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노인성 폐렴

Community-acquired pneumonia in elderly patients

장현하
대한내과학회 (The Korean Association Of Internal Medicine)|2010.10|대한내과학회지 (The Korean Journal of Medicine)|제79권 제4호|pp. 346-355

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키워드

지역사회획득 폐렴; 노인Pneumonia; Community-acquired infections; Elderly
주제분류내과학

초록

특히 Christenson 등51)이 스웨덴에서 실시한 대규모 코호트 연구에서 노인에게서 백신을 하나도 맞지 않은 군보다 하나라도 맞은 군에서 더 낮은 사망률을 보였으며, 특히 인플루엔자 백신과 폐렴사슬알균 백신, 두 백신을 다 맞은 군에서 어느 하나만 맞은 군보다 폐렴, 인플루엔자와 침습적 폐렴사슬알균 감염으로 입원하는 빈도가 낮게 나타나 백신 접종이 매우 효과적임을 보고하였다. 이와 같이 노인에게서 인플루엔자 백신과 폐렴사슬알균 백신 접종은 노인 인구에게서 치명적인 폐렴을 예방하고, 균혈증 등 폐렴 합병증으로 인한 사망률을 낮출 수 있는 간단하면서도 비용대비효과에서도 상당히 효과적인 방법으로, 대한감염학회에서 권장하는 성인 표준예방접종에서도 65세 이상 노인에서의 표준예방접종으로 권장되고 있다43,44). 우리나라의 경우 매년 노인들의 인플루엔자 예방접종율은 외국에 비교하여 높은 편이나, 최근 한 보고에서 전체 건강한 65세 이상 노인에게서의 폐렴사슬알균 예방접종률은 0.8%로 매우 저조한 것으로 보고한 연구결과도 있어52) 향후 임상현장에서 더욱 적극적으로 노인 환자들을 대상으로 이 둘의 예방접종을 권장, 홍보할 필요가 있다고 사료된다.

Abstract

Pneumonia is the one of the 10 leading causes of overall mortality and the most common cause of infection-related death in Korea, especially in elderly patients. Streptococcus pneumoniae is the most common pathogen causing community-acquired pneumonia (CAP) in elderly patients, and gram-negative bacilli have also been reported as an important pathogen in Korea. Treatment guidelines for community-acquired pneumonia, which were published by the Joint Committee of the Korean Society for Chemotherapy, the Korean Society of Infectious Diseases, and the Korean Academy of Tuberculosis and Respiratory Diseases, are briefly presented in this article. A special consideration should be given to active preventive measures for CAP in elderly patients, especially vaccination using a seasonal influenza and pneumococcal 23-valent polysaccharide vaccine.

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