effu- sion (n=352) and with effusion (n=93). And data of 18 patients with examined pleural effusion were summarized.
Results: Multivariate analysis demonstrated that following four factors were signifi - cantly associated with the occurrence of pleural effusion of scrub typhus as independ- ent risk factors: older age (odd ratio[OR] = 1.03, p = 0.037); male sex (OR = 1.92, p
= 0.020); presence of underlying heart failure (OR = 2.63, p = 0.039, CI = 1.05-6.56);
lower albumin (OR = 0.11, p = <0.001). Most of the effusions were bilateral location (88%) and small in size (91%). The mean pleural fl uid WBC count was 1619.7/mm3, and the differential count showed a predominance of mononuclear cell in 11 patients.
Effusion of 11 patients (61.1%) was classifi ed as exudates by Light’s criteria. The mean pleural fl uid total protein was 2.30 ± 0.58 g/dL, and the mean pleural fl uid LDH was 275.8 ± 101.6 U/L. The mean pleural fl uid pH was 7.43 ± 0.82. The mean ADA was 32.5 ± 20.9 U/L, and ADA was above 35 U/L in 8 patients (44.4%).
Conclusions: This study provides fi rst data regarding the factors associated with the occurrence of pleural effusion and the characteristics of pleural effusion of adult scrub typhus.
PS 1288 Pulmonology
Empyema Necessitatis Due to Aspergillus Fumigatus
Hyun Woo Lee1, Yeon Wook Kim1, Jaeyoung Cho1, Han-Sol Choi1, Jungsil Lee1, Chang- Hoon Lee1
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National Uni- versity Hospital, Korea1
We present an extremely rare case of empyema necessitatis secondary to Aspergillus fumigatus infection. A 58-year-old woman presented to our hospital with a painful skin rash on the right thorax. Three fi stulas communicating with the pleural space were found. Because she did not show a clinical improvement despite anti-tubercu- lous and anti-bacterial treatment, we looked for other causes. Pleural fungus culture showed A. fumigatus and chest wall biopsy revealed numerous fungal hyphae. Treat- ment with necrotic tissue debridement and anti-fungal agents was successful.
PS 1289 Pulmonology
Rapid Pathogen Identifi cation Using MALDI-TOF MS for Critically Ill Patients with Pneumonia
Minji Kim1, Sang Hee Lee1, Jung Sup Eom1, Eun Jung Cho1, Mi Hyun Kim1, Kwangha Lee1, Ki Uk Kim1, Hye-Kyung Park1, Min Ki Lee1, Jeong Ha Mok1
Department of Internal Medicine, Pusan National University Hospital, Korea1
Background: Rapid pathogen identification and appropriate antibiotics therapy is important to treat critically ill patients. This study was conducted to evaluate the use- fulness of Matrix-Assisted Laser Desorption/Ionization-Time of Flight Mass spectrom- etry (MALDI-TOF MS) for rapid pathogen identifi cation for critically ill patients with pneumonia.
Methods: We conducted a retrospective study in the intensive care unit (ICU) at Pu- san National University Hospital in Korea from May 2012 to February 2014. Patients who performed microbial culture and organism identifi cation of endotracheal aspirate while receiving ventilator care were enrolled.
Results: A total 50patients were included fi nal analysis. Pathogen identifi cation was performed using MALDI-TOF MS in 27patients (MS group) and conventional methods in 23patients (Conventional group). There were no differences in demographic charac- teristics and disease severity between two groups. When comparing two groups, the av- erage time between endotracheal aspirate sample collection and pathogen identifi cation (with antibiotics susceptibility test result) was shorter in MS group than conventional group (51.9 ± 10.8hr vs. 70.5 ± 28.2hr, p < 0.05). Thirty-seven patients changed antibiot- ics according to the identifi cation results (21patients in MS group, 16patients in conven- tional group). The average time between sample collection and antibiotics change was shorter in MS group than conventional group (55.8 ± 10.6hr vs. 74.9 ± 29.8hr, p < 0.05).
However, there were no signifi cant differences in duration of mechanical ventilation, length of hospital stay and hospital mortality between two groups.
Conclusion: Pathogen identifi cation and antibiotics change was faster when using MALDI-TOF MS in critically ill patients with pneumonia. Further investigation is needed to evaluate the impact of rapid pathogen identifi cation on clinical courses of critically ill patients.
