파상풍 환자의 합병증 빈도와 원내 폐렴발생의 위험인자 분석
Incidence of complications and risk factors for nosocomial pneumonia in patients with tetanus
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 파상풍 환자에서 발생하는 합병증의 빈도와 그 중 원내 폐렴을 일으키는 위험인자에 대해 조사하고자 하였다. 방법: 1999년 1월부터 2008년 6월까지 파상풍으로 전남대학교 병원에 입원 치료한 환자들을 대상으로 하였다. 환자들의 임상양상과 치료방법, 합병증을 조사하였으며 APACHE II score와 Ablett score를 이용한 중등도 평가를 시행하였다. 또한 환자들을 원내 폐렴 발생여부에 따라 두 군으로 나누어 폐렴발생의 위험인자에 대해 평가하였다. 결과: 42명의 환자 중 29명(69%)이 여자, 13명(31%)이 남자였으며 평균 나이는 64.3세였다. 이 중 3명의 환자만이 파상풍 기본예방접종을 시행한 상태였으며 나머지 환자들은 기본예방접종 혹은 추가접종을 전혀 시행하지 않은 상태였다. 21명의 환자는 후두 및 호흡기 근육 경직에 의한 호흡부전으로 인공 기계환기를 시행하였다. 입원치료를 받은 38명의 자율신경계 합병증으로는 심한 혈압변동(31.6%), 부정맥(26.3%), 심정지(7.9%) 등이 빈번하게 발생하였다. 가장 흔한 감염성 합병증은 폐렴(47.4%)이었으며, 다음으로 혈류감염(15.8%), 요로감염(13.2%)이었다. 다변량 분석에서 자율신경계 이상(OR=32.0, 95% CI 1.9~524.2.1; p=0.005)과 중환자실 입원기간(OR=1.145, 95% CI 1.02~1.29; p=0.024)이 원내 폐렴 발생의 독립적인 위험인자로 분석되었다 결론: 파상풍의 발생위험이 높은 지역에서는 질환에 대한 교육과 예방접종이 발병률을 감소시키는데 매우 중요한 역할을 하며, 파상풍을 치료하는데 있어서 질환의 특성을 고려한 치료 및 합병증에 대한 주의 깊은 감시와 치료가 필요하다.
Abstract
Background/Aims: Tetanus is a fatal disease and various complications affect its prognosis. In Korea, tetanus cases have been reported, but no studies, thus far, have examined its complications. We investigated the complications of tetanus and analyzed the risk factors for nosocomial pneumonia, one of most common complications of tetanus. Methods: We retrospectively reviewed the clinical features, treatment, and complications of 42 patients diagnosed with tetanus at Chonnam National University Hospital from January 1999 through June 2008. The severity of tetanus was assessed using the APACHE II and Ablett scores. We compared two groups, one with nosocomial pneumonia and the other without it, and analyzed the risk factors for nosocomial pneumonia. Results: Forty-two patients (13 men, 29 women) were enrolled. Only three of them had received a primary tetanus vaccination; the others had not received primary or booster vaccinations. Twenty-one patients needed mechanical ventilation. The most common infectious complication was pneumonia (47.4%), followed by blood stream (15.8%) and urinary tract (13.2%) infections. Regarding noninfectious complications, dysautonomia was also common, including fluctuating blood pressure (31.6%), arrhythmias (26.3%), and cardiac arrest (7.9%). Nosocomial pneumonia was associated with autonomic disturbance (OR=32.0, 95% CI 1.9-524.2; p=0.005) and length of stay in the intensive care unit (OR=1.145, 95% CI 1.02-1.29; p=0.024) in the multivariate analysis. Conclusions: Careful monitoring and treatment of complications are essential in managing tetanus, along with specific therapy for tetanus itself. Education and tetanus immunization are important for preventing the disease, especially in high-risk areas.
참고문헌 (29)
- Lee DH, "Past, present and future of the national immunization program", Korean J Infect Dis, 27, pp.213~219 (1995)
- Korea Centers for Disease Control and Prevention, "National communicable disease report by weekly and area", Comm Dis Wkly Rep, 7, pp.11~ (2008)
- Chung GT, "Diphtheria and tetanus immunity of different age adult populations in Korea", The Report of National Institute of Health, 40, pp.264~265 (2003)
- Udwadiaa FE, "Tetanus and its complications: intensive care and management experience in 150 Indian patients", Epidemiol Infect, 99, pp.675~684 (1987)
- Harding-Goldson HE, "Tetanus: a recurring intensive care problem", J Trop Med Hyg, 98, pp.179~184 (1995)
- Orellana-San Martín C, "Tetanus in intensive care units", Rev Neurol, 36, pp.327~330 (2003)
- Centers for Disease Control and Prevention (CDC), "Pneumonia and influenza death rates: United States, 1979-1994", MMWR Morb Mortal Wkly Rep, 44, pp.535~537 (1995)
- Cavalcante NJ, "Incidence of and risk factors for nosocomial pneumonia in patients with tetanus", Clin Infect Dis, 33, pp.1842~1846 (2001)
- Barsić B, "Nosocomial infections in critically ill infectious disease patients: results of a 7-year focal surveillance", Infection, 27, pp.16~22 (1999)
- Centers for Disease Control and Prevention, "Case definitions for infectious conditions under public health surveillance", MMWR Recom Rep, 46, pp.1~55 (1997)
- Ablett JJ, "Analysis and main experience in 82 patients treated in the Leeds tetanus unit. In Symposium on tetanus in Great Britain", pp.1~ (1967)
- Horan TC, "CDC", NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting, 2008, pp.36, 309~332
- Farrar JJ, "Fairweather N, Binh N, Parry J, Parry CM. Tetanus", J Neurol Neurosurg Psychiatry, 69, pp.292~301 (2000)
- Alfery DD, "Tetanus: a review", Crit Care Med, 7, pp.176~181 (1979)
- Kang JH, "Age related serosurvey of immunity to tetanus in Korean populations", Korean J Infect Dis, 33, pp.104~111 (2001)
- Shon YD, "Qualitative analysis of anti-tetanus antibody titers in Korean", J Korean Soc Traumatol, 17, pp.27~36 (2004)
- Sanford JP, "Tetanus-forgotten but not gone", N Engl J Med, 332, pp.812~813 (1995)
- Cook TM, "Tetanus: a review of the literature", Br J Anaesth, 87, pp.477~487 (2001)
- Craven DE, "Nosocomial pneumonia: emerging concepts in diagnosis, management, and prophylaxis", Curr Opin Crit Care, 8, pp.421~429 (2002)
- Ewig S, "The pulmonary physician in critical care * 4: nosocomial pneumonia", Thorax, 57, pp.366~371 (2002)
- Ebisawa I, "Pulmonary and muscular changes in tetanus", Jpn Exp Med, 38, pp.27~36 (1968)
- Hariparsad D, "Renal function in tetanus", Intensive Care Med, 10, pp.67~70 (1984)
- Edmondson RS, "Intensive care in tetanus: management, complications, and mortality in 100 cases", BMJ, 1, pp.1401~1404 (1979)
- Udwadia FE, "Autonomous dysfunction in severe tetanus", Intensive Care Med, 16, pp.520~ (1990)
- Izurieta HS, "Tetanus Surveillance-United States, 1991-1994", MMWR CDC Surveill Summ, 46, pp.15~25 (1997)
- Bardenheier B, "Tetanus surveillance: United States, 1995-1997", MMWR CDC Surveill Summ, 47, pp.1~13 (1998)
- Patel JC, "Tetanus: study of 8,697 cases", Indian J Med Sci, 53, pp.393~401 (1999)
- Sangalli M, "Tetanus: a rare but preventable cause of mortality among drug users and the elderly", Eur J Epidemiol, 12, pp.539~540 (1996)
- The Korean Society of Infectious Diseases, "Vaccination for adults. 1st ed", Koonja Publishing Co., pp.26~34 (2007)