Researchers

1. The study of Pathogens causing Community Acquired Pneumonia in hematological malignancy patients comparing to general patients who hospitalized in Naresuan University Hospital

2. Researchers • Chatchawan Aungsirikultumrong code51460773 • Teerasit Viyanantcode 52460420 • Sireekarn Samanukorn code52461045 Advisor • Dr. Thanakorn Laksomya • Dr. Suwit Leartkajonsin

3. Agenda • Background • Objectives • Research methodology • Result • Discussion • Conclusion • Recommendation

4. 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)

5. 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)

6. 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

7. 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

8. 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

9. Research methodology (1) Patient population Data collection Statistical analysis

10. Research methodology (2) • Type of research • Retrospective study • Cross-sectional descriptive study • Source • Medical record NU hospital

11. Patient population Patient n=237 Inclusion criteria Exclusion criteria • Group 1general patients with CAP • Group2hematological malignancy patients with cap • Age > 15 years • 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 n=41 General host n=36 Hematologic malignancy N=5

12. Statistical analysis Descriptive study Microsoft office excel STATA Table & Bar chart

13. Data collection (1)

14. Data collection (2)

15. Result

16. Normal host Hematological malignancy Sex

17. Normal host Hematological malignancy Age 50%

18. Initial laboratory(1)

19. Initial laboratory(2)

20. Initial antibiotic

21. 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

22. Sputum culture (2) P. aeruginosa Normal flora Hematological malignancy (%) N = 5

23. Hemoculture (1) K.pneumoniae Normal flora Normal host (%) N = 36

24. Hemoculture (2) K.pneumoniae Normal flora Hematological malignancy (%) N = 5

25. 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 • Most patients are 65 years old and above in both groups

26. 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)

27. 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

28. 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

29. Discussion (5) • The most initial antibiotic used in general patients with Community Acquired Pneumonia • 1. ceftriaxone and ceftriaxone with clarithromycin • 2. amoxicillin/clavulanate andceftriaxone with azithromycin • These initial antibiotic could cover the pathogens causing Community Acquired Pneumonia in general patients who admitted in Naresuan University Hospital

30. 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

31. Conclusion The pathogens in hematological malignancy patient are different from general patient The initial antibiotic doesn’t cover this pathogens

32. Recommendation (1) The selection of antibiotic for treatment should cover the pathogens The patient should be taken sputum culture and hemoculture

33. Recommendation (2) • Study in different population • DM • Patient on immunosuppressant • Other malignancy • Study in out-patient department

34. 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.

35. 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. • สมาคมอุรเวชช์แห่งประเทศไทย. แนวทางการรักษาโรคปอดอักเสบชุมชนในประเทศไทย(สำหรับผู้ใหญ่). (2544). สมาคมอุรเวชช์แห่งประเทศไทย : กรุงเทพฯ. 3–16. • วิภา รีชัยพิชิตกุล. (2554). Pneumonia in ambulatory care. วารสารอายุรศาสตร์อีสาน, 10(3). 83 – 93.

36. References (3) • วัชรี แก้วนอกเขา. (2554). โรคปอดอักเสบ ประเทศไทย ปี พ.ศ. 2548-2553. Weekly epidemiological Surveillance report, 43. 90-98.

37. Thank You !