Infectious lung and pleural diseases

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					Electronic Poster Discussion                                                                                              Room B9 - 14:45-16:45

                                                   Monday, September 17th 2007

                                                                          277. Infectious lung and pleural diseases

                                                                     Nosocomial pneumonia: influence of smoking on the course of disease
                                                                     K. Bogats’ka1 , K. Gashynova1 , T. Onyshchenko1 . 1 Internal Medicine, DSMA,
                                                                     Dnipropetrovs’k, Ukraine

                                                                     The aim of study was to reveal influence of smoking status on the course of
                                                                     nosocomial pneumonia.
                                                                     Methods and Study population: 27 patients (19 men, mean age 40.8±4.3
                                                                     years) with surgical pathology with nosocomial pneumonia was divided on three
                                                                     groups depending on the smoking status (Group I – 10 smokers, group II –
                                                                     10 non-smokers, Group III – 7 ex-smokers). Duration of antibiotic therapy and
                                                                     hospitalization and the complications rate were evaluated.
                                                                     Results: All groups were similar regarding to sex, age and the kind of comorbidity.
                                                                     The course of disease characteristics are presented in table 1.
                                                                     Conclusions: Tobacco smoke worse the course of nosocomial pneumonia. We
                                                                     did not find any significant difference between current and ex-smokers with
                                                                     nosocomial pneumonia in duration of antibiotic therapy and hospitalization and
                                                                     the complications rate.

                                                                     Table 1

                                                                     Groups    Duration of antibiotic    Duration of hospitalization    Complications
                                                                               therapy (M±m, days)       (M±m, days)                    rate (%)

                                                                     I         12.3±2.4                  22.9±1.2                       3
                                                                     II        6.9±1.1                   15.7±2.6                       1
                                                                     II        12.8±2.7                  19.7±1.7                       4.6

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                                                                    Monday, September 17th 2007

E2720                                                                                   patient received IV imipenam and mebendazole. Clinical and radiological follow
The assessment of pulmonary aspergiloma                                                 up after 2 month revealed complete cure.
D. Todea1 , M. Simon1 , M. Man1 , D. Nicolau2 , N. Ariesanu1 . 1 Pneumology,
Clinical Hospital of Pneumology, Cluj Napoca, Romania; 2 Thoracic Surgery,              E2723
Clinical Hospital of Pneumology, Cluj Napoca, Romania                                   Dependence between procalcitonin level and pneumonia risk classes
                                                                                        N. Karchevskaya1 , M. Koutsenko1 , A. Chuchalin1 . 1 Department of Clinical
The aspergilloma consists of masses of fungal mycelia, inflammatory cells, fibrin         Investigations, Pulmonology Research Institute, Moscow, Russian Federation
and tissue debrids, usually developing in a preformed lung cavity, most common
associated with tuberculosis. The purpose of this study was to estimate the             Background: calculation of pneumonia’s risk prognosis needs a lot of estimated
incidence of intracavitary aspergilloma, to analyze the time from bacteriological       factors. Procalcitonin (PCT), as inflammation’s severity marker, could be useful
negativity and radiological stability of the cavity to the diagnosis of aspergilloma,   for simplifying of estimating of pneumonia’s risk prognosis.
as well as to establish the efficiency of medical and surgical treatment. The lot        Study objectives: To evaluate the usefulness of procalcitonin serum level as
of study evolved 44 patients (35 males and 7 females, aged between 43 and               a predictor of prognosis in adult patients with community-acquired pneumonia
68 years) with radiological aspects suggestive for aspergilloma, admitted in our        (CAP) in comparing with severity’s stratifying according to Fine score.
clinic in last 30 years. The fungal filaments was identified in the sputum in 2/44        Materials: it’s prospective study and at this moment we have data from 27 patients
cases and in the fibro-bronchoscopic samples in 5/44 cases. The radiological             with CAP.
diagnosis was describe as intracavitary upper-lobe mass with an air crescent in         Methods: In patients who gave informed consent we estimated pneumonia’s risk
the periphery. The surgical therapy was applied in 29 cases (65.9 %) by lobe            with Fine score and measured PCT level by immunoluminometric assay (limit of
exeresis, atypical resection and cavernoplasty and the diagnosis was confirmed by        detection = 0.1 ng/ml).
the histopathological examination in 26 cases. In 2/29 patients the post surgical       Results: See table 1.
diagnosis was epidermoid cancer. 4 cases (9.1%) died because of complications –         Conclusion: there were trends of depending between PCT level and pneumonia’s
infections, hemoptisy. One year post surgical treatment, 19 patients had a favorable    risk classes, but the study needs to be continued for getting more reliable data.
evolution and the rest were “lost” of following, because of their absence at the
periodical controls (at 1,3,6.9.12 months). The intracavitary aspergillomas have
                                                                                        Table 1.
appeared 3 to 5 years after radiological stability in most of cases, 31 (70.45%)
manifested by small and repetitive haemoptoic sputum. In the rest of the cases,         Class of     Class II    Class III    Class IV    P (II vs    P (II vs   P (III vs
intracavitary aspergilloma was present at the same time with active bacillary
                                                                                        risk                                              III)        IV)        IV)
lesions, but with other pulmonary localisations.

E2721                                                                                   Number of    12          10           5           –           –          –
The diagnostic value of serum procalcitonin in differential diagnosis of                patients
pulmonary embolism and pneumonia                                                        Age          45.6±11.7 50.3±13.9 57.8±8.0         p = 0.4     p = 0.05   p = 0.3
N. Kokturk1 , A. Kanbay1 , N. Bukan2 , N. Ekim1 . 1 Pulmonary Medicine, Gazi            (years)
University School of Medicine, Ankara, Turkey; 2 Biochemistry, Gazi University          Fine score   61.5±4.9    80.3±5.8     98.8±7.1    p < 0.001 p < 0.001 p < 0.001
School of Medicine, Ankara, Turkey                                                      (points)
                                                                                        PCT level    1.28±1.26 2.22±1.98 3.52±2.75 p = 0.21           p = 0.14   p = 0.38
Presence of high fever may cause confusion in differential diagnosis of pulmonary       (ng/ml)
embolism (PE) versus pneumonia. Serum procalcitonin (PCT) level is a useful
test to identify bacterial infections. The aim of this study is to investigate the
diagnostic value of PCT in differential diagnosis of PE and community acquired
pneumonia (CAP). The second goal is to demonstrate possible relation of PCT
with other systemic markers in appropriately treated patients (pts). 22 pts with        E2724
                                                                                        Diagnostic errors of community-acquired pneumonias in outpatients
pneumonia and 24 pts with proven PE were included in the study. The study
                                                                                        E.I. Khristolubova1 , L.I. Volkova1 . 1 Internal Diseases Department, Siberian State
population was subdivided as CAP (group 1), PE with fever in first 72 hours
                                                                                        Medical University, Tomsk, Russian Federation
(group 2, n = 8); and PE without fever (group 3, n = 16). Serum PCT level was
measured in diagnosis day and the third day of treatment. The relation of PCT
with body temperature and serum leukocyte, CRP, and sedimentation (ESR) level           To determine the frequency of clinical signs and diagnostic errors in community-
were investigated in each measurement point. The initial mean serum PCT level           acquired pneumonia (CAP) on consulting a doctor for the first time.
in group 1 (2.61±2.91 ng/ml) was statistically different from group 2 (0.48±0.77        Medical cards of 345 outpatients having consulted a policlinic and had a diagnosis
ng/ml) and group 3 (0.14±0.17 ng/ml) (p = 0.000, 0.000, respectively). PCT level        of CAP after an X-ray examination have been studied.
at the initial (2.61±2.91 ng/ml) and the 3rd day of treatment (1.19±1.10 ng/ml)         Typical CAP symptoms on consulting a doctor first were observed not in all
in group 1 showed a statistically significant reduction (p = 0.007). There are no        patients: elevated temperature was noted in 87.5% of patients, nonproductive
statistically significant reduction in PCT levels by anticoagulation in group 2 and      cough was in 45.2% of examinees, productive cough was in 38.5% of cases,
3. Leukocyte, CRP and ESR levels were significantly decreased by the treatment in        bloody expectoration was seen in 2.9% of patients, pains in the chest was in 25.8%
all groups. Furthermore, the correlation of serum PCT level and body temperature,       of cases. In 26.9% of patients the initial clinical manifestations of pneumonia
leukocyte, CRP, ESR levels, was not reach statistical significance. This study           were masked by the symptoms of the upper respiratory tracts lesion. In 1.2%
shows that serum PCT level may be used for differentiating patients with PE with        of patients the onset of pneumonia had nontypical symptoms, namely: abdominal
or without fever than CAP.                                                              pains, nausea which simulated other diseases. Most patients had no objective signs
                                                                                        of pneumonia on the first day. Thus, the typical feature of pneumonia, namely:
E2722                                                                                   the presence of crepitation and moist rales was not observed in 78.9% of patients,
Ascaris pneumonia                                                                       the loss of resonance was revealed in 1.2% of cases only. In first time consulting
S. Diab. Medicine, Speciality Hospital, Amman, Jordan                                   a doctor the diagnosis of CAP was not made in 53% of patients. In most cases
                                                                                        (94.6%) incorrect diagnosis seemed to be acute respiratory tracts diseases (ARVI,
A 64-year old man presented with flue-like illness, fever, cough-, and sputum for        the flu, tracheitis, bronchitis), and in 5.4% of cases other diseases (appendicitis,
2months. He gave no history of haemoptysis,dyspnea,profuse sweating, loss of            pyelonephritis, myositis, measles, rubeola).
appetite and no history of weight loss. During the past few weeks, he received          The errors made by the doctor of policlinics on CAP diagnosting are associated
multiple courses of oral antibiotics without improvement for a diagnosis of             with diagnostic difficulties on the first days of a disease due to similar clinical
pneumonia                                                                               symptoms of pneumonia and ARVI and the absence of objective CAP symptoma-
Physical examinations vital signs were remarkable for a temperature of 38C, heart       tology, resulting in insufficient or delayed examination of patients.
rate of 90 beats/min, and respiratory rate of 18 breaths/min. Oxygen saturation
by pulse oximetry was 95%. There was no respiratory distress. Chest auscultation        E2725
revealed no signs. The rest of the examination was unremarkable. Laboratory and         Pulmonary aspiration of a four-unit temporary bridge during a dental
radiographic findings.                                                                   treatment procedure with late onset diagnosis: a case report
WBC count was 16 ×109 /L with neutrophilia of 80%. Platelet count was                   Hu. Lakadamyali, Ha. Lakadamyali, T. Dogan. Pulmonology Department, Baskent
450×109 /L. Serum electrolytes and renal functions were normal.                         University Alanya Research and Training Center, Antalya, Turkey; Radiology
Erythrocyte sedimentation rate 80 mm firs hour. chest radiography (Fig) CT chest         Department, Baskent University Alanya Research and Training Center, Antalya,
showed peripheral small mass anterior segment (RUL) with central necrosis.l.            Turkey; Anesthesiology and Reanimation Department, Baskent University Alanya
The patient underwent CT guided FNAC which ruled out tuberculo-                         Research and Training Center, Antalya, Turkey
sis &malignancy. The second presentation was with persistent low grade
fever,cough,sputum,anorexia,lassitude and dyspnea. Chest radiography showed an          Aspirations of teeth and dental implants are a recognized, yet an infrequent
increase in the side of the same mass and righr side pleural effusion The patient       happening in the literature. The main reasons of aspiration are maxillofacial
unde went.CT lung guided biopsy.                                                        trauma, dental treatment procedures or ethanol intoxication and dementia. A 53-
Low power magnification of the histopathology revealed inflammation. High power           year-old male referred to the our Chest Diseases Department because of left
magnification demonstrated Ascaris pneumonia with section of ascaris worm. The           sided recurrent pneumonia and shortness of breath. He had an unclear history

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                                                                     Monday, September 17th 2007

of his 4-unit temporary bridge aspiration during dental procedure 4 years ago.           imbalance was characterized by significant increase of elastase and trypsine-like
In our investigation foreign body was diagnosed neither at chest radiograph nor          activity against the background of expressed deficiency of the protease inhibitors.
at thorax CT. Although, at left main bronchus irregular mass was reported at             Thus, mean baseline levels of elastase, trypsine-like as well as middle molecules
the thorax CT. After diagnostic fiberoptic bronchoscopy the foreign body can              (MM) in serum were significantly elevated by ~5 times (in ~90% of the patients)
be seen. The procedure was changed to rigid bronchoscopy and a temporary                 and 2.5 times in all groups. Meanwhile the baseline levels of a1-antitrypsine
bridge (3.5 cm x 1.5 cm) was removed successfully. After 3 months follow-up              (a1 -AT) as well as a2 -macroglobuline (a2 -MG) were significantly decreased by
all the respiratory symptoms had relieved. In conclusion we think that diagnostic        ~2.0 times in all groups. Using EEDM corrected this imbalance. Such positive
bronchoscopy should be made to the adult patients who have recurrent pneumonias          dynamics was accompanied by decrease of endogenic intoxication signs. Thus,
and past dental procedures must be interrogated carefully. Also we have to know          the high MM and initial elastase levels as well as trypsine-like activity were
that direct radiography may not be enough to determine non-radiopaque foreign            significantly decreased: by 2.5; 3.1; 3.0 times; 2.1; 4.1; 6.6 times and by 3.8; 6.4;
bodies like temporary teeth.                                                             6.0 times after therapy in the 2d -4th groups respectively as compared with 1.8;
                                                                                         1.5; 2.1 times after STA. The level of a1 -AT was increased by 2.3; 2.3; 2.8 times
E2726                                                                                    (p < 0.05) in the 2d -4th groups respectively as well as the level of a2 -MG (up to
The correction of oxydant-antioxidant imbalance in severe                                normal in these groups). These inhibitors did not significantly change after STA.
community-acquired pneumonia (CAP) by extracorporeal efferent                            Conclusion. The use of EEDM is more effective (as compared with STA only)
detoxication methods (EEDM)                                                              for faster improvement of imbalance in proteases-inhibitors system.
A. Makarevich1 , J. Pancratova1 . 1 Internal Diseases N1, Belarusian State Medical
University, Minsk, Belarus

Background: The efficacy of EEDM as supportive option to standard treatment               E2729
with antibiotics (STA) of severe CAP has not been studied yet.                           Epidemiology and outcome of hospital-acquired and ventilator-associated
The aim was the analysis of EEDM influences on this imbalance in dynamics                 pneumonia at the Philippine General Hospital central intensive care unit
(pre-post therapy). 107 severe CAP in-patients (aged 18−60 yrs) were randomly            J. Sanico-Soliano, E. Dominguez. Internal Medicine, Philippine General Hospital,
divided into 4 comparable groups on admission. These patients underwent: STA             Manila, Philippines
(1st group) and additionally courses of extracorporeal ultraviolet light-exposure
(EUVLE), biospecific hemosoptions (BSS) and BSS plus EUVE (2d –3d –4th
                                                                                         Background: Inappropriate treatment of nosocomial pneumonia is a risk factor
groups respectively).
                                                                                         for increased mortality.
Results: The imbalance of the lipid peroxidation and antioxidant defense in blood
                                                                                         Objectives: (1) To determine the microbiology and outcomes of patients with
was characterized by a significantly increased baseline level of malondialdehyde
                                                                                         hospital-acquired and ventilator-associated pneumonia. (2) To determine the atti-
(MDA) by 30% as well as compensatory activity of syperoxidedysmutase (SOD)
                                                                                         tudes of physicians on antibiotic use given the results of semiquantitative cultures
by 1.7 times in all groups vs. the control. On the contrary, initial catalase activity
                                                                                         of respiratory specimens.
was significantly decreased (by 10%) in all groups. The high baseline level of
                                                                                         Methods: This is a cross-sectional cohort study involving 42 adult patients
MDA and SOD activity were significantly decreased by 17%; 33%; 30% and by
                                                                                         admitted at the Philippine General Hospital central intensive care unit between
1.7 times in the 2d -4th groups respectively, while it did not change during STA.
                                                                                         May 1, 2006 and July 31, 2006 who were diagnosed with hospital-acquired or
The catalase activity was also reduced after STA (by 18%; p < 0.05 vs the initial
                                                                                         ventilator-associated pneumonia. Attitudes of physicians in antibiotic selection
level), it did not change in the 2d group and increased by 6% and 13% (p < 0.05)
                                                                                         given the semi-quantitative culture of respiratory specimens, in-hospital mortality,
in patients of the 3d -4th groups (rising to the control level). This action of EEDM
                                                                                         length of ICU stay, and response to antibiotics were recorded.
was caused by the decreasing of oxidative stress in severe CAP.
                                                                                         Results: The most common pathogens isolated were Pseudomonas aeruginosa,
Conclusion: The use of EEDM (better BSS plus EUVLE) is more effective
                                                                                         Klebsiella pneumoniae and Acinetobacter baumanii. Seventy-six percent of the
(as compared with STA only) for faster improvement of imbalance in oxydant-
                                                                                         patients received culture-guided treatment and twenty-four percent received non-
antioxidant system.
                                                                                         culture guided treatment. There was resolution of pneumonia in ninety-one percent
                                                                                         of the culture-guided patients and in seventy-one percent of the non-culture guided
The correction of immune disorders by extracorporeal efferent detoxication               patients (p = 0.238, Fisher’s exact). All-cause mortality was 10% for the culture-
methods (EEDM) in severe community-acquired pneumonia (CAP)                              guided group and 28.5% for the non culture-guided group (p = 0.238, Fisher’s
                                                                                         exact). The average ICU stay was 23 days for the culture-guided group and 31
A. Makarevich1 , J. Pancratova1 . 1 Internal Diseases N1, Belarusian State Medical
                                                                                         days for the non culture-guided group.
University, Minsk, Belarus
                                                                                         Conclusions: The present analysis justified the use of semi-quantitative cultures in
                                                                                         the selection of proper antibiotic therapy in patients with nosocomial pneumonia.
The aim was the analysis of EEDM influence on the immune status of severe
CAP 107 in-patients who were randomly divided into 4 comparable groups on
admission. They underwent standard treatment with antibiotics (STA) and addi-
tionally, courses of extracorporeal ultraviolet light-exposure (EUVLE), biospecific
hemosoptions (BSS) and BSS plus EUVLE (2nd -4th groups respectively).
                                                                                         Prophylactic antibiotics will affect the occurrence of post-bronchoscopic
Results: The baseline changes of immune response concerned both cellular
                                                                                         fever and pneumonia in patient with endobronchial obstructive lesions?
(most – depression) and humoral (intensity) links. We mostly detected the relative
lymphopenia, deficiency of absolute count of T-B-lymphocytes, T-helper and                D.K. Kim1 , H.R. Kim2 , S.-W. Um2 , Y.W. Kim2 , S.K. Han2 , Y.-S. Shim2 ,
increase of T-supressors in all groups. The mean counts of T-B-lymphocytes               H.S. Chung1 . 1 Department of Internal Medicine, Seoul National University
and complement did not change during the treatment in all groups. Using EEDM             Boramae Hospital, Seoul, Korea, Republic of; 2 Department of Internal Medicine
led to the normalization of helpers/suppressors ratio by increasing of T-helper          and Lung Institute, Seoul National University College of Medicine, Seoul, Korea,
(significantly in 3d− 4th groups) and by lowering of T-supressors (in 3/4 patients        Republic of
of the 2nd -4th groups). The deficiency of T-helper kept during STA. Leucocyte
phagocytary activity was elevated by 26%, 33%, 24%; p < 0.05 in the 2d -4th              The presence of endobronchial obstructive lesion(s) was known as one of the
groups after treatment, while it did not change during STA. The baseline levels          risk factors of postbronchoscopic complication such as fever and pneumonia. The
of immunoglobulins (Ig) G, M, A were significantly increased in all groups and            effect of prophylactic antibiotics in developing postbronchoscopic complication
tended to normalize by the end of therapy. The mean Ig M level kept increased            was not well known. The aim of the study was to elucidate that prophylactic
(p < 0.05 vs the control) after STA in contrast to the significant Ig M reduction         antibiotics before bronchoscopy will decrease the occurrence of postbronchoscopic
in the 2nd -4th groups (by 18%; 31%, 24%). The level of circulating immune               complication.
complexes was decreased by 2 times (p < 0.05) in the 2nd group (less in the 3d -4th      A retrospective study was performed comparing the occurrence of postbrocho-
groups) but it did not change during STA.                                                scopic fever and pneumonia in patients with endobronchial obstructive lesion
Conclusion: Using EEDM caused faster improvement of immune disorders than                according to the use of prophylactic antibiotics.
STA only.                                                                                After excluding 23 patients treated with antibiotics to control the obstructive
                                                                                         pneumonia before bronchoscopy, 83 patients with endobronchial obstruction
E2728                                                                                    such as bronchogenic cancer, tuberculosis and antrhacofibrosis were enrolled. 26
The improvement of proteases-inhibitors imbalance in severe                              patients (27.7%) out of them were treated with prophylactic antibiotics before
community-acquired pneumonia (CAP) by extracorporeal efferent                            the bronchoscopy. Age, sex ratio, body mass index, the degree and level of
detoxication methods (EEDM)                                                              endobronchial obstruction, and the frequency of underlying diseases were not
A. Makarevich1 , J. Pancratova1 . 1 Internal Diseases N1, Belarusian State Medical       different between the groups. Among the patients who treated with prophylactic
University, Minsk, Belarus                                                               antibiotics, postbronchoscopic fever and new pneumonic infiltration on radiograph
                                                                                         were developed in 17 patients (29.8%) and 5 patients (8.8%) respectively. The
The aim was the analysis of EEDM influence on this imbalance in 107 severe CAP            incidence of postbronchoscopic fever and pneumonia were not different from
in-patients who were randomly divided into 4 comparable groups on admission.             those of control group. (p = 0.79 for fever, p = 0.319 for pneumonia)
They underwent standard treatment with antibiotics (STA; 1st group) plus, addi-          Even in the patients with the endobronchial obstructive lesion(s), administration of
tionally, courses with extracorporeal ultraviolet light-exposure (EUVE), biospecific      prophylactic antibiotics before the bronchoscopy will not affect the development
hemosoptions (BSS) and BSS plus EUVE (2nd -4th groups respectively). This                of postbrochoscopic fever or pneumonia.

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Electronic Poster Discussion                                                                                                                    Room B9 - 14:45-16:45

                                                                     Monday, September 17th 2007

E2731                                                                                     thoracoscopy in 16 patients. The median length of hospital stay was 18.5 days Vs
Effects of long-term azithromycin treatment in patients with non-cystic                   13 days Vs 9.5 days in the treatment groups respectively (p < 0.05; “wait/watch”
fibrosis stable bronchiectasis                                                             Vs others). The rates of surgical drainage were 31% Vs 41% Vs 81% respectively
M. Palop1 , A. De Diego1 , E. Martinez Moragon2 , M. Leon1 , J. Fullana2 ,                (p < 0.05; thoracoscopy Vs others).
M. Martinez Losa3 , J. Cortijo3 . 1 Pneumology, University Hospital La Fe, Valencia,      Conclusions: In the management of pleural empyema, a less aggressive approach
Spain; 2 Pneumology, Hospital Sagunto, Valencia, Spain; 3 Pharmacology, Facultat          to pleural space drainage resulted in fewer operative procedures but longer duration
of Medicine, University of Valencia, Valencia, Spain                                      of hospitalization. In the absence of definitive cost-effectiveness trials, patients’
                                                                                          preferences should be taken into consideration in deciding between the different
Objective: To investigate the clinical, functional and anti-inflammatory effects of        treatment strategies.
long-term treatment with azithromycin (AZ) in non-cystic fibrosis patients with
bronchiectasis (BQ).                                                                      E2734
Methods: Twenty five patients (15 F, 10M) with BQ who had not suffered any                 Efficacy and safety of various antimicrobial regimens in the treatment of
exacerbation in the last month were studied, 16 of them were treated with AZ 250          acute exacerbations of chronic bronchitis
mg three times per week during three months and 9 were studied like controls.             J. Minov1 , J. Karadzinska-Bislimovska1 , Z. Stojanovski1 , S. Stoleski1 . 1 Dpt of
Beside that, both groups were identically treated. Dyspnea (Borg scale), exacerba-        Cardiorespiratory Functional Diagnostics, Institute of Occupational Health-WHO
tions (No.) in the last three months, sputum volume (cc), sputum colour (15-point         Collaborating Center, Skopje, Fyrom (Macedonia)
scale), and health related quality of life (Questionnaire St.George) were measured
in both groups before and after treatment. Lung function, sputum culture, CT scan         Objective: To compare the efficacy and safety of the different antibiotics empir-
(Bhalla score) and inflammatory markers in blood (ESR, PCR),exhaled air (Nitric            ically administered for acute exacerbation of chronic bronchitis (AECB).
Oxide,) and exhaled condensed air (pH, nitrites, isoprostane) were assessed before        Methods: We performed an observational, non-randomised, open-label study
and after treatment.                                                                      including 207 patients with AECB, 118 males and 89 females, aged 24 to 81. All
Results: AZ produced a significant decrease in sputum volume [24(18)cc vs                  patients were followed up for 30 days, with an intermediate visits at 5 and 10 days
15(13)cc], dyspnea [1,6(1.05) vs 1.2(0,9)], and number of exacerbations. Health           at which they were asked about the duration of symptoms (increased expectoration,
related quality of life also improved after AZ [61(17) vs 40(16)]. However                increased dyspnea and/or presence of purulent sputum) and the side-effects of the
there were no significant differences in functional, radiological or inflammatory           drug. Four antibiotic regimens were evaluated: amoxicillin/clavulonic acid 875
variables after treatment. When comparing differences between patients treatred or        mg/125 mg twice daily for 10 days, cefuroxime 250 mg twice daily for 10 days,
not treated with AZ, only the number of exacerbations was significantly lowered            clarithromycin 500 mg twice daily for 10 days, and ciprofloxacin 500 mg twice
in patients in the latter group,                                                          daily for 10 days.
Conclusion: Long-term azythromicin treatment had some clinical benefits in                 Results: The clinical success rate, defined as a complete resolution or a re-
patients with non-cystic fibrosis stable bronchiectasis.                                   turn of the symptoms to the baseline severity, in the groups receiving amoxi-
Supported by Grant SVN 2005 and CYCYT_SAF05–669.                                          cillin/clavulonic acid, cefuroxime, clarithromycin, and ciprofloxacin was 68.9%,
                                                                                          75.0%, 72.7%, and 77.1%, respectively. The mean time to relief of the symptoms
E2732                                                                                     varied from 6.8 days with amoxicillin/clavulonic acid to 6.1 days with cefuroxime.
Community-acquired thoracic empyema in young adults                                       Relapse within the first month was registered in the group receiving clarithromycin
W.-E. Cheng1,2 , W. Chen1 , S.J. Liang1 , Y.-C. Lin1 , Y.-L. Tsai1 , C.-M. Shih1,2 .      and ciprofloxacin (3.1% and 2.6%, respectively). The prevalence of the adverse
  Divisions of Pulmonary and Critical Care Medicine, Departments of Internal              events varied from 10.4% with ciprofloxacin, following by 8.9% with amoxi-
Medicine, China Medical University Hospital, Taichung, Taiwan, Province of                cillin/clavulonic acid, 6.8% with clarithromycin to 6.1% with cefuroxime.
China; 2 School of Respiratory Therapy, China Medical University, Taichung,               Conclusions: Our findings indicate high efficacy and safety of all studied regimens
Taiwan, Province of China                                                                 in the treatment of AECB.

Objective: To evaluate the clinical characteristics, bacteriology, and therapeutic        E2735
outcomes of community-acquired thoracic empyema (CATE) in young adults.                   Thoracic empyema and drainage
Methods: From January 2001 to December 2006, four hundred and twenty-eight                J. Plutinsky1 , D. Magula1 , S. Petricek1 , K. Bitter1 , E. Pechacova1 . 1 2nd
adult patients with the diagnosis of thoracic empyema in a tertiary hospital were         Pneumology, Specialized Hospital St. Zoerardus Zobor, Nitra, Slovakia
retrospectively reviewed. Totally, there were 64 young adult patients who were
diagnosed of CATE enrolled in our series, including 56 men (87.5 %) and 8                 The chest drainage (CHD) is one of the methods used in the treatment of thoracic
women (12.5 %), and age ranged from 18 to 44 year-old (mean = 37).                        empyema (EMP).
Results: The most common underlying disease was alcoholism (28%), and the                 Aim of study: The authors – pneumologists – share their experience with CHD
most common isolated microorganism was Viridans streptococcus (25%). Among                in patients (pts) with EMP.
the 62 patients who underwent invasive drainage procedure, forty (64%) patients           Methods: 103 pts underwent CHD for EMP. The standard indication for CHD
who received pigtail tube drainage as their initial treatment yielded a success           was pus or the level of pH (<7.1), glucose (<2 mmol/l) in pleural effusion (PE).
rate of 70 %. Fifteen (24%) patients who received video-assisted thoracoscopic            CHD was also performed on pts with fever, history of unsuccessful treatment
surgery as first-line treatment yielded a success rate of 100 %. Further comparing         with antibiotics (ATB), loculated PE, microorganism found in pleural sample
variables between septic shock and nonseptic shock patients, serum C-reactive             and a high number of polymorphonuclear in PE. The localisation of CHD was
protein (CRP) level on the first admission day (22.9±9.1 vs. 13.2±8.1 mg/dl,               determined by USG or CT examinations. A chest drain from 16 to 24 CH, active
p < 0.05), presence of bacteremia (60 vs. 13 %, p < 0.05), and occurrence of              or passive suction systems were used in management. CHD was removed when
polymicrobial infection (30 vs. 6 %, p < 0.05) were statistically significant.             PE was clear, sterile and its production was <50−75 ml/24 hours. ATB and local
Conclusions: Viridans streptococcus was the most frequently isolated causative            sterilising solutions were applied.
microorganism in young adults CATE and alcoholism was the most common                     Results: CHD was performed in 83 M, mean age 54.9±15.2 yrs and in 20 F
underlying disease. Moreover, higher serum CRP level on the first admission day,           53.9±20.2 yrs. Encapsulated EMP was found in 43 pts (41.7%), pyopneumothorax
occurrence of bacteremia, and presence of polymicrobial infection were significant         in 20 pts (19.4%). The mean pH in PE was 7.22±0.22, mean glucose 2.7±2.4
risk factors for developing septic shock.                                                 mmol/l, LDH 46.3±62.9 ukat/l, ADA 110.6±80.7 nkat/l. 53 pts (51.5%) had
                                                                                          parapneumonic EMP. Pathogens were isolated in 26 (25.2%) pts. Median drainage
E2733                                                                                     was 12 (2−59) days in M and 13.5 (3−44) in F. CHD was successful in 86 pts
The relation between timing of surgical drainage and results in pleural                   (83.5%), 7 pts underwent surgical treatment (6.8%), 8 pts died (7.8%) and the
empyema                                                                                   status of 2 pts was unchanged.
T.K. Lim1 , K.L. Khoo1 , J. Tham2 . 1 Medicine, National University Hospital,             Conclucions: CHD is an effective method for treat EMP. We have good experience
Singapore; 2 Thoracic Surgery, National University Hospital, Singapore                    with various diameter of drains, with ATB or sterilising solutions. An experienced
                                                                                          staff, suitable equipment and skilful of draining pneumologist is essential.
Introduction: There is uncertainty regarding the best treatment of pleural
empyema, in particular with regards to the timing of operative drainage. In-              E2736
trapleural streptokinase (SK), when compared with saline, neither reduces the             An unusual empyema case (candida curvata) and succesfull treatment
need for surgical drainage nor improved patient outcomes. Ongoing European and            A. Ozturk1 , D. Karnak1 , S. Beder1 , O. Kayacan1 . 1 Chest Diseases, Ankara
American trials examine the roles of more aggressive treatment with thoracoscopy          University School of Medicine, Ankara, Turkey
and early surgical drainage respectively. The aim of this study was to compare
the results of surgical drainage undertaken at different times following diagnosis        Empyema is the pus in the pleural space which is the end stage of a compli-
of pleural empyema.                                                                       cated pneumonia or effusion. Fungi can cause empyema very rarely. Especially
Methods: This was a sequentially controlled study of 3 management strategies in           immunocompromised hosts are known to susceptable to fungal disease including
consecutive patients with pleural empyema. We compared treatment with a “wait             empyema. Herein we report a 68 years-old female with empyema complaining
and watch” strategy following chest-tube insertion Vs chest-tube with a view to           of fever and weakness occured just after right mastectomy and existed during
surgical drainage after 3 days of SK Vs immediate thoracoscopy followed, in               last two or three weeks. On physical examination; fever, paleness and decreased
non-responders, by conversion to surgical drainage.                                       breath sounds at the lower right hemitorax was determined. On the chest x-ray and
Results: We treated 54 patients with pleural empyema. The treatment consisted of          thorax computed tomography, dense-loculated fluid collection with air-fluid level
chest-tube then “wait and watch” in 16 patients Vs 3 days of SK in 22 patients Vs         was detected in the right pleural space. Extensive antibiotic therapy was started

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Electronic Poster Discussion                                                                                          Room B9 - 14:45-16:45

                                                                  Monday, September 17th 2007

emprically containing gram negative and positive spectrum including anaerobes.
Pleural fluid was removed via thoracentesis revealing Escherichia coli type bacilli
which was resistant to almost every antibiotics. Twenty days later, Candida curvata
grew on the fungal culture of the specimen. Image guided catheter was placed into
loculation and Amphotericine B was given 25 mg via intrapleural catheter and 75
mg intravenously for fifteen days. Within first week, her clinical symptoms and
signs began to improve. Pseudomonas aeruginosa also grew on culture during this
therapy and imipenem-amikacin combination was also commenced. After catheter
was removed, she was discharged on oral antifungal therapy (itracanazole) and
large spectrum cephalosporin (cefixime) for six weeks. On control admission, her
chest and clinical findings almost completely recovered proved by radiology and
clinical examination. To our best knowledge, this is the first reported case of
Candida curvata empyema.

Pulmonary diseases in patients 90 years of age and older
S. Akcay1 , S.S. Ulasli1 , G. Ulubay1 , I. Dogrul1 . 1 Pulmonary Diseases, Baskent
University School of Medicine, Ankara, Turkey

Introduction: Clinicians now meet very elderly patients more frequently owing to
improvements in medical care and facilities. Treatment modalities for respiratory
diseases need to be well defined in very elderly patients. This study sought to
reveal the clinical course and prognosis of respiratory diseases in patients 90
years of age.
Methods: We retrospectively analyzed data from 79 patients (35 men; mean
age, 92.18 years) admitted with respiratory problems between 2003 and 2007.
Demographic data, laboratory test results, possible risk factors for pulmonary
diseases, functional statuses, and mortality rates were obtained.
Results: 39 (49.5%) had pneumonia, 27 (34.4%) had COPD, 6 had bronchial
asthma, 5 had pulmonary thromboembolism, 3 had pulmonary edema, 3 had pleu-
ral effusion, and 2 had lung carcinoma. Pneumonia was classified as community-
acquired (CAP) in 26 patients (64.9%) and hospital-acquired (HAP) in 13
patients (35.1%). None of the patients stayed in a nursing home. A significant
difference was found regarding mortality rates between patients with hospital-
acquired pneumonia (61.5 %) and CAP (18.5 %) (P = 0.007). The mortality rate
for COPD was 27.3%. The overall mortality rate was 23.1%. The mortality rate
in very elderly patients was found to be associated with pneumonia, difficulty in
swallowing, inability of oral intake, immobility, and congestive heart failure.
Conclusions: The most common cause of admission to our clinic in very elderly
patients was pneumonia. The mortality rate for CAP in very elderly patients was
similar to the mortality rate in younger persons. Advanced diagnostic tests and
treatment modalities should be used in very elderly patients, as was the case in
our relatively large series.

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