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ABSTRACT Background and objective Post-intubation tracheal stenosis ( PITS) and post-tracheostomy tracheal stenosis ( PTTS) are serious complications in mechanically ventilated patients. Although the aetiologies and mechanisms of PITS and PTTS are quite different, little is known about the clinical impact of differentiating one from the other. Methods We retrospectively conducted a chart review of 117 patients with PITS and 88 patients with PTTS who were treated with interventional bronchoscopy at Samsung Medical Center between January 2004 and December 2013. Results Compared to patients with PITS, patients with PTTS had a lower BMI, poorer performance status and more frequent neurological aetiologies, mid-to-lower tracheal lesions, total obstruction and mixed stenosis types. Although there were no differences in the number of patients who received silicone stents between the two groups, Montgomery T-tubes were more frequently used in the PTTS group than in the PITS group. The final success rate without surgery, mortality or tracheostomy in situ was higher in the PITS group than in the PTTS group (76.9% vs 63.6%, P = 0.043). Additionally, airway prosthesis removal was achieved in 46.2% of patients in the PITS group and in 33.0% of the PTTS group ( P = 0.063). Conclusion There were significant differences between PITS and PTTS in terms of patient and stenosis characteristics, treatment modalities and clinical outcomes. Therefore, PITS and PTTS should be considered two different entities. [ABSTRACT FROM AUTHOR]

Background: Clinical data for bacterial coinfection of the lower respiratory tract in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) are scarce. This study aims to assess the prevalence of bacterial coinfection and clinical features in NTM-PD patients., Methods: This retrospective study screened 248 patients with NTM-PD who underwent bronchoscopy between July 2020 and July 2022, from whom newly diagnosed NTM-PD patients were analyzed. Bacterial culture using bronchial washing fluid was performed at the time of NTM-PD diagnosis., Results: In the 180 patients (median age 65 years; 68% female), Mycobacterium avium complex (86%) was the most frequent NTM isolated. Bacterial coinfections were detected in 80 (44%) patients. Among them, the most common bacterium was Klebsiella pneumoniae (n=25/80, 31.3%), followed by Pseudomonas aeruginosa (n=20/80, 25%) and Staphylococcus aureus (n=20/80, 25%). Compared with NTM-PD patients without bacterial coinfections, patients with bacterial coinfections showed more frequent extensive lung involvement (33% vs. 1%, p<0.001). Additionally, compared with NTM-PD patients without P. aeruginosa infection, those with P. aeruginosa infection were older (74 years vs. 64 years, p=0.001), had more frequent respiratory symptoms (cough/excessive mucus production 70% vs. 38%, p=0.008; dyspnea 30% vs. 13%, p=0.047), and had extensive lung involvement (60% vs. 9%, p<0.001)., Conclusion: Less than half of patients with newly diagnosed NTM-PD had bacterial coinfections, linked to extensive lung involvement. Specifically, P. aeruginosa coinfection was significantly associated with older age, more frequent respiratory symptoms, and extensive lung involvement.

Background: There is insufficient data on the benefits of empiric antibiotic combinations for hospital-acquired pneumonia (HAP). We aimed to investigate whether empiric anti-pseudomonal combination therapy with fluoroquinolones decreases mortality in patients with HAP., Methods: This multicenter, retrospective cohort study included adult patients admitted to 16 tertiary and general hospitals in Korea between January 1 and December 31, 2019. Patients with risk factors for combination therapy were divided into anti-pseudomonal non-carbapenem β-lactam monotherapy and fluoroquinolone combination therapy groups. Primary outcome was 30-day mortality. Propensity score matching (PSM) was used to reduce selection bias., Results: In total, 631 patients with HAP were enrolled. Monotherapy was prescribed in 54.7% (n = 345) of the patients, and combination therapy was prescribed in 45.3% (n = 286). There was no significant difference in 30-day mortality between the two groups (16.8% vs. 18.2%, P = 0.729) or even after the PSM (17.5% vs. 18.2%, P = 0.913). After the PSM, adjusted hazard ratio for 30-day mortality from the combination therapy was 1.646 (95% confidence interval, 0.782-3.461; P = 0.189) in the Cox proportional hazards model. Moreover, there was no significant difference in the appropriateness of initial empiric antibiotics between the two groups (55.0% vs. 56.8%, P = 0.898). The proportion of multidrug-resistant (MDR) pathogens was high in both groups., Conclusion: Empiric anti-pseudomonal fluoroquinolone combination therapy showed no survival benefit compared to β-lactam monotherapy in patients with HAP. Caution is needed regarding the routine combination of fluoroquinolones in the empiric treatment of HAP patients with a high risk of MDR., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2023 The Korean Academy of Medical Sciences.)

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are important causes of hospital admission and mortality. Pneumonia is a major contributor to hospitalization for AECOPD and has a close relationship with poor outcomes. We performed a prospective cohort study to evaluate the prognosis of AECOPD patients with or without community-acquired pneumonia (CAP) who hospitalized from January 2012 to December 2015. We investigated mortality and readmission rates within 6 months after the first admission between two groups and analyzed the difference of survival rate according to readmission duration (≤30 vs. >30 days) or intensive care unit (ICU) treatment. Total 308 AECOPD patients (134 with CAP and 174 without CAP) were enrolled. The mean age was 72.3 ± 9.5 years old, and 235 patients (76.3%) were male. The 180-day mortality was higher in AECOPD with CAP than without CAP (24.6% vs. 13.2%; hazard ratio (HR): 1.982; 95% CI: 1.164-3.375; p = 0.012). However, readmission rate showed no significant difference between two groups (51.5% vs. 46.6%; HR: 1.172; 95% CI: 0.850-1.616; p = 0.333). It showed a significantly lower survival rate in AECOPD with CAP rather than without CAP when were readmitted within 30 days (HR: 1.738; 95% CI:1.063-3.017; p = 0.031). According to ICU treatment, survival rate was not significantly different between two groups. Multivariate analysis revealed the readmission within 30 days ( p  <  0.001), serum hemoglobin concentration ( p  =  0.010), and albumin level ( p =  0.049) were significantly associated with 180-day mortality of AECOPD with CAP. AECOPD with CAP showed lower survival rate than AECOPD without CAP during 6 months. Early readmission within 30 days was significantly associated with an increased risk of mortality.