scholarly journals Antimicrobial Susceptibility among Pathogens Isolated in Early- versus Late-Onset Ventilator-Associated Pneumonia

2021 ◽  
Vol 13 (2) ◽  
pp. 401-410
Author(s):  
Hend Ben Lakhal ◽  
Aymen M’Rad ◽  
Thierry Naas ◽  
Nozha Brahmi
Keyword(s):  
Early Onset ◽  
Bacterial Culture ◽  
Late Onset ◽  
Multidrug Resistant ◽  
First Episode ◽  
High Morbidity ◽  
Ventilator Associated Pneumonia ◽  
Bacterial Isolates ◽  
Positive Bacterial Culture ◽  
Significant Difference

Ventilator-associated pneumonia (VAP) is associated with increased hospital stay and high morbidity and mortality in critically ill patients. The aims of this study were to (i) determine the incidence of multidrug-resistant (MDR) pathogens in the first episodes of VAP and to assess potential differences in bacterial profiles of subjects with early- versus late-onset VAP. This was a retrospective cohort study over a period of 18 months including all patients who had a first episode of VAP confirmed by positive bacterial culture. Subjects were distributed into two groups according to the number of intubation days: early-onset VAP (<5 days) or late-onset VAP (≥5 days). The primary endpoint was the nature of causative pathogens and their resistance profiles. Sixty patients were included, 29 men and 31 women, with an average age of 38 ± 16 years. The IGS 2 at admission was 40.5 [32–44] and APACHE was 19 [15–22]. Monomicrobial infections were diagnosed in 77% of patients (n = 46). The most frequently isolated bacteria were A. baumannii, 53% (n = 32); P. aeruginosa in 37% (n = 22); Enterobacterales in 28% (n = 17) and S. aureus in 5% (n = 3). Ninety-seven percent of the bacteria were MDR. The VAP group comprised 36 (60%) episodes of early-onset VAP and 24 (40%) episodes of late-onset VAP. There was no significant difference in the distribution of the bacterial isolates, nor in terms of antibacterial resistances between early- and late-onset VAPs. Our data support recent observations that there is no microbiological difference in the prevalence of potential MDR pathogens or in their resistance profiles associated with early- versus late-onset VAPs, especially in countries with high rates of MDR bacteria.

scholarly journals The effect of prior antimicrobial therapy for community acquired infections on the aetiology of early and late onset ventilator-associated pneumonia in a level I trauma intensive care unit

2017 ◽  
Vol 32 (3) ◽  
pp. 91-95
Author(s):  
Yogandree Ramsamy ◽  
David J.J. Muckart
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Antimicrobial Therapy ◽  
Late Onset ◽  
Bacterial Flora ◽  
First Episode ◽  
Ventilator Associated Pneumonia ◽  
Bacterial Isolates ◽  
Prior Therapy ◽  
Hospital Acquired

Background: Ventilator-associated pneumonia (VAP) is the most common hospital acquired infection in patients who require mechanical ventilation. Early VAP is associated with community acquired pathogens whereas late VAP involves hospital flora. Based on this premise, a protocol may be formulated for microbiological surveillance and antimicrobial stewardship within a specific intensive care unit (ICU) to ensure appropriate empiric antimicrobial choice. The bacterial flora in VAP may be affected, however, by antimicrobials prescribed during the ICU stay. Aim: The aim of this study was to determine the effect of prior antimicrobial therapy for community acquired infections on aetiology and the susceptibility of bacterial isolates from the first episode of early or late VAP in a trauma intensive care unit.Methods: Endotracheal aspirates (ETAs) were obtained from patients with suspected early and late VAP. All ETAs were processed and interpreted as per the Clinical and Laboratory Standards Institute (CLSI). Patients were divided into two cohorts: those whose injuries had required antimicrobial therapy for community acquired infections and those who were antimicrobial naïve. The effect of prior antimicrobial therapy on bacterial isolates from the first episode of suspected VAP was compared between the two groups.Results: Of 288 patients admitted to the Trauma ICU between January and December 2014, pneumonia was suspected in 91 (31.6%). Of these, 69 (76%) patients were antimicrobial naïve and 22 (24%) had received prior antimicrobial therapy. Early VAP occurred in 31 (45%) patients in the naïve cohort compared to 3 (12.5%) with prior antimicrobial exposure (p = 0.01). Of the early VAP isolates 25 (81%) in the naïve cohort contained community flora, whereas all isolates in those with prior antimicrobial therapy revealed hospital acquired organisms (p = 0.01). In the antimicrobial naïve cohort with late VAP 27 (71%) patients had community acquired organisms, whereas only 3 (16%) isolates in late VAP in those with prior therapy revealed community acquired flora (p 0.001).Conclusion: Patients who receive prior antimicrobial therapy have a significantly lower incidence of early VAP, but in those who developed either early or late VAP hospital acquired pathogens were more commonly isolated. Knowledge of prior antimicrobial exposure in a patient with early or late VAP will assist in determining the correct empiric antimicrobial choice.

Risk Factors for Early-onset, Ventilator-associated Pneumonia in Critical Care Patients

2000 ◽  
Vol 93 (3) ◽  
pp. 638-645 ◽  
Author(s):  
Ozan Akça ◽  
Kemalettin Koltka ◽  
Serdar Uzel ◽  
Nahit Çakar ◽  
Kamil Pembeci ◽  
...  
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Glasgow Coma Score ◽  
Early Onset ◽  
Odds Ratio ◽  
Late Onset ◽  
Multidrug Resistant ◽  
Ventilator Associated Pneumonia ◽  
Clinical Criteria ◽  
Potential Risk Factors

Background Ventilator-associated pneumonia is the leading nosocomial infection in critically ill patients. The frequency of ventilator-associated pneumonia caused by multidrug-resistant bacteria has increased in recent years, and these pathogens cause most of the deaths attributable to pneumonia. The authors, therefore, evaluated factors associated with selected multidrug-resistant ventilator-associated pneumonia in critical care patients. Methods The authors prospectively recorded potential risk factors at the time of intensive care unit admission. An endotracheal aspirate was obtained in all patients who met clinical criteria for pneumonia. Patients were considered to have ventilator-associated pneumonia only when they met the clinical criteria and aspirate culture was positive for bacteria 48 h or more after initiation of mechanical ventilation. Pediatric patients were excluded. Adult patients with ventilator-associated pneumonia were first grouped as "early-onset" (&lt; 5 days) and "late-onset," determined by episodes of ventilator-associated pneumonia, and then, assigned to four groups based on the bacteria cultured from their tracheal aspirates: Pseudomonas aeruginosa, Acinetobacter baumanii, methicillin-resistant staphylococci, and all others. The first three bacteria were considered to be multidrug resistant, whereas the others were considered to be antibiotic susceptible. Potential risk factors were evaluated with use of univariate statistics and multivariate regression. Results Among 486 consecutive patients admitted during the study, 260 adults underwent mechanical ventilation for more than 48 h. Eighty-one patients (31%) experienced 99 episodes of ventilator-associated pneumonia, including Pseudomonas(33 episodes), methicillin-resistant staphylococci (17 episodes), Acinetobacter(9 episodes), and nonresistant bacteria (40 episodes). Sixty-six of these episodes were early onset and 33 episodes were late onset. Logistic regression analysis identified three factors significantly associated with early-onset ventilator-associated pneumonia caused by any one of the multidrug-resistant bacterial strains: emergency intubation (odds ratio, 6.4; 95% confidence interval, 2.0-20.2), aspiration (odds ratio, 12.7; 95% confidence interval, 2.4-64.6), and Glasgow coma score of 9 or less (odds ratio, 3.9; 95% confidence interval, 1.3-11.3). A. baumanii-related pneumonia cases were found to be significantly associated with two of these factors: aspiration (odds ratio, 14.2; 95% confidence interval, 1.5-133.8) and Glasgow coma score (odds ratio, 6.0; 95% confidence interval, 1.1-32.6). Conclusions The authors recommend that patients undergoing emergency intubation or aspiration or who have a Glasgow coma score of 9 or less be monitored especially closely for early-onset multidrug-resistant pneumonia. The occurrence of aspiration and a Glasgow coma score of 9 or less are especially associated with pneumonia caused by A. baumanii.

Post-thymectomy myasthenia gravis: a case report and systematic review of literature

2021 ◽  
Vol 14 (12) ◽  
pp. e246005
Author(s):  
Louise Gurowich ◽  
Gabriel Yiin ◽  
Adam Maxwell ◽  
Alexandra Rice
Keyword(s):  
Systematic Review ◽  
Case Report ◽  
Myasthenia Gravis ◽  
Early Onset ◽  
Late Onset ◽  
High Morbidity ◽  
Review Of Literature ◽  
Prompt Treatment ◽  
Autoimmune Condition ◽  
Anti Acetylcholine

Myasthenia gravis (MG) is an autoimmune condition affecting the neuromuscular junction characterised by weakness and fatiguability, carrying a high morbidity if treatment is delayed. A clear association with thymoma has led to management with thymectomy as a common practice, but MG presenting post-thymectomy has rarely been reported. We present a case of an 82- year-old woman developing fatigue, ptosis and dysarthria 3 months after thymectomy. After a clinical diagnosis of MG was made, she responded well to prompt treatment with prednisolone and pyridostigmine. Her anti-acetylcholine receptor antibody (anti-AChR) subsequently came back positive. Our systematic review reveals that post-thymectomy MG can be categorised as early-onset or late-onset form with differing aetiology, and demonstrated correlation between preoperative anti-AChR titres and post-thymectomy MG. The postulated mechanisms for post-thymectomy MG centre around long-lasting peripheral autoantibodies. Clinicians should actively look for MG symptoms in thymoma patients and measure anti-AChR preoperatively to aid prognostication.

scholarly journals Etiology and resistance patterns of bacteria causing ventilator-associated pneumonia in a respiratory intensive care unit

2017 ◽  
Vol 74 (10) ◽  
pp. 954-962 ◽  
Author(s):  
Vlada Injac ◽  
Uros Batranovic ◽  
Jovan Matijasevic ◽  
Marija Vukoja ◽  
Mirjana Hadnadjev ◽  
...  
Keyword(s):  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Early Onset ◽  
Late Onset ◽  
Resistance Rate ◽  
Ventilator Associated Pneumonia ◽  
Gram Negative ◽  
Resistance Patterns ◽  
Acinetobacter Spp ◽  
Gram Negative Organisms

Background/Aim. Ventilator-associated pneumonia (VAP) incidence, causative pathogens, and resistance patterns are different among countries and intensive care units (ICUs). In Europe, resistant organisms have progressively increased in the last decade. However, there is a lack of data from Serbian ICUs. The aims of this study were to evaluate etiology and antimicrobial resistance for pathogens causing VAP in ICU patients, to examine whether there were differences among pathogens in early-onset and late-onset VAP and to identify mortality in patients with VAP after 30 and 60 days of hospitalization. Methods. A retrospective cohort study was conducted in the respiratory ICU and all adult patients diagnosed with VAP from 2009 to 2014 were included. Results. Gram negative organisms were the major pathogens (80.3%). The most commonly isolated was Acinetobacter spp (59.8%). There was a statistically significant increase in the incidence of infection with Klebsiella pneumoniae (8.9% vs 25.6%; p = 0.019). Extensively drugresistant strains (XDR) were the most common (78.7%). Lateonset VAP was developed in 81.1% of patients without differences among pathogens in comparison with early-onset VAP. Acinetobacter spp was susceptible to tigecycline and colistin with a significant increase in resistance to ampicillin/sulbactam (30.2% vs 58.6%; p = 0.01). Resistance rate of Pseudomonas aeruginosa and Klebsiella pneumoniae to carbapenems was 38% and 11%, respectively. In methicillin-resistant Staphylococcus aureus no resistance was observed against vancomycin and linezolid. There was no difference in mortality rate between patients with earlyonset and late-onset VAP after 30 and 60 days of hospitalization. Conclusion. Gram negative organisms were the primary cause of bacterial VAP of which the most common was the XDR strain of Acinetobacter spp. Patients with early- and late-onset VAP had the same pathogens. There was no difference in mortality between this two group of patients during 60 days of hospitalization.

scholarly journals Maternofetal outcomes in early versus late onset pre-eclampsia: a comparative study

2019 ◽  
Vol 8 (2) ◽  
pp. 548
Author(s):  
Poornima Shankar ◽  
Kavitha Karthikeyan ◽  
Amrita Priscilla Nalini ◽  
Sindhura M. ◽  
Gowtham Kim
Keyword(s):  
Risk Factors ◽  
Gestational Age ◽  
Early Onset ◽  
Age Of Onset ◽  
Late Onset ◽  
Fetal Outcomes ◽  
Chi Square ◽  
Onset Type ◽  
Significant Difference ◽  
Early Onset Preeclampsia

Background: Preeclampsia is being increasingly recognized as two different entities: early-onset preeclampsia occurring at less than 34 weeks of gestation, and late-onset disease occurring at 34 or more weeks of gestation. Early-onset and late-onset pre-eclampsia are found to have different implications for the mother and neonate. The aim of this study is to compare the risk factors, maternal and fetal outcomes in early (<34 weeks) versus late (≥34weeks) onset preeclampsia.Methods: 208 patients diagnosed with pre-eclampsia in Chettinad Academy of Research and Education over a period of three years (From January 2014 to December 2016) were retrospectively studied. Patients were classified as early onset and late onset pre-eclampsia based on the gestational age of onset. Data on risk factors, maternal and fetal outcomes were collected and analyzed using Chi Square and Fisher’s test and compared.Results: The overall preeclampsia rate was 6.3%. Early onset and late onset were 34.6% and 65.3% respectively and the rate increased with increasing gestational age.35.3% of patients with late onset preeclampsia and 55.6% patients of early onset type required more than one drug which is a statistically significant difference. Proteinuria more than 3gm/l/day was significantly more in late onset preeclampsia than in early onset preeclampsia. 55.5% of patients with early onset pre-eclampsia required MgSO4 when compared to 17.4%. There was no statistically significant difference in the rate of caesarean section (61.1% vs 73.5%). Altered coagulation profile was significantly more in early onset preeclampsia (11.1%). The incidence of oligohydramnios, SGA and low APGAR at 5 minutes of birth were significantly high in early onset pre-eclampsia when compared to late onset type.Conclusions: Patients with early onset pre-eclampsia are found to have significantly higher rates of specific maternal and fetal morbidity when compared to the late onset type.

Risk Factors for Ventilator-associated Pneumonia by Pseudomonas aeruginosa  in Presence of Recent Antibiotic Exposure

2006 ◽  
Vol 105 (4) ◽  
pp. 709-714 ◽  
Author(s):  
Jordi Rello ◽  
Camilla Allegri ◽  
Alejandro Rodriguez ◽  
Loreto Vidaur ◽  
Gonzalo Sirgo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Relative Risk ◽  
Confidence Interval ◽  
Early Onset ◽  
Late Onset ◽  
Interquartile Range ◽  
Ventilator Associated Pneumonia ◽  
Antibiotic Exposure ◽  
Retrospective Case

Background To facilitate the decision-making process for therapy and prevention of ventilator-associated pneumonia (VAP) in patients undergoing recent antibiotic exposure, this study investigated whether the development of VAP episodes caused by Pseudomonas aeruginosa or other pathogens are related to different risk factors, thereby distinguishing two risk population for this serious complication. Methods A 5-year retrospective case-control observational study was conducted. Cases of VAP caused by P. aeruginosa were compared with those caused by other pathogens. Univariate and multivariate analysis was performed using SPSS 11.0 software (SPSS Inc., Chicago, IL). Results Two groups were identified: P. aeruginosa (group P) was isolated in 58 (63.7%) episodes, and 33 episodes served as controls (group C), after a median of 12 days (interquartile range, 4-28 days) and 9 days (interquartile range, 3-12.5 days) of mechanical ventilation, respectively. P. aeruginosa was identified in 34.7% of episodes with early-onset pneumonia and in 73.5% with late-onset pneumonia. In a logistic regression analysis, P. aeruginosa was independently associated with duration of stay of 5 days or longer (relative risk = 3.59; 95% confidence interval, 1.04-12.35) and absence of coma (relative risk = 8.36; 95% confidence interval, 2.68-26.09). Risk for pathogens different from P. aeruginosa (group C) in early-onset pneumonia associated with coma was estimated to be 87.5%. Conclusions Risk factors in episodes under recent antibiotic treatment caused by P. aeruginosa or other microorganism are not the same, a fact that could have implications for preventive and therapeutic approaches for this infection.

scholarly journals Associations Between Procalcitonin and Markers of Bacterial Sepsis

Medicina ◽  
2012 ◽  
Vol 48 (8) ◽  
pp. 57 ◽  
Author(s):  
Veeresh Patil ◽  
Jaymin Morjaria ◽  
Francois De Villers ◽  
Suresh Babu
Keyword(s):  
Bacterial Culture ◽  
White Cell Count ◽  
Bacterial Sepsis ◽  
Reactive Protein ◽  
Paired Samples ◽  
Positive Bacterial Culture ◽  
Specificity And Sensitivity ◽  
Significant Difference ◽  
Culture Positive ◽  
Culture Negative

Background. Bacterial sepsis with no bacterial isolates can be a difficult clinical conundrum, where other markers like C-reactive protein (CRP), white cell count (WCC), and neutrophilia are helpful to arrive at a diagnosis. Procalcitonin (PCT) has been shown to be a useful biomarker in bacterial sepsis. The aim of the study was to look at the association of PCT with bacterial cultures and compare this to currently used markers of bacterial sepsis. Material and Methods. WCC, neutrophil count, and CRP with PCT were compared in patients with a positive bacterial culture from blood/body fluid. The specificity and sensitivity of PCT were compared with those of CRP. Results. Of the 99 paired samples obtained, 25 cultures were positive for bacteria. There was a significant difference in CRP (P=0.04) and PCT (P<0.001) levels between culture-positive and culture-negative samples. PCT had a better sensitivity and specificity than CRP (84% and 64.9% vs. 69.6% and 52.9%, respectively), with a combined specificity (CRP and PCT) of 83.5%. Conclusions. PCT has a better association with bacterial sepsis and is superior to currently available biomarkers in the clinical setting. The rapid pharmacodynamics of PCT can serve as an early predictor of the diagnosis of bacterial sepsis while awaiting the bacterial culture results avoiding undue delay in the institution of antibiotics, hence, potentially improving the prognosis of patients with bacterial sepsis.

scholarly journals Differences in levelFms-Like Tyrosine Kinase-1 (sFlt-1), soluble Endoglin (s-Eng), and Placental Growth Factor (PIGF) between Early Onset Preeclampsia and Late Onset Preeclampsia

2018 ◽  
Vol 3 (2) ◽  
pp. 11
Author(s):  
Lita Nafratilova ◽  
Yusrawati Yusrawati ◽  
Irza Wahi
Keyword(s):  
Early Onset ◽  
Late Onset ◽  
Serum Levels ◽  
Enzyme Linked Immunosorbent Assay ◽  
Cross Sectional ◽  
Intrinsic Factors ◽  
Significant Difference ◽  
The Difference ◽  
Cross Sectional Design ◽  
Early Onset Preeclampsia

Early Onset Preeclampsia (EO-PE) is preeclampsia that develops before 34 weeks 'gestation, caused by intrinsic factors, while Late Onset Preeclampsia (LO-PE) is preeclampsia that develops after 34 weeks' gestation due to extrinsic and maternal factors. There is an increased production of antiangiogenic factors (sFlt-1, s-Eng and PIGF) contribute to pathophysiology of preeclampsia.This study aims to measure the difference of sFlt-1, sEng, PIGF levels between EO-PE and LO-PE. This was an observational study with cross sectional design conducted at Dr. M. Djamil, TK Hospital. III dr. Reksodiwiryo and Biomedical Laboratory FK Unand Padang from August 2017 to August 2018. The sample of this study were 26 severe preeclampsia women : 13 (EO-PE)  and 13 (LO-PE), selected using consecutive sampling. Levels of sFlt-1, sEng, PIGF were examined using the enzyme-linked immunosorbent assay (ELISA) method. Statistical analysis was performed using unpaired t test and Mann-Whitney Test. Results shown that serum levels of sFlt-1 and sEng in (EO-PE)  were 9.51 ± 0.71 ng / L, 1.44 ± 0.06 ng / mL, 5.79 ± 0.42 ng / mL while in PEAL it was 8, 89 ± 0.78 ng / mL, 1.35 ± 0.14 ng / mL, 6.72 ± 0.76. There were a significant difference with a value of p <0.05. The conclusion of this study is that the levels of sFlt-1 and sEng are higher in (EO-PE)  than(LO-PE)and PIGF levels was lower in (EO-PE) compared to (LO-PE)

scholarly journals Study of quantitative bacterial cultures of non-bronchoscopic samples in ventilator associated pneumonia

2018 ◽  
Vol 5 (5) ◽  
pp. 1837 ◽  
Author(s):  
Mohamed Azarudeen ◽  
B. S. Sharma ◽  
Pankaj Kumar Jain ◽  
Alok Kumar Goyal ◽  
Bharti Malhotra
Keyword(s):  
Mechanical Ventilation ◽  
Observational Study ◽  
Early Onset ◽  
Late Onset ◽  
Sampling Techniques ◽  
Ventilator Associated Pneumonia ◽  
Quantitative Culture ◽  
Gram Negative ◽  
Bacterial Cultures ◽  
Causative Agents

Background: Diagnosis of VAP based on non bronchoscopic samples-ETA, NB-BAL culture. The aim is to study quantitative culture of the non-bronchoscopic sampling techniques such as Blind Broncho-alveolar lavage (NB-BAL) and endotracheal aspirates (ETA)in Ventilator Associated Pneumonia. It is a hospital based, observational study conducted in SPMCHI, Jaipur from September 2015 to September 2016.Methods: Seventy patients who were under mechanical ventilation for more than 48 hours and clinically suspected for VAP were included in the study and divided into early and late onset VAP. The NB-BAL and ETA were obtained from these patients and quantitative cultures were performed.Results: Out of the 70 samples analysed, 60 patients were found positive in BAL and 61 positive in ETA. The agreement between NB-BAL and ETA is 86.8%. GNBs remain the main burden of both early and late onset VAP. Most common organisms isolated were Enterobacter and Acinetobacter in early onset and Pseudomonas and Acinetobacter in late onset VAP. All the GNB isolates were sensitive to Polymyxin and Colistin and were resistant to majority of routinely used antibiotics.Conclusions: The quantitative culture of   non-bronchoscopic samples is a useful alternative to bronchoscopy, in the diagnosis of VAP in resource deprived centers. MDR gram negative bacilli are the main causative agents of VAP. 

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