CAJ | 학술논문

目的探讨社区获得性肺炎(CAP)治疗失败的原因和危险因素.方法回顾性分析2006年1-12月拟诊CAP入院病例378例,以无反应性肺炎及进展性肺炎定义治疗失败,以此分析治疗失败CAP患者的临床特征,探讨治疗失败的原因,并进行高危因素分析.结果 378例CAP患者中,治疗失败50例,其中无反应性肺炎32例,进展性肺炎18例.分析失败原因:感染性原因35例,占70%;非感染性原因11例,占22%;无法明确原因4例,占8%.50例患者中共有9例死亡(18%),8例为感染性原因,1例为无法明确原因.C反应蛋白、多叶受累、白蛋白<30g/L、肾功能损害、肝功能损害均与CAP治疗失败有关,其中多叶受累、白蛋白<30 g/L、肾功能损害是CAP治疗失败独立的危险因素.结论 CAP治疗失败及死亡的主要原因是感染性原因,多为耐药菌株感染.
목적 탐토사구획득성폐염(CAP)치료실패적원인화위험인소.방법 회고성분석2006년1-12월의진CAP입원병례378례,이무반응성폐염급진전성폐염정의치료실패,이차분석치료실패CAP환자적림상특정,탐토치료실패적원인,병진행고위인소분석.결과 378례CAP환자중,치료실패50례,기중무반응성폐염32례,진전성폐염18례.분석실패원인:감염성원인35례,점70%;비감염성원인11례,점22%;무법명학원인4례,점8%.50례환자중공유9례사망(18%),8례위감염성원인,1례위무법명학원인.C반응단백、다협수루、백단백<30g/L、신공능손해、간공능손해균여CAP치료실패유관,기중다협수루、백단백<30 g/L、신공능손해시CAP치료실패독립적위험인소.결론 CAP치료실패급사망적주요원인시감염성원인,다위내약균주감염.
Objective To determine the causes and risk factors of antimicrobial treatment failure in patients with community-acquired pneumonia(CAP). Methods Hospitalized adults with CAP from January 2006 to December 2006 were analyzed retrospectively. Treatment failure was defined as appearance of nonresponding pneumonia and progressive pneumonia. Patient's clinical features were analyzed. Results All of 378 patients were involved in this study. Total antimicrobial treatment failure was happened in 50 patients(32 patients with non-responding pneumonia and 18 patients with progressive pneumonia). The causes were infectious (35 patients,70% ), non-infectious (11 patients,22% ) and undetermined (4 patients,8% ).Mortality of antimicrobial treatment failure was 18%(9/50, 8 patients died of infectious cause, 1 patient had no clear cause of death). Stepwise Logistic regression analysis showed that C-reactive protein, multilobar pneumonia,albumin < 30 g/L,renal function lesion,liver function lesion were related with antimicrobial treatment failure. Independent factors of treatment failure were multilobar pneumonia (P= 0.002) ,albumin <30 g/L(P = 0.001 ) and renal function lesion (P = 0.000). Conclusion The major challenge associated with antimicrobial treatment failure in hospitalized patients with CAP is infection, most of which is infection of drug resistant strain.