Acute and Critical Care

Original Articles

Infection
Impact of negative-pressure room utilization in the emergency department on hospitalized pneumonia patients during the COVID-19 pandemic in Thailand: Teeravit Danrungrot, Theerapon Tangsuwanaruk, Wachira Wongtanasarasin, Borwon Wittayachamnankul; Received August 22, 2025 Accepted December 25, 2025 Published online March 27, 2026; DOI: https://doi.org/10.4266/acc.003350 [Epub ahead of print]

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Abstract PDF: Background
During the coronavirus disease 2019 (COVID-19) outbreak, negative-pressure rooms were implemented to isolate high-risk COVID-19 patients. This study compared pneumonia patient outcomes before and after their implementation, focusing on in-hospital mortality as the primary outcome.
Methods
We conducted a retrospective cohort study of adult pneumonia patients admitted to a tertiary hospital in Northern Thailand, excluding those with trauma-related illness, out-of-hospital cardiac arrest/in-hospital cardiac arrest, or incomplete data. The primary outcome was in-hospital mortality, and the outcomes were door-to-first doctor contact time, door-to-antibiotic time, emergency department (ED) length of stay (LOS), intensive care unit (ICU) admission, and 30-day mortality.
Results
Data from 220 pneumonia patients (104 pre-pandemic, 116 pandemic) were analyzed. Of these, 58.6% were elderly males with comorbidities like hypertension and diabetes. Door-to-first doctor contact time was longer during the pandemic (median, 1 vs. 0 minutes; P<0.001), as was ED LOS (median, 5.9 vs. 4.1 hours; P<0.001). Door-to-antibiotic time was also longer in unadjusted comparisons (median, 60.0 vs 36.5 minutes; P<0.001), but the difference was attenuated and not statistically significant after adjustment (adjusted mean difference, 14.2 minutes; P=0.071). No significant differences in in-hospital mortality, 30-day mortality, or ICU admissions were observed.
Conclusions
Negative-pressure rooms led to increased door-to-doctor contact time and ED LOS during COVID-19, although without significant differences in mortality. These findings highlight the need to improve ED workflows for future pandemic preparedness.

Pulmonary
Incidence and risk factors associated with progression to severe pneumonia among adults with non-severe Legionella pneumonia: Jin-Young Huh, Sang-Ho Choi, Kyung-Wook Jo, Jin Won Huh, Sang-Bum Hong, Tae Sun Shim, Chae-Man Lim, Younsuck Koh; Acute Crit Care. 2022;37(4):543-549. Published online October 21, 2022; DOI: https://doi.org/10.4266/acc.2022.00521

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Background
Legionella species are important causative organisms of severe pneumonia. However, data are limited on predictors of progression to severe Legionella pneumonia (LP). Therefore, the risk factors for LP progression from non-severe to the severe form were investigated in the present study.
Methods
This was a retrospective cohort study that included adult LP patients admitted to a 2,700-bed referral center between January 2005 and December 2019.
Results
A total of 155 patients were identified during the study period; 58 patients (37.4%) initially presented with severe pneumonia and 97 (62.6%) patients with non-severe pneumonia. Among the 97 patients, 28 (28.9%) developed severe pneumonia during hospitalization and 69 patients (71.1%) recovered without progression to severe pneumonia. Multivariate logistic regression analysis showed platelet count ≤150,000/mm3 (odds ratio [OR], 2.923; 95% confidence interval [CI], 1.100–8.105; P=0.034) and delayed antibiotic treatment >1 day (OR, 3.092; 95% CI, 1.167–8.727; P=0.026) were significant independent factors associated with progression to severe pneumonia.
Conclusions
A low platelet count and delayed antibiotic treatment were significantly associated with the progression of non-severe LP to severe LP.

Citations

Citations to this article as recorded by

Understanding the Correlation between Blood Profile and the Duration of Hospitalization in Pediatric Bronchopneumonia Patients: A Cross-Sectional Original Article
Dessika Listiarini, Dev Desai, Yanuar Wahyu Hidayat, Kevin Alvaro Handoko
The Journal of Critical Care Medicine.2024; 10(3): 254. CrossRef
An Investigation of Mortality Associated With Comorbid Pneumonia and Thrombocytopenia in a Rural Southwest Missouri Hospital System
Tabitha Ranson , Hannah Rourick , Rajbir Sooch , Nicole Ford, Nova Beyersdorfer, Kerry Johnson, John Paulson
Cureus.2024;[Epub] CrossRef
Legionella Pneumonia Undetected by Repeated Urinary Antigen Testing With Ribotest® Legionella
Yasushi Murakami, Mika Morosawa, Yasuhiro Nozaki, Yoshio Takesue
Cureus.2024;[Epub] CrossRef
Atraumatic Splenic Rupture in Legionella pneumophila Pneumonia
Elliott Worku, Dominic Adam Worku, Salim Surani
Case Reports in Infectious Diseases.2023; 2023: 1. CrossRef
Short- and long-term prognosis of patients with community-acquired Legionella or pneumococcal pneumonia diagnosed by urinary antigen testing
Leyre Serrano, Luis Alberto Ruiz, Silvia Perez-Fernandez, Pedro Pablo España, Ainhoa Gomez, Beatriz Gonzalez, Ane Uranga, Sonia Castro, Milagros Iriberri, Rafael Zalacain
International Journal of Infectious Diseases.2023; 134: 106. CrossRef
Case report: Fatal Legionella infection diagnosed via by metagenomic next-generation sequencing in a patient with chronic myeloid leukemia
Chunhong Bu, Shuai Lei, Linguang Chen, Yanqiu Xie, Guoli Zheng, Liwei Hua
Frontiers in Medicine.2023;[Epub] CrossRef

Case Report

Endocarditis Caused by Community-Acquired Klebsiella pneumoniae Infection - A Case Report -: Ji Ae Hwang, Charles Her, Yang Wook Kim; Korean J Crit Care Med. 2013;28(1):41-45.; DOI: https://doi.org/10.4266/kjccm.2013.28.1.41

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Abstract PDF

In community-acquired Klebsiella pneumoniae infection, pyogenic liver abscess is common as a primary site of infection, particularly in Asia, that can progress to bacteremia. Diabetes mellitus is a usual predisposing factor. Pneumonia as primary site of infection by community-acquired Klebsiella pneumoniae infection is not common but carries a poor outcome. Early administration of appropriate antibiotics is extremely important to avoid the development of bacteremia and septicemia. An infective endocarditis caused by community-acquired Klebsiella pneumoniae infection is very rare; particularly, such a case of endocarditis in which pneumonia was the primary site of infection has never been reported previously. In this report we described a case of community-acquired Klebsiella pneumoniae infection that started with pneumonia and progressed to bacteremia, leading to endocarditis, liver abscess, and other systemic septic complications. Delayed administration of appropriate antibiotics may have played a role in this case.

Citations

Citations to this article as recorded by

Double trouble: an unusual case of Klebsiella pneumoniae invasive syndrome with liver abscess, gallbladder empyema and infective endocarditis
Ze Chen Lee, Chu Ee Seow, Petrick Periyasamy
BMC Infectious Diseases.2024;[Epub] CrossRef
Infective endocarditis due to Klebciella pneumonia
Masoume Mesgarian, Mehrangiz Zanganeh, Mino Shafiei, Hoda Kermsetji, Sahr Shador
Medical Sciences Journal of Islamic Azad University.2024; 34(4): 456. CrossRef
Infective endocarditis caused by Klebsiella pneumoniae in a patient with non ST elevation myocardial infarction
M.Yu. Zhilinskiy, N.V. Mukhina, I.S. Komarova, S.A. Rachina, N.A. Cherkasova, A.B. Borisov, L.V. Fedina, S.M. Nasrulloeva
Clinical Microbiology and Antimicrobial Chemotherapy.2023; 25(1): 100. CrossRef
Infective endocarditis by Klebsiella species: a systematic review
Petros Ioannou, Eugenia Miliara, Stella Baliou, Diamantis P. Kofteridis
Journal of Chemotherapy.2021; 33(6): 365. CrossRef

Original Article

Change of Antibiotics Resistance Pattern of Microorganism Cultured in Tracheal Aspirate in Mechanical Ventilated Patients after Antibiotics Restriction Policy: Jeong Eun Ma, Soo Kyong Kim, Min Kyung Kang, Yi Yeong Jeong, Ho Cheol Kim, Jong Deok Lee, Young Sil Hwang; Korean J Crit Care Med. 2008;23(1):25-29.; DOI: https://doi.org/10.4266/kjccm.2008.23.1.25

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Abstract PDF

BACKGROUND
To reduce production of resistant bacteria by over-use of antibiotics, an antibiotics restriction policy became effective in several hospitals. However, there are different views on its effect. This study aims to examine antibiotic resistance of pathogenic organisms cultured in tracheal aspirates of the patients who need to maintain mechanical ventilation in medical intensive care unit before and after the antibiotics restriction policy.
METHODS
Before and after 2 years from August 2003, when carried out the antibiotics restriction policy in Gyeongsang university hospital, it was retrospectively investigated the antibiotic resistance pattern of bacteria cultured in tracheal aspirates of the patient who is maintained by mechanical ventilation more than 48 hours in the medical intensive care unit. Restricted antibiotics are ceftazidime, piperacillin/tazobactam, imipenem, meropenem, vancomycin, and teicoplanin.
RESULTS
Before the antibiotics restriction policy, (Sep 2001~Aug 2003) and after, (Sep 2003~Aug 2005), there were 306 and 565 patients applied in each case and the total use of antibiotics, except piperacillin/tazobactam, was reduced and that of cefotaxime and ceftriaxone was increased. There was no significant change in antibiotic resistance among Acinetobacter, Pseudomonas, and Enterobacter species.
CONCLUSION
The result of this study shows that the antibiotics restriction policy does not reduce production of antibiotic resistant bacteria in tracheal aspirate in a medical intensive care unit. However, it is considered that long-term observation may be necessary.

Citations

Citations to this article as recorded by

Clinical Characteristics in Patients with Carbapenem-ResistantAcinetobacter baumanniiIsolates from Tracheal Secretions
Jeong Ha Mok, Mi Hyun Kim, Kwangha Lee, Ki Uk Kim, Hye-Kyung Park, Min Ki Lee
Korean Journal of Critical Care Medicine.2013; 28(3): 173. CrossRef
Overview of Antibiotic Use in Korea
Baek-Nam Kim
Infection & Chemotherapy.2012; 44(4): 250. CrossRef

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