The study of Pathogens causing Community Acquired Pneumonia in hematological malignancy

patients comparing to general patients who hospitalized in Naresuan University Hospital

Researchers

Chatchawan Aungsirikultumrong code51460773

Teerasit Viyanant code52460420

Sireekarn Samanukorn code52461045

Advisor Dr. Thanakorn Laksomya Dr. Suwit Leartkajonsin

Agenda

Background Objectives Research methodology Result Discussion Conclusion Recommendation

Background (1)

Hematological malignancy patients are the immunocompromised host

They have more risk to be infected than general patients

Most of the pathogens that cause community acquired pneumonia in these patients are not found in general patients

These patients were classified in high risk group with the mortality rate of 24% (KM Sanders, 2006, p89)

Background (2)

Hematological malignancy patients with Community Acquired Pneumonia are the group of patients that have modifying factor

The management of this group is different from those of general patients by using broader spectrum antibiotics which are more effective, yet more expensive

(Thoracic Society of Thailand, 2544, p11)

Gap of Knowledge

Nowadays, guidelines on the management of Community Acquired Pneumonia in Naresuan University hospital are adapted from American Thoracic Society

Still, a study on pathogen in hematological malignancy patients with CAP has not been conducted

There is a possibility that the pathogens could be either the same or different from those found in general patients

Rationale

To select proper antibiotics for hematological malignancy patients

To study about the risk factor and mortality of Community Acquired Pneumonia

Leading to the building of the prevention and health promotion in community and hospital further

Objective

Primary objective To identify the pathogens causing Community

Acquired Pneumonia comparing between hematological malignancy patients and general patients in NU hospital

Secondary objective To identify the general data, initial antibiotic,

and complication of patient with Community Acquired Pneumonia

Research methodology (1)

Patient population Data collection Statistical analysis

Research methodology (2)

Type of research Retrospective study Cross-sectional descriptive study

Source Medical record NU hospital

Patient population

Patient n= 237

Inclusion criteria

Exclusion criteria

n=41

D/C less than 3 weeks, Admit more than 48 hr then develop pneumonia, Develop pneumonia after ETT more than 48 hr, Refer form others hospital, HIV , Chronic lung disease, DM, Chronic renal failure, Chronic liver disease, CVA, CHF, Connective tissue disease

Group 1 general patients with CAPGroup 2 hematological malignancy

patients with cap

Age > 15 years

General host n=36

Hematologic malignancy

N=5

Statistical analysis

Descriptive study Microsoft office excel STATA Table & Bar chart

Data collection (1)

Data collection (2)

Result

Normal host Hematological malignancy

Sex

Normal host Hematological malignancy

50%

Age

Initial laboratory Normal host Hematological malignancy

NO. of cases

% of cases

NO. of cases

% of cases

White blood cell count (cells/mm3) < 1500 1,500 – 5,000 5,001 – 10,000 10,001 – 15,000 15,001 – 20,000 20,001 – 25,000 25,001 – 30,000 > 30,000

0 1 17 8 4 5 1 0

02.7847.2222.2211.1113.892.78

0

1 1 0 2 0 0 0 1

202004000020

Initial laboratory(1)

Initial laboratory Normal host (%) Hematological malignancy (%)

NO. of cases

% of cases

NO. of cases

% of cases

Absolute neutrophil count < 500 500 – 999 1,000 – 1,499 1,500 – 2,000 > 2,000

0 0 0 0 36

0000

100

20003

4000060

Initial laboratory(2)

Initial antibiotic

Sputum culture (1)

K.pneumoniae

Candida albican

Serratia spp.

Klebsiella pneumonia &

Haemophilus influenzae.

Non fermented gram negative bacilli (MDR) & Candida albican

Normal flora

No growth

Sputum culture (2)

Hematological malignancy (%) N = 5

P. aeruginosa

Normal flora

Hemoculture (1)

Normal host (%) N = 36

K.pneumoniae

Normal flora

Hemoculture (2)

Hematological malignancy (%) N = 5

K.pneumoniae

Normal flora

Discussion (1)

The study showed that in general patients with Community Acquired Pneumonia, there were female patients more than male patients

In hematological malignancy patients with Community Acquired Pneumonia there were more male patients than female patients

65Most patients are years old and above in both hhhhhh

Discussion (2)

The pathogens causing Community Acquired Pneumonia in hematological malignancy patients are different from those detected in general patients

In general patients, most sputum culture revealed negative for any pathogen

Secondly, Klebsiella pneumoniae and normal flora were found respectively Different from the result in Wattanatum A . et al study about

Community Acquired Pneumonia in Southeast Asia Their study showed that most pathogens causing Community

Acquired Pneumonia was Streptococcus pneumoniae Secondaly Chlamydia pneumoniae and Klebsiella

pneumoniae were found respectively

(Wattanatum A,et al. ,2003)

Discussion (3)

Most pathogens causing Community Acquired Pneumonia in hematological malignancy patients were Pseudomonas aeruginosa and yeast which were not found in general patients at all

Discussion (4)

Streptococcus pneumoniae, Chlamydia pneumoniae, and Mycloplasma pneumoniae were not found in both the sputum culture and hemoculture Different from the result in Wattanatum A . et al study

about Community Acquired Pneumonia in Southeast Asia

(Wattanatum A,et al. ,2003)

This result might be caused by the sensitivity problem that both of hemoculture and sputum culture only have about 10 % of sensitivity

Discussion (5)

The most initial antibiotic used in general patients with Community Acquired Pneumonia 1. ceftriaxone and ceftriaxone with

clarithromycin 2. amoxicillin/clavulanate and ceftriaxone with

azithromycin

These initial antibiotic could cover the pathogens causing Community Acquired Pneumonia in general patients who admitted in Naresuan University Hospital

Discussion (6)

The most initial antibiotic used in hematological malignancy patients with Community Acquired Pneumonia 1. ceftriaxone and ceftazidime 2. clarithromycin

These initial antibiotic couldn’t cover the pathogens causing Community Acquired Pneumonia in hematological malignancy patients who admitted in Naresuan University Hospital which were Pseudomonas aeruginosa and Yeast

Conclusion

The pathogens in hematological malignancy patient are different from general patient

The initial antibiotic doesn’t cover this pathogens

Recommendation (1)

The selection of antibiotic for treatment should cover the pathogens

The patient should be taken sputum culture and hemoculture

Recommendation (2)

Study in different population DM Patient on immunosuppressant Other malignancy

Study in out-patient department

References (1)

British Thoracic Society. (2009). Thorax an international journal of respiratory medicine 2009 Guidelines for the management of community acquired pneumonia in adults. Thorax, 64(3). 1-55

KM Sanders, TK Marras, CKM Chan. (2006). Pneumonia severity index in the immunocompromised. Can Respir J, 13(2). 89-93.

M B Feinstein. Memorial Sloan-Kettering Cancer Center, New york. Pneumonia in the immunocompromise host. (2006). Elsevier : New York. 466-474

Robert H. Rubin and JAY A. Fishman. Community-Acquired Pneumonia in the Immunocompromised Host. (2001). Academic/Plenum : New York. 321-335.

References (2)

Wattanatum A,et al. (2003). Community-acquired pneumonia in Southeast- Asia : the microbial different between ambulatory and hospitalized patients. Chest 2003, 123. 1512-1519.

Wipa Reechaipichitkul and Veeradej Pisprasert. (2004). Severe Community – Acquired Pneumonia (CAP) treated at Srinagarind Hospital, Khon Kaen, Thailand. Southeast Asian J Trop Med Public Helath, 35(2). 430-433.

สมาคมอุ�รเวชช แห่�งประเทศไทย. แนวทางการรกษาโรคปอดอกเสบชุ�มชุนในประเทศไทย(ส�าหรบผู้� ใหญ่") . (2544). สมาคมอุ�รเวชช แห่�งประเทศไทย : กร�งเทพฯ. 3 – 16.

ว�ภา ร�ช�ยพ�ช�ตก�ล. (2554). Pneumonia in ambulatory care. วารสารอาย�รศาสตร$อ%สาน, 10(3). 83 – 93.

References (3)

ว�ชร� แก!วนอุกเขา. (2554). โรคปอุดอุ�กเสบ ประเทศไทย ป' พ.ศ. 2548-2553. Weekly epidemiological Surveillance report, 43. 90-98.