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The Korean Journal of Medicine 2009;77(1): 84-90.
파상풍 환자의 합병증 빈도와 원내 폐렴발생의 위험인자 분석
이성지, 강승지, 장미옥, 정숙인, 박경화
Incidence of complications and risk factors for nosocomial pneumonia in patients with tetanus
Sung Ji Lee, Seung Ji Kang, Mi Ok Jang, Sook In Jung, Kyung Hwa Park
Tetanus is a fatal disease and various complications affect its prognosis. In Korea, tetanus cases have been reported, but no studies, thus far, have examined its complications. We investigated the complications of tetanus and analyzed the risk factors for nosocomial pneumonia, one of most common complications of tetanus.
We retrospectively reviewed the clinical features, treatment, and complications of 42 patients diagnosed with tetanus at Chonnam National University Hospital from January 1999 through June 2008. The severity of tetanus was assessed using the APACHE II and Ablett scores. We compared two groups, one with nosocomial pneumonia and the other without it, and analyzed the risk factors for nosocomial pneumonia.
Forty-two patients (13 men, 29 women) were enrolled. Only three of them had received a primary tetanus vaccination; the others had not received primary or booster vaccinations. Twenty-one patients needed mechanical ventilation. The most common infectious complication was pneumonia (47.4%), followed by blood stream (15.8%) and urinary tract (13.2%) infections. Regarding noninfectious complications, dysautonomia was also common, including fluctuating blood pressure (31.6%), arrhythmias (26.3%), and cardiac arrest (7.9%). Nosocomial pneumonia was associated with autonomic disturbance (OR=32.0, 95% CI 1.9-524.2; p=0.005) and length of stay in the intensive care unit (OR=1.145, 95% CI 1.02-1.29; p=0.024) in the multivariate analysis.
Careful monitoring and treatment of complications are essential in managing tetanus, along with specific therapy for tetanus itself. Education and tetanus immunization are important for preventing the disease, especially in high-risk areas. (Korean J Med 77:84-90, 2009)
Keywords: Tetanus; Complications; Pneumonia
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