WCIM 2014 SEOUL KOREA 215
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0651 Respiratory Medicine
Clinical Characteristics and Prognostic Factors of the Patients Who Admitted in Intensive Care Units with Nursing and Healthcare-Associated Pneumonia
Ji Sun CHOI1, Myoung Kyu LEE1, Sang-Ha KIM1, Won-Yeon LEE1, Suk Joong YONG1, Kye Chul SHIN1, Jiwon CHOI1, Yeun Seoung CHOI1, Jae Ho SEONG1, Ye-Ryung JUNG1 Wonju Christian Hospital, Korea1
Background: Limited studies have been identifi ed about nursing and healthcare-asso- ciated pneumonia (NHCAP) requiring intensive care unit (ICU) admission. We evaluated the clinical and microbiological characteristics of NHCAP patients admitted to the ICU.
Methods: NHCAP was categorized as four groups. Reviewed database included age, gender, comorbid diseases, laboratory data and microbiological Results: The severity of pneumonia was assessed by using the pneumonia severity index (PSI) and CURB-65.
The 30-day mortality and duration of ICU stay were evaluated as endpoints Results: Total 428 patients (men, 67.1%) were reviewed. The mean age was 71.2 ± 11.9 year-old. Thirty-day mortality was 25.5%, and duration of ICU stay was 13.8
± 13.3 days. Mortality (P = 0.349) had no signifi cant difference among four groups although duration of ICU stay (P = 0.008) was signifi cantly longer in group C and D. When we performed multivariate logistic analysis using signifi cant variables, PSI score (OR 1.015 95% CI 1.004-1.026, P = 0.009), serum HCO3- level (OR 0.954 95%
CI 0.918-0.993, P = 0.020), duration of ICU stay (OR 0.971 95% CI 0.950-0.993, P = 0.010), multidrug-resistant (MDR) pathogens including ESBL-producing K. pneumoniae (OR 2.688 95% CI 1.237-5.840, P = 0.013) and MDR A. baumannii (OR 3.081 95% CI 1.504-6.311, P = 0.002) were signifi cantly associated with 30-day mortality.
Conclusions: ESBL-producing K. pneumoniae and MDR A. baumannii were more often isolated and associated with mortality in NHCAP in ICU patients, therefore these MDR pathogens as well as PSI score should be considered as prognostic factors in NHCAP.
PS 0652 Respiratory Medicine
Bronchobiliary Fistula (BBF) Treated with Lipiodol Em- bolization
Min Je KIM1, Seonhye KIM1, In Kyoung HWANG1, Hyo Seok LIM1, Yee Hyung KIM2, Myung Jae PARK1, Jee-Hong YOO2, Hong Mo KANG1
Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital, Korea1, Depart- ment of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Korea2 Introduction: Bronchobiliary fi stula (BBF) usually occurs either in the congenital form or following thoracoabdominal trauma. However, it can also occur as a rare complica- tion of diseases of biliary tract. Herein, we report the case of a 53-year-old man with acquired, non-traumatic BBF, treated with lipiodol embolization.
Case: A 53-year-old man visited our hospital with fever, cough, and brownish spu- tum for 2 months. One year ago, he was diagnosed with hepatocellular carcinoma, and received transarterial chemoembolization (TACE) 5 months ago. After procedure, multiple hepatic abscesses and biloma developed. Multiple abscess drain tube and per- cutaneous transbiliary gall bladder drain (PTBD) tube were inserted and he was treated with antibiotics for a month. He was readmitted 3 months after his discharge with biloptysis. Laboratory data showed leukocytosis with an elevated C-reactive protein (10 mg/dL). Chest X-ray demonstrated peribronchial infi ltration in the right lower lung fi eld and chest computed tomography (CT) revealed a consolidation in right lower lobe with sub-diaphragmatic abscess. Antibiotics started and drain tube for sub-diaphrag- matic abscess was inserted and PTBD tube was changed. However, his symptoms and pneumonic infi ltration on chest x-ray was not improved. We performed a tubogram which showed dilated bile duct and a fi stulous communication with the right bronchial tree. He was diagnosed as BBF and lipiodol embolization was performed successfully.
His symptoms and pneumonic infi ltration on chest x-ray was improved, and was dis- charged on the 18th post-procedure day.
Discussion: BBF in adults is a rare condition complicating bile duct obstruction and liver abscesses. Rapid diagnosis and early treatment of septic complications are neces- sary. Early intervention for embolization should be considered in patients who did not show good response to conservative treatments.
PS 0653 Respiratory Medicine
Organizing Pneumonia and Cytomegalovirus Infection
Vânia GOMES1, Rosa MACEDO CARVALHO1, Maria João FERREIRA DA SILVA1, Céu RODRIGUES1, António OLIVEIRA E SILVA1
Hospital De Braga, Portugal1
Objective: Organizing pneumonia is a diffuse interstitial lung disease. Secondary or- ganizing pneumonia can be seen in association with various diseases, including infec- tions. Cytomegalovirus (CMV) is a human herpesvirus that has as peculiar characteris- tic its capacity of latency. The clinical disease is rare in immunocompetents individuals.
Methods: Revision of one clinical case.
Results: A 54 years old male, with known diabetes mellitus, was admitted to the emergency room due to rest dyspnoea, productive cough and fever. These symptoms were preceded by the acute onset of a fl u-like illness with odynophagia, nonproduc- tive cough, diarrheal stools and fatigue. He was discharged with empiric antibiotics and low dose prednisolone. On the seventh day, he was readmitted with persistent fever, mild hemoptysis and pleuritic bilateral chest pain. He presented hypoxemic with severe acute respiratory failure, requiring noninvasing ventilation. The chest radio- graph revealed bilateral, diffuse and consolidative opacities. Different antibiotics were started. There was no microbiological isolation. As an inpatient, he improved clinically and was discharged after 17 days. After fi ve days, he was readmitted with the same clinical picture. The high resolution computerized axial tomography showed extensive bilateral disease consistent with organizing pneumonia: small nodular opacities in a subpleural location, patchy air-space consolidation and ground glass diffuse opacities.
He was medicated with prednisolone 1mg/kg/day. Viral serologies were performed and revealed active acute infection with CMV. The bronchoalveolar lavage showed a pre- dominance of lymphocytes and CMV was isolated. He began oral valciclovir and was discharged after 10 days with no symptoms. After 4 weeks, the dose of glucocorticoid was tapered, the patient remained asymptomatic and serological conversion of CMV titles was confi rmed.
Conclusions: We describe a rare case of organizing pneumonia in a diabetic male who was pharmacology immunosuppressed after initial symptoms. As the patient improved, no lung biopsy was performed.
PS 0655 Respiratory Medicine
Fatal Pneumonia in the Structure of Comorbidity
Arcady VERTKIN1, Anton SKOTNIKOV2, Janar ORALBEKOVA3
Moscow State Medical-Stomatological University, Russia1, Moscow State Medical-Stomatological Uni- versity, Russia2, Moscow State Medical-Stomatological University, Russia3
Background: The aim of our investigation was evaluation of the frequency of fatal pneumonia and studying of diseases which it was complicated. The study has included two parts. There were retrospective analysis of autopsy results and detection of rela- tionships between comorbid pathology and features of the damage of lung tissue.
Methods: We have analyzed 5931 cases of autopsy in the multi-specialty hospital of Moscow over 5 years (2006-2010). Pneumonia was detected in 1497 cases (25.2%), out of which 793 were men (52.9%) and 704 were women (47.1%). These were pre- dominantly people older than 60 years (1197 cases or 79.9%).
Results: Pneumonia was the primary disease in 97 cases (6.5%) but it was the fatal complication of another primary disease in 1400 cases (93.5%). Nosological structure of these diseases has associated with cardiovascular illnesses (78%), chronic obstruc- tive lung disease (5%), oncopathology (9%) and chronic alcohol intoxication (8%).
Pneumonia as primary disease was in 69% of men and 62,8% of middle age people.
Pneumonia as a fatal complication of a primary disease was in 51,8% of men and in 36,8% of women. Double-sided (62.1%) and lower lobe (62.6%) pneumonia were most prevalent but focally pneumonia and pneumonia with confl uent focus (79.5%) were predominant in terms of the type of damage to lung tissue. Patients with vascu- lar diseases and diabetes mellitus were associated with most unfavorable progress and poor outcomes. Diabetes mellitus was associated with double-sided pneumonia (88%) while the highest frequency of abscess formation (73%) was observed among patients with chronic alcohol intoxication.
