BackgroundAfter the concept of healthcare associated pneumonia (HCAP) was introduced in 2005 by the American Thoracic Society/Infectious Disease Society of America (ATS/IDSA), pneumonia in hemodialysis patients has been classified as HCAP. Even though there are several risk factors and scoring systems of drug-resistant pathogens (DRPs) in HCAP, the risk factors for DRPs in hemodialysis-associated pneumonia are unclear.MethodsPatients who were admitted to our tertiary care hospital from January 2005 to December 2010 were screened by a discharge diagnosis of pneumonia. Patients were enrolled if they fulfilled the definition of HCAP according to the 2005 ATS/IDSA guidelines.ResultsA total of 530 subjects were diagnosed with HCAP, of whom 48 (9.1 %) received regular hemodialysis (HD group) and the other 482 did not (non-HD group). The most common pathogens in HD group were Pseudomonas aeruginosa and methicillin resistant Staphylococcus aureus (MRSA). There was a similar distribution of Gram-negative bacilli infections between the two groups except for Haemophilus influenzae and Citrobacter species. The incidence of DRPs was not significantly different between the two groups (HD vs. non-HD, 35.4 vs. 39.2 %, p = 0.607). Wound care, severe pneumonia and an age of more than 70 years were significant risk factors for DRPs. The area under the operating cure of predicting DRPs was 0.727 (0.575–0.879, p = 0.01).ConclusionP. aeruginosa and MRSA were the most important pathogens in hemodialysis-associated pneumonia. Wound care, severe pneumonia and old age were significant risk factors for DRPs.
Tuberculous prosthetic joint infection is rare. While early diagnosis is critical for treatment, it is usually delayed. Here, we present the case of a 72-year-old patient who underwent total knee arthroplasty for his right knee due to degenerative arthritis 4 years ago. Three years after arthroplasty, pulmonary tuberculosis was found and he hesitated on starting antituberculosis chemotherapy. He suffered from progressive pain and swelling of the right prosthetic knee for 2 months before this admission. The pathologic report of the debridement of the right prosthetic knee was caseous granulomatous inflammation with positive acid-fast staining bacilli. The culture of the debridement also yielded Mycobacterium tuberculosis. He died due to aspiration pneumonia with multiorgan dysfunction. This case is a reminder of the possibility of tuberculosis while dealing with prosthetic joint infection.
Clinical deterioration during the treatment of tuberculosis remains a diagnostic challenge. We describe the case of a 46-year-old man with a history of oral cancer status after a radical operation who had pulmonary tuberculosis with pleura and neck lymph node involvement. The clinical condition improved after antituberculosis therapy. However, the patient suffered from low-grade fever, progressive dyspnea, and cough after 7 weeks of the therapy. The findings of chest plain films were relapse and progression of left lung haziness. The deterioration was caused by disseminated Penicillium marneffei infection. Disseminated P. marneffei in a non-HIV patient with tuberculosis is rarely seen, and the manifestations are similar to a paradoxical response and relapse of pulmonary tuberculosis, thereby making it difficult to establish a diagnosis.
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