scholarly journals The Challenging Diagnosis of Non-Community-Acquired Pneumonia in Non-Mechanically Ventilated Subjects: Value of Microbiological Investigation

2015 ◽  
Vol 61 (2) ◽  
pp. 225-234 ◽  
Author(s):  
J. Messika ◽  
A. Stoclin ◽  
E. Bouvard ◽  
J.-P. Fulgencio ◽  
C. Ridel ◽  
...  
Keyword(s):  
Community Acquired Pneumonia ◽  
Microbiological Investigation ◽  
Mechanically Ventilated

A Comparative Cross-Sectional Study to compare the Isolated Organism and their Antibiotic Sensitivity Pattern Between Community-Acquired Pneumonia (CAP) and Ventilator-Associated Pneumonia (VAP) in Intensive Care Unit (ICU).

2021 ◽  
Vol 11 (Number 2) ◽  
pp. 26-34
Author(s):  
Nahian Ahmed Chowdhury ◽  
Dipak Kumar Mitra ◽  
Afrin Ahmed Clara ◽  
Md. Suhail Alam ◽  
MD. Zahed Hossain
Keyword(s):  
Medical Information ◽  
Antibiotic Sensitivity ◽  
Cross Sectional Study ◽  
Community Acquired Pneumonia ◽  
Ventilator Associated Pneumonia ◽  
Sectional Study ◽  
Cross Sectional ◽  
Mechanically Ventilated ◽  
Sensitivity Pattern ◽  
Staphylococcus Spp

Background: The moment most common cause of in-hospital infection is pneumonia. Pneumonia is prevalent within the ICU (Intensive Care Unit) setting and can be deadly. The Incidence of pneumonia is approximately 17% in the therapeutic ICU2 but can be 6 to 20 times increased in mechanically ventilated patients. The duration of hospital stay and expenditure are both expanded in patients who develop ventilator-associated pneumonia. This study aims to identify the causative microorganism responsible for CAP (Community-Acquired Pneumonia) and VAP (Ventilator-Associated Pneumonia) and their antibiotic sensitivity pattern. Methods: This was a comparative cross-sectional study that was carried out at two ICU in Sylhet city. The data was collected from the patient's medical information, the patient's file, and the hospital information system. Culture and sensitivity (C/S) were collected from the electronic medical information system (MIS). All data from January 2019 to December 2020, including patient's information, course of the disease (in terms of death or recovery-if available), clinical features, and investigation reports, was transferred to an electronic data collection sheet (Microsoft Excel). After completion of all data collection, analysis was conducted through a spreadsheet. Comparison between two disease groups was made by independent t-test. Within the group, the analysis was done by the Chi-Square test. Results: In this thesis study, it was found that the most common organism responsible for CAP was Streptococcus spp. (34.70%) and is sensitive to Meropenem (92.21%), Imipenem (88.16%), Amikacin (70.67%), Piperacillin (70.91%), Moxifloxacin (70.96%), Levofloxacin (67.95%), Amoxiclav (67.92%), and Ceftriaxone(63.95%). The most common causative organism responsible for VAP was Staphylococcus spp. (36.51%) and it was sensitive to Imipenem (100%), Moxifloxacin (100%), Meropenem (94.73%), Amikacin (85.71%), Ceftriaxone (60%), Amoxiclav (66.66%), Levofloxacin (57.14%), and Cefuroxime (50%). Conclusion: Pneumonia is still one of the most common reasons for hospitalization, particularly for those admitted to ICU. It has been observed in several studies that the majority of the cases are communityacquired pneumonia. Many mechanically ventilated patients often develop VAP, which is fatal if timely diagnosis and appropriate antibiotics administration are not made. Streptococcus spp. was the most common organism responsible for CAP, and Staphylococcus spp. mainly was responsible for VAP.

Staphylococcus aureus Pneumonia in the Community

2020 ◽  
Vol 41 (04) ◽  
pp. 470-479
Author(s):  
Hangyong He ◽  
Richard G. Wunderink
Keyword(s):  
Staphylococcus Aureus ◽  
Influenza Infection ◽  
Community Acquired Pneumonia ◽  
Mechanically Ventilated ◽  
First Line Therapy ◽  
High Incidence ◽  
Polymerase Chain ◽  
Staphylococcus Aureus Pneumonia ◽  
Severe Community Acquired Pneumonia ◽  
Panton Valentine Leukocidin

Abstract Staphylococcus aureus is an emergent etiology of community-acquired pneumonia (CAP) over the past 2 decades, with severe community-acquired pneumonia (SCAP) caused by methicillin-resistant S. aureus (MRSA) leading to critical illness and death. S. aureus colonization is associated with a high incidence of pneumonia. Panton-Valentine leukocidin (PVL) is one of the most important virulence factors of S. aureus associated with serious complications. In recent years, community-associated MRSA (CA-MRSA) clones that caused infections in young adults and healthy individuals with no exposure to health care settings and no classical risk factors have emerged. Clinical features at admission including concurrent influenza infection, hemoptysis, multilobar infiltrates, and neutropenia should suggest S. aureus CAP. Sputum Gram stains, cultures (or tracheobronchial aspirates or bronchoalveolar lavage in mechanically ventilated patients), polymerase chain reaction (nasopharyngeal or oropharyngeal or lower respiratory tract specimens), and two sets of blood cultures should be obtained from patients presenting with severe S. aureus CAP. For CAP due to methicillin-susceptible S. aureus, first-line therapy is usually cefazolin, oxacillin, or ceftaroline. For CA-MRSA pneumonia, linezolid is recommended. If vancomycin or teicoplanin are used, combination with clindamycin or rifampicin should be considered in cases of PVL-positive MRSA CAP.

scholarly journals Use of nebulised N-acetylcysteine as a life-saving mucolytic in intensive care: A case report

2019 ◽  
Vol 21 (4) ◽  
pp. 296-298 ◽  
Author(s):  
Elizabeth A Brodier ◽  
Meera Raithatha ◽  
Santhana Kannan ◽  
Niroshini Karunasekara
Keyword(s):  
Intensive Care ◽  
Post Partum ◽  
Airway Disease ◽  
Community Acquired Pneumonia ◽  
Mechanically Ventilated ◽  
Life Saving ◽  
Chronic Airway Disease ◽  
Mucus Plug ◽  
Tracheal Mucus

We present a case of critical airway obstruction secondary to a solid tracheal mucus plug in a patient with pneumonia. Following failed conventional mucolysis therapy, nebulised N-acetylcysteine acted as a life-saving mucolytic, and prevented imminent cardiorespiratory arrest. Use of oral N-acetylcysteine as a mucolytic has been long established within respiratory medicine in managing chronic airway disease, but is rarely utilised in critically ill or mechanically ventilated patients due to the lack of comparative studies in literature. A 28-year-old female presented to the emergency department with shortness of breath and a productive cough. She was six weeks post-partum with no past medical history. Initial management for a community acquired pneumonia with type 1 respiratory failure included intensive care admission, antibiotics, fluid therapy and bronchodilators. The patient acutely deteriorated 48 h after admission becoming unresponsive and severely hypoxaemic. Intubation did not achieve ventilation, and subsequent direct bronchoscopy revealed a thick, solid, obstructing tracheal mucus plug, superior to the carina. It was resistant to aspiration despite the use of saline flushes, chest physiotherapy and bronchodilators and the bronchoscope could not pass it. N-acetylcysteine, administered via the bronchoscopic port, caused sufficient mucolysis to enable removal of the thick mucus cast, enabling ventilation and gas exchange. Such resistant mucus plugging is a rare cause of failed ventilation, with limited therapeutic options. Here, the unlicensed and rarely reported use of nebulised N-acetylcysteine was a life-saving mucolytic, allowing removal of the obstructing plug and re-establishing ventilation.

scholarly journals Quality of life of the mechanically ventilated patients with community-acquired pneumonia

2018 ◽  
Vol 75 (9) ◽  
pp. 864-874
Author(s):  
Nenad Zornic ◽  
Dragan Milovanovic ◽  
Miroslav Stojadinovic ◽  
Dragce Radovanovic ◽  
Goran Davidovic ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Psychological Symptoms ◽  
Community Acquired Pneumonia ◽  
Control Group ◽  
Mechanically Ventilated ◽  
Euroqol Group ◽  
Clinical Center ◽  
Student’S T ◽  
Poor Outcomes

Background/Aim. Patients with pneumonia who require mechanical ventilation (MV) are associated with several poor outcomes such as prolonged hospitalization, higher rate of mortality and increased spread of antibioticsresistant pathogens. MV in patients with communityacquired pneumonia (CAP) could cause development of psychological symptoms, often neglected in the Intensive Care Units (ICU) as well as decreased quality of life after the withdrawal of the MV. The aim of the study was to evaluate the quality of life in patients with CAPs treated with MV in ICU. Methods. The study was designed as a cohort study of hospital-treated patients with CAP with prospective data collection. The quality of life was defined as the primary outcome, while the use of MV was assumed as the primary prognostic factor that adversely affected the outcome. The patients were recruited from the population of patients with CAPs who were hospitalized at the ICU, Clinical Center Kragujevac, Serbia, from January 2013 to January 2014. The experimental group consisted of patients who were on MV while the control group included patients who were treated for CPAs in the ICU, but were not subjected to MV. The quality of life was assessed by using patient-rated Euro Quality of Life (EuroQoL) Group-EQ-5D index. The calculation of the total EQ-5D-5L score values was performed by using the predefined, validated mapping key according to response combinations. Statistical analysis was performed by using ?2 test, Student's t-test, univariate and multivariate logistic regression analyses. Results. The patients with MV had worse EQ5D-5L values in comparison to the control group for all 5 domains. Mobility, self-care and usual activities were negatively affected during the whole follow-up period. Pain or discomfort and anxiety or depression differed significantly between the study group and the control group at days 7 and 30. Conclusion. Patients with MV tend to have poorer quality of life, especially in 3 domains. The main reasons are the presence of chronic comorbidities in the population that require MV.

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