CLINICOAETIOLOGICAL STUDY ON RESPIRATORY TRACT INFECTION IN CRITICAL CARE UNITOF ATERTIARY CARE HOSPITAL

2021 ◽  
pp. 36-38
Author(s):  
Sourav Kundu ◽  
Bibhuti Saha ◽  
Debarshi Jana
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Respiratory Tract ◽  
Proteus Mirabilis ◽  
Lower Respiratory Tract ◽  
Lower Lobe ◽  
Klebsiella Pneumonia ◽  
Care Hospital ◽  
Antibiotic Policy ◽  
Staphylococcus Haemolyticus ◽  
Tract Infections

Introduction: Infections of the lower respiratory tract is one of the common and important causes of human disease from the points of view of morbidity, mortality and economic cost to society. A new study has found that about 3.6 million people have died due to the two most common chronic lung diseases in 2015.1 According to the study, in 2015, about 3.2 million people worldwide succumbed to chronic obstructive pulmonary disease (COPD) - caused mainly by smoking and pollution - while 400,000 people died from asthma. Aims And Objective: Study of clinical, laboratory and radiological features of LRTI cases in CCU, Identication of organisms causing LRTI and their resistance pattern. To study the outcome of treatment. Materials And Methods: In Patients Department CCU of Carmichael Hospital for Tropical Diseases (CHTD), School of Tropical Medicine (STM), Kolkata. July 2018 to June 2019 Patients >18 years of age of both sexes with LRTI diagnosed by history, clinical ndings, laboratory tests, radiological ndings. Result And Analysis: 11(22.0%) patients had BI LAT lower lobe patchy pneumonitis, 12(24.0%) patients had BI LAT syn pneumonic effusion, 6(12.05) patients had L lower lobe consolidation, 6(12.0%) patients had L sided pneumonitis, 14(28.0%) patients had R sided pneumonitis and 1(2.0%) patient had R upper lobe pneumonitis. 26(52.0%) patients had ventilation. 24(48.0%) patients had sputum. 26(52.0%) patients had ET tube suction. 14(28.0%) patients had Acinetobacterbaunnii complex, 20(40.0%) patients had Klebsiellapneumoniae, 3(6.0%) patients had Proteus mirabilis, 7(14.0%) patients had Pseudomonas aeruginosa, 5(10.0%) patients had Staphylococcus aureus and 1(2.0%) patients had Staphylococcus haemolyticus. Conclusion:There is use and misuse of the broad spectrum antibiotics that has given rise to this problem. The lack of a denite antibiotic policy is a matter of great concern in management of LRTI. To conclude, this study suggests that the most common organism isolated in lower respiratory tract infections is Acinetobacterbaunnii complex, Klebsiella pneumonia, Pseudomonas aeruginosa, Staphylococcus haemolyticus and Proteus mirabilis among Gram negative bacilli and Gram positive cocci respectively of which mortality rate is very signicant in Acinetobacterbaunnii complex and Klebsiella pneumonia infection. By knowing the etiological organism and their antibiotic sensitivity pattern of this organism every institution have their specic use of antibiotic policy can be drafted.

scholarly journals Predominance of Bacterial Flora Causing Lower Respiratory Tract Infections Following Tracheostomy in Patients of Chettinad Hospital & Research Institute, Chennai, India

2021 ◽  
Vol 10 (35) ◽  
pp. 2964-2968
Author(s):  
Swetha Thirumurthi ◽  
Priya Kanagamuthu ◽  
Rajasekaran Srinivasan ◽  
Bhalaji Dhanasekaran
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Antibiotic Sensitivity ◽  
Klebsiella Pneumonia ◽  
Lower Respiratory Tract Infections ◽  
Empirical Antibiotics ◽  
Tract Infections ◽  
Research Institute

BACKGROUND The term tracheostomy refers to forming an opening in the trachea.1,2 Its advantages include easy and direct access to lower respiratory tract, reduced risk of aspiration, faster weaning from ventilation support and improved physical and psychological comfort. But a common problem in tracheostomised patients is increased risk of colonisation of lower respiratory tract by exogenous bacteria because of direct exposure.1,3 This study was done to recognise pathogens in tracheal secretions collected from tracheostomised patients and their antibiotic sensitivity to treat them with appropriate antibiotics. METHODS This prospective study was done in 138 tracheostomised patients from October 2020 to March 2021 in intensive care unit (ICU) of Chettinad Hospital and Research Institute. Under sterile aseptic precautions, Day 0 and Day 7 cultures posttracheostomy was obtained and their antibiotic sensitivity was studied. Data was analysed using Statistical Package for Social Sciences (SPSS version 19) and presented in proportion, mean and standard deviation (Descriptive statistics). RESULTS In this study, of the 56 cases who had growth in their culture and sensitivity reports on day 0, the most common organism was Pseudomonas aeruginosa (33.9 %) sensitive to imipenem (94.7 %) followed by klebsiella (25 %) sensitive to teicoplanin, vancomycin, amikacin, cefoperazone/tazobactam, linezolid and piperacillin/tazobactam. On day 7, the growth of organisms isolated in tracheal culture got reduced from 56 cases to 16 cases. The prevalence of Pseudomonas reduced to 18.8 % in day 7 whereas Klebsiella pneumonia and Acinetobacter remained almost same from day 0 to day 7. CONCLUSIONS This study concludes the predominant pathogen as Pseudomonas aeruginosa with sensitivity to imipenem followed by Klebsiella with sensitivity to teicoplanin, vancomycin, amikacin, cefoperazone/tazobactam, linezolid and piperacillin/tazobactam on day 0 with reduction in the number of organisms on day 7 due to the fact that all our patients were admitted in ICU several days prior to tracheostomy and were started on antibiotics soon after admission as per choice of the treating physician. Hence, a clear understanding of bacterial colonisation post tracheostomy and its change in course is essential for timely intervention with empirical antibiotics for reducing the incidence of lower respiratory tract infections after tracheostomy in future. KEY WORDS Tracheostomy, Lower Respiratory Tract Infections, Pseudomonas Aeruginosa, Empirical Antibiotics.

scholarly journals Molecular epidemiology of Pseudomonas aeruginosa isolated from lower respiratory tract of ICU patients

2020 ◽  
Author(s):  
X. Yang ◽  
Y. Lai ◽  
C. Li ◽  
J. Yang ◽  
M. Jia ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Drug Resistance ◽  
Antibiotic Resistance ◽  
Respiratory Tract ◽  
Molecular Epidemiology ◽  
Dna Fingerprinting ◽  
Lower Respiratory Tract ◽  
Genetic Profile ◽  
Icu Patients ◽  
Tract Infections

Abstract Lower respiratory tract infections (LRTIs) caused by Pseudomonas aeruginosa are the most common infection among hospitalized patients, associated with increased levels of morbidity, mortality and attributable health care costs. Increased resistant Pseudomonas worldwide has been quite meaningful to patients, especially in intensive care unit (ICUs). Different species of Pseudomonas exhibit different genetic profile and varied drug resistance. The present study determines the molecular epidemiology through DNA fingerprinting method and drug resistance of P. aeruginosa isolated from patients with LTRIs admitted in ICU. A total of 79 P. aeruginosa isolated from patients with LRTIs admitted in ICU were characterized by Restriction Fragment Length Polymorphism (RFLP), Random Amplified Polymorphic DNA (RAPD) and Repetitive Extrapalindromic PCR (REP-PCR). Antibiotic resistance was determined by minimum inhibitory concentration (MIC) assay while MDR genes, viz, blaTEM, blaOXA, blaVIM, blaCTX-M-15 were detected by polymerase chain reaction (PCR). Of the 137 Pseudomonas sp isolated from ICU patients, 57.7% of the isolates were reported to be P. aeruginosa. The overall prevalence of P. aeruginosa among the all included patients was 34.5%. The RAPD analysis yielded 45 different patterns with 72 clusters with 57% to 100% similarity level. The RFLP analysis yielded 8 different patterns with 14 clusters with 76% to 100% similarity level. The REP PCR analysis yielded 37 different patterns with 65 clusters with 56% to 100% similarity level. There was no correlation among the different DNA patterns observed between the three different methods. Predominant of the isolates (46.8%) were resistant to amikacin. Of the 79 isolates, 60.8% were positive for blaTEM gene and 39.2% were positive for blaOXA gene. P. aeruginosa was predominantly isolated from patients with LRTIs admitted in ICU. The difference in the similarity level observed between the three DNA fingerprinting methods indicates that there is high inter-strain variability. The high genetic variability and resistance patterns indicates that we should continuously monitor the trend in the prevalence and antibiotic resistance of P. aeruginosa especially in patients with LRTIs admitted in ICU.

scholarly journals Risk factors responsible for lower respiratory tract infections in children aged under five: a hospital based study

2020 ◽  
Vol 7 (7) ◽  
pp. 1578
Author(s):  
Samrita Seth ◽  
Sristi Ganguly ◽  
Saroj K. Satpathy
Keyword(s):  
Risk Factors ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Treatment Modalities ◽  
P Value ◽  
Care Hospital ◽  
Lower Respiratory Tract Infections ◽  
Tract Infections ◽  
At Home

Background: Lower respiratory tract infections (LRTI) contribute significantly in terms of hospital admission and mortality. Along with attempts to improve treatment modalities, it is imperative to identify risk factors that will aid in prevention of these infections.Methods: This was a case-control study done in tertiary care hospital, Cuttack, enrolling inpatients between 2 months to 5 years with symptoms suggestive of LRTI as cases. Those with tuberculosis, aspiration pneumonia, asthma and nosocomial infections were excluded. After obtaining consent, questionnaire was administered to parents, regarding their socio-demographic and other relevant details. Data analysis was done using statistical software Epi Info™, version 6 and association of each variable with LRTI assessed with chi-square test.Results: A total of 314 children were enrolled in the study, with 158 being cases. The case-fatality rate was 23% and 53.8% suffered from complications, the most common being respiratory failure. A significant association was seen between LRTI and social variables namely maternal literacy(p-value<0.005), socioeconomic status (p-value<0.001) and number of children (p-value<0.001), housing pattern (p-value<0.001), fuel used at home (p-value=0.003), ventilation adequacy (p-value=0.004), presence of separate kitchen at home (p-value=0.0009) and presence of overcrowding (p-value<0.001) and individual factors improper breastfeeding(p-value<0.005) and weaning(p-value=0.03), malnutrition (p-value<0.001), vitamin A deficiency(p-value=0.03) and history of respiratory infection in mother (p-value=0.025) or siblings(p-value=0.048).Conclusions: The burden of lower respiratory tract infections can be substantially reduced by prevention using the identification of risk factors such as housing patterns, education of parents and improved nutrition of the children, and measures to combat the same, at each level.

scholarly journals Clinical study of lower respiratory tract infections in children attending a tertiary care hospital

2017 ◽  
Vol 4 (5) ◽  
pp. 1733
Author(s):  
Venkata Krishna Munagala ◽  
Ramisetty M. Uma Mahesh ◽  
Jithendra Kandati ◽  
Munilakshmi Ponugoti
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Bacterial Pathogens ◽  
Tertiary Care ◽  
Care Hospital ◽  
Upper Respiratory Tract ◽  
Lower Respiratory Tract Infections ◽  
Cross Sectional ◽  
Tract Infections

Background: WHO estimated burden of respiratory tract infections in 2010, estimates four and half million deaths due to respiratory tract infections among children every year. In India, 1.2 million deaths have been reported among children due to RTI among 5.9 million deaths globally. Lower respiratory tract infections are most common causes of death than upper respiratory tract infections. Pneumonia and Bronchiolitis are most common types of LRTI in children. Pneumonia accounts for most of the deaths in children < 5 years of age. The present study was undertaken with an objective to know the various types of lower respiratory tract infections in children less than 12 years of age. The study also aims to know the various bacterial agents causing respiratory tract infections with their antibiotic susceptibility.Methods: Hospital based, prospective cross-sectional study was conducted for a period of one year and 375 children were enrolled. Demographic, clinical history and examination was done and signs and symptoms noted. All necessary investigations were performed and followed regularly for management and outcome.Results: Incidence of LRTI in the study was 9.76% with male preponderance (65.33%) and most common among children in 1-4 years age group. Ratio of males to females was 1.9:1. 73.6% of cases were in low socio-economic group, 35.2% were found with PEM-I grade and 18.13% had no immunization coverage. Cough and breathlessness were the major symptoms and respiratory distress and clubbing were major signs in the study. Bronchopneumonia was the commonest cause (38.7%) followed by bronchiolitis and Allergic bronchitis. 18.45 of cases had anemia and Leucocytosis was also present. Pulmonary infiltration was the major finding in the X-ray of chest. Streptococcus pneumoniae and Klebsiella pneumoniae were the common bacterial pathogens isolated.Conclusions: To conclude, our study clearly highlighted the various types of clinical presentations, risk factors and different types of LRTI in children <12 years of age. Understanding a clear knowledge of the etiology and bacterial pathogens clearly provides guidance for the physician in management and clinical outcome. 

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