Klebsiella pneumoniae is an uncommon cause of septic arthritis in adults. However, late detection can cause serious complications, including joint destruction and immobility. The purpose of this study was to report a case of successfully treated septic arthritis of the hip joint (SAHJ) caused by K. pneumoniae. A 49-year-old female patient presented to our hospital with fever and progressive severe pain in the right hip area. Although there was no abnormality on plain radiographs, ultrasonography revealed diffuse swelling of the right hip joint. Under ultrasonography guidance, the hip joint fluid was aspirated, and Gram staining and culturing were performed. The patient's pain was significantly reduced after the joint aspiration. The Gram staining and culturing revealed gram-negative bacilli, which were subsequently identified as K. pneumoniae. According to the results, systemic intravenous antibiotic (ceftriaxone) was administered without complications, and the patient was discharged on oral antibiotic (ciprofloxacin). Clinical cases of septic arthritis of the knee or sacroiliac joint have been occasionally reported in adults, but cases of SAHJ are rare. Moreover, K. pneumonia-induced SAHJ has not been reported to date. Therefore, we report this very rare case and its successful treatment.
Objective: The purpose of this study was to determine oral intake predictors, including videofluoroscopic swallow study (VFSS) and Charlson Comorbidity Index (CCI), in patients with diseases/conditions requiring nasogastric (NG) tube feeding for dysphagia. Methods: We retrospectively extracted the clinical or radiological medical records of 501 patients with internal medicine diseases who were referred for VFSS to evaluate dysphagia between January 2012 and August 2021. Our study analyzed 310 (61.9%) subjects using the NG tube out of 501 patients surveyed. The demographic features of the subjects, comorbidities, including CCI, and the VFSS results were extracted. Immediately after the VFSS test, the subjects were categorized into two groups: 153 who removed the NG tube and 157 who retained it. The chi-square test, Fisher's exact test, and the independent t-test were used to analyze the data. We used the logistic regression analysis to determine the independent predictors of NG tube removal. The receiver operating characteristic (ROC) curve analysis was used to determine the best cut-off value of the Functional Dysphagia Scale (FDS) score for NG tube removal. Results: The FDS score, the Penetration-Aspiration Scale (PAS) score, the diagnosis of aspiration pneumonia, and the presence of hemiplegia affected the NG tube removal. The optimal cut-off value for the NG tube removal was a score of 36.5 based on the FDS. Conclusion: We clarified factors that may affect the NG tube removal in patients hospitalized for internal medicine disease. This study will assist in the future development of an oral intake strategy for patients with medical conditions receiving NG tube feeding. (JKDS 2022;12:35-44
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