The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Bacterial etiology in hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease

만성폐쇄성폐질환 급성 악화로 입원한 환자의 세균성 원인

Joo, Sae-Kyung;Koo, Seung-Won;Kim, Mi-Ae;Cho, Yang-Hyun;Cha, Sung-Tae;Hong, Gi-Youn;Kim, Eun-Kyung;Lee, Ji-Hyun;Hong, Seong-Geun;Jeong, Hye-Cheol
주세경;구승원;김미애;조양현;차성태;홍기연;김은경;이지현;홍성근;정혜철

  • Published : 20090900
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Abstract

Background/Aims: Bacterial infections play an important role in acute exacerbations of chronic obstructive pulmonary disease (AECOPD). While critically ill patients requiring admission need proper antibiotic treatment for the causative pathogen, little is known about the bacterial etiology of AECOPD in Korea. We therefore studied the bacterial etiology of hospitalized patients with COPD in our institution. Methods: The study enrolled 149 patients who were admitted to the hospital in Sungnam with the diagnosis of AECOPD between July 1, 2004 and June 1, 2007. We retrospectively reviewed the clinical data and results of sputum cultures. Results: Of the 149 subjects with sputum collected, 51% (76 cases) had positive bacterial cultures [age 70.7${\pm}$9.2 years (mean${\pm}$SD);116 males] of sputum. Pseudomonas aeruginosa (24 cases, 30.4%) was the organism cultured in sputum most commonly, followed by Streptococcus pneumonia (15 cases, 18.9%), Acinetobacter sp. (9 cases, 11.4%), and Klebsiella pneumonia (7 cases, 8.9%). Patients whose FEV1 was <50% of the predicted value had a greater chance of showing positive growth of P. aeruginosa than patients having a FEV1 >50% (17/96 vs. 4/53, respectively, p=0.002). Patients taking systemic steroids also had a higher rate of sputum culture of P. aeruginosa (85.7%). Conclusions: P. aeruginosa was the pathogen most commonly isolated in hospitalized patients with COPD. This species should be considered when physicians select empirical antibiotics to treat patients with AECOPD.

목적: 만성폐쇄성폐질환 급성 악화에서 세균성 감염이 중요한 역할을 하는 것으로 알려져 있다. 특히 입원을 요하는 등의 악화 환자에게 원인 균주에 대한 적절한 항생제 선택은 매우 중요하다. 그러나 그 원인 균주에 대한 국내 연구가 부족한 실정이다. 본 연구에서는 경기도 성남 소재 1개 종합병원에 만성폐쇄성폐질환 급성 악화로 입원한 환자들에게 배양된 원인 균주를 확인하고자 하였다. 방법: 2004년 7월부터 2007년 6월까지 만성폐쇄성폐질환 급성 악화로 입원한 환자들을 대상으로 하였다. 환자들의 임상양상과 객담배양 검사 결과를 후향적으로 분석하였다. 결과: 전체 149명의 환자 중 76명(51%)의 환자에게 균이 동정되었으며 Pseudomonas aeruginosa (24명, 30.4%)가 가장 높은 빈도를 차지하였다. 그 밖에 Streptococcus pneumoniae (15명, 18.9%), Acinetobacter (9명, 11.4%), Klebsiella pneumoniae (7명, 8.9%) 등이 확인되었다. P. aeruginosa는 FEV1이 추정 정상치의 50% 이하인 경우(96명 중 17명, 17.7%)에서 그렇지 않은 경우(53명 중 4명, 7.5%)에 비하여 높게 배양되었다(p<0.05). 그리고 스테로이드를 투여 중인 환자 (7명 중 6명, 85.7%)에게 P. aeruginosa의 배양률이 스테로이드를 투여하지 않은 환자의 배양률(42명 중 16명, 38.1%)보다 높았다(p=0.0002). 결론: 만성폐쇄성폐질환 급성악화로 입원한 환자에게 P. aeruginosa가 가장 흔하게 검출되었다. 만성폐쇄성폐질환 급성 악화로 입원한 환자에게 폐기능이 심하게 저하되어 있던 환자이거나 전신적 스테로이드를 복용하고 있던 환자에게는 초기 경험적 항생제 치료 시 이에 대한 고려가 되어야 할 것으로 사료된다.

Keywords

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