Incidence Of Nosocomial Pneumonia Research Articles

Predicting nosocomial pneumonia risk in level-1 trauma patients: An external validation study using the trauma quality improvement program

BackgroundEarly identification of patients at risk of nosocomial pneumonia enables the opportunity for preventative measures, which may improve survival and reduce costs. Therefore, this study aimed to externally validate an existing prediction model (issued by Croce et al.) to predict nosocomial pneumonia in patients admitted to US level-1 trauma centers. MethodsA retrospective cohort study including patients admitted to level-1 trauma centers and registered in the TQIP, a US nationwide trauma registry, admitted between 2013–2015 and 2017–2019. The main outcome was total nosocomial pneumonia for the first period and ventilator-associated pneumonia (VAP) for the second. Model discrimination and calibration were assessed before and after recalibration. ResultsThe study comprised 902,231 trauma patients (N2013–2015 ​= ​180,601; N2017–2019 ​= ​721,630), with a median age of 52 in both periods, 64–65 ​% male, and approximately 90 ​% sustaining blunt traumatic injury. The median Injury Severity Scores were 13 (2013–2015) versus 9 (2017–2019); median Glasgow Coma Scale scores were 15. Nosocomial pneumonia incidence was 4.4 ​%, VAP incidence was 0.7 ​%. The original model demonstrated good to excellent discrimination for both periods (c-statistic2013–2015 0.84, 95%CI 0.83–0.84; c-statistic2017–2019 0.92, 95%CI 0.91–0.92). After recalibration, discriminatory capacity and calibration for the lower predicted probabilities improved. ConclusionsThe Croce model can identify patients admitted to US level-1 trauma centers at risk of total nosocomial pneumonia and VAP. Implementing (modified) Croce models in route trauma clinical practice could guide judicious use of preventative measures and prescription of additional non-invasive preventative measures (e.g., increased monitoring, pulmonary physiotherapy) to decrease the occurrence of nosocomial pneumonia in at-risk patients.

Effects of non-invasive respiratory support in post-operative patients: a systematic review and network meta-analysis

BackgroundRe-intubation secondary to post-extubation respiratory failure in post-operative patients is associated with increased patient morbidity and mortality. Non-invasive respiratory support (NRS) alternative to conventional oxygen therapy (COT), i.e., high-flow nasal oxygen, continuous positive airway pressure, and non-invasive ventilation (NIV), has been proposed to prevent or treat post-extubation respiratory failure. Aim of the present study is assessing the effects of NRS application, compared to COT, on the re-intubation rate (primary outcome), and time to re-intubation, incidence of nosocomial pneumonia, patient discomfort, intensive care unit (ICU) and hospital length of stay, and mortality (secondary outcomes) in adult patients extubated after surgery.MethodsA systematic review and network meta-analysis of randomized and non-randomized controlled trials. A search from Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science from inception until February 2, 2024 was performed.ResultsThirty-three studies (11,292 patients) were included. Among all NRS modalities, only NIV reduced the re-intubation rate, compared to COT (odds ratio 0.49, 95% confidence interval 0.28; 0.87, p = 0.015, I2 = 60.5%, low certainty of evidence). In particular, this effect was observed in patients receiving NIV for treatment, while not for prevention, of post-extubation respiratory failure, and in patients at high, while not low, risk of post-extubation respiratory failure. NIV reduced the rate of nosocomial pneumonia, ICU length of stay, and ICU, hospital, and long-term mortality, while not worsening patient discomfort.ConclusionsIn post-operative patients receiving NRS after extubation, NIV reduced the rate of re-intubation, compared to COT, when used for treatment of post-extubation respiratory failure and in patients at high risk of post-extubation respiratory failure.

Профілактика інфекцій при тяжких ушкодженнях мозку: акцентування на вентилятор-асоційовану пневмонію і зовнішнє вентрикулярне дренування

Вентилятор-асоційована пневмонія у пацієнтів із тяжкою черепно-мозковою травмою може досягати 40 %, і це значною мірою пов’язано з тривалим впливом механічної вентиляції легень. Наявність вентилятор-асоційованої пневмонії посилює тяжкість захворювання, що асоційоване з такими факторами, як гіпоксія, лихоманка, гіпотензія, збільшення внутрішньочерепного тиску. Пацієнти з інвазивним моніторингом інтракраніального тиску мають високий інфекційний ризик, що становить 27 %. У статті, виходячи з позицій Guidelines for Management of Severe Traumatic Brain Injury 4th Edition 2016, наведено дані щодо попередження ризиків розвитку інфекцій, пов’язаних із вентилятор-асоційованою пневмонією (рання — пізня трахеостомії, обробка ротової порожнини повідон-йодом) і зовнішнім вентрикулярним дренуванням (застосування катетерів, імпрегнованих антибіотиками).

Psoas compartment block efficacy and safety for perioperative analgesia in the elderly with proximal femur fractures: a randomized controlled study

BackgroundProximal femur fractures are most common fractures in the elderly and associated with significant mortality and morbidity, with high economic and social impact. Perioperative pain management influence outcomes and mortality after surgery with early mobilization being possible. The goal of the study was to compare the efficacy and safety of the psoas compartment block (PCB) with spinal and general anesthesia.MethodsWe included 90 patients in this randomized controlled study and divided them into three groups. For patients in group 1 ultrasound-guided PCB with bupivacaine 0.125% 6–8 ml / h was performed. Intraoperative anesthesia was provided with PCB and a sciatic nerve block. Postoperative analgesia include prolonged CPB with bupivacaine 0.125% 6–8 ml / h. In group 2 intraoperative spinal anaesthesia were performed. Group 3 patients underwent general sevoflurane inhalation anaesthesia with fentanyl infusion for analgesia. All patients received paracetamol 3 g/day and dexketoprofen 75 mg/day during hospitalization. On-demand, nalbuphine 5 mg SC was used for analgesia. Efficacy outcomes were the ICU length of stay and the total duration of hospitalization, number of patients who had severe pain after surgery, incidence of on-demand analgesia, sleep quality, postoperative mobilization time. Safety outcomes include complication incidence.ResultsThere were no differences in the duration of ICU stay - gr.1 72 [70–75], gr.2 74 [72–76], gr.3 72 [70–75] hours respectively (p = 0.29), and the total duration of hospitalization - gr.1144 [170–184], gr.2170 [148–188], gr.3178 [144–200] hours respectively. Patients in gr.1 had significantly lower nalbuphine consumption in the first 24 h after surgery and total during hospitalization (0 [0–5] mg versus 15 [10–20] and 20 [15–25] mg in the first 24 h in groups 2 and 3, respectively (p < 0.001). Gr. 1 had lower number of patients with severe pain (10% vs. 47 and 60% in groups 2 and 3, respectively, p < 0.05), lower number of on demand analgesia (0 [0–1] vs. 3 [2–4] and 4 [3, 4] in groups 2 and 3, respectively), better sleep quality (8 [7–9] vs. 6 [5–7] and 4 [3, 4] in groups 2 and 3, respectively, p < 0.001), significantly faster mobilization after surgery – sitting in bed and getting to his feet. MINS was diagnosed significantly more often in gr. 2 and 3 compared with gr. 1 (OR 9 95 CI 1,01–77, p = 0,048 for gr. 2 and OR 11 95 CI 1,2–91, p = 0, 03 for gr. 3). However, none of the patients had symptoms of myocardial ischemia and was not diagnosed with myocardial infarction. There were no difference in the incidence of nosocomial pneumonia and delirium.ConclusionPerioperative PCB in elderly patients with a proximal femur fracture could be an effective analgesia technique, as it decrease the number of patients with severe pain, need for on demand analgesia and opioid consumption. PCB also decrease the incidence of opioid-associated nausea and vomiting, comparing to general anesthesia, and increase the number of patients, who was mobilized in the 1st day (sitting) and 2nd day (getting up) after surgery. PCB may reduce the incidence of MINS, although to assess this outcome more studies are needed.Trial registrationClinicaltrials.gov: NCT04648332, first registration date 1/12/2020.

511 A Retrospective Review of the Timing of Tracheostomy in Mechanically Ventilated Patients

Abstract Introduction Tracheostomy is indicated for prolonged mechanical ventilation. Tracheostomy provides various benefits over prolonged endotracheal intubation including improved airway care, diminished need for sedation, reduced airway resistance, and increased patient comfort. However, the timing and effectiveness of tracheostomies has been controversial. Several studies, have indicated that early tracheostomy reduces the length of ICU and hospital stay, decrease the time on mechanical ventilation, and reduces the incidence of nosocomial pneumonia. In contrast other studies have shown that early tracheostomy shows no benefit, or even extends the length of mechanical ventilation in some patients. The purpose of this study was to evaluate the timing and the appropriateness of timing of tracheostomy. Methods This was a retrospective study of burn patients requiring mechanical ventilation over a 5-year period. The main comparison groups were endotracheal tube only (ETT) vs tracheostomy (Trach) and early tracheostomy (ETrach) vs. late tracheostomy (LTrach). Tracheostomies that were performed within the first 7 days were considered to be ETrach. Results Age, gender, ethnicity, % TBSA burned, presence of inhalation injury did not differ between any of the groups. The Trach group demonstrated increased hospital length of stay (LOS) (22 vs. 39 days, p&amp;lt; .0001), greater number of ICU days (11 vs. 31 days, p&amp;lt; .0001), greater number of surgeries (3.7 vs. 6.6, p&amp;lt; .0001) and patients in this group were more likely to be discharged to a post-acute care facility rather than home, when compared to the ETT group (p&amp;lt; .0001). The Trach group also was more likely to develop ventilator-associated pneumonia (VAP) (23% vs. 48%, p&amp;lt; .0001), and more likely to develop swallowing abnormalities. Similarly, the LTrach group demonstrated greater number of ICU days (25 vs. 32 days, p=.04), greater number of ventilator days (23 vs. 29 days, p=.03), greater number of surgeries (4.5 vs 7.2, p=.02), but fewer days to liberate from the ventilator (19.4 vs 13.6 days, p=.04). This group also was more likely to develop VAP than the ETrach group (28% vs 53%, p=.03). Conclusions This study demonstrates a number of improved outcomes of tracheostomy over continued endotracheal intubation, and a number of improved outcomes of early tracheostomy over later tracheostomy. The most significant improved outcomes were decreased incidence of VAP and decreased swallowing difficulties following extubation/decannulation.

Protocol for an international, multicentre, prospective, observational study of nosocomial pneumonia in intensive care units: the PneumoINSPIRE study

Background: Nosocomial pneumonia in the critical care setting is associated with increased morbidity, significant crude mortality rates and high health care costs. Ventilator-associated pneumonia represents about 80% of nosocomial pneumonia cases in intensive care units (ICUs). Wide variance in incidence of nosocomial pneumonia and diagnostic techniques used has been reported, while successful treatment remains complex and a matter of debate. Objective: To describe the epidemiology, diagnostic strategies and treatment modalities for nosocomial pneumonia in contemporary ICU settings across multiple countries around the world. Design, setting and patients: PneumoINSPIRE is a large, multinational, prospective cohort study of adult ICU patients diagnosed with nosocomial pneumonia. Participating ICUs from at least 20 countries will collect data on 10 or more consecutive ICU patients with nosocomial pneumonia. Site-specific information, including hospital policies on antibiotic therapy, will be recorded along with patient-specific data. Variables that will be explored include: aetiology and antimicrobial resistance patterns, treatment-related parameters (including time to initiation of antibiotic therapy, and empirical antibiotic choice, dose and escalation or de-escalation), pneumonia resolution, ICU and hospital mortality, and risk factors for unfavourable outcomes. The concordance of ventilator-associated pneumonia diagnosis with accepted definitions will also be assessed. Results and conclusions: PneumoINSPIRE will provide valuable information on current diagnostic and management practices relating to ICU nosocomial pneumonia, and identify research priorities in the field. Trial registration:ClinicalTrials.gov identifier NCT02793141.

Strategy and Control of Antimicrobial Therapy Program Implementation at the B.V. Petrovsky National Research Center of Surgery

The introduction of local programs for the rational use of antibiotics in a multidisciplinary hospital is aimed at reducing the level of antibiotic resistance and the frequency of healthcare associated infections (HAI). The aim of the study was to analyze the frequency of infectious complications caused by pathogens with multidrug resistance and the level of resistance at the B.V. Petrovsky National Research Center of Surgery based on the implementation of the SCAT program. Material and methods. A retrospective analysis of the SCAT program implementation results on the basis of the B.V. Petrovsky National Research Center of Surgery was carried out. 1850 case histories of the surgical profile for 2018 were analyzed (male —1095, average age 56.2±14.9 years; female — 755, average age 53.7±11.9 years) and 1502 case histories for the January–October period for 2019 (male — 1114, average age 58.3±12.1 years, and female — 388, average age 55.4±12.6 years). Results. The incidence of HAI in 2018 and 2019 was 354 and 159 cases, respectively. Of these, the incidence of nosocomial pneumonia (NP) was 64 cases (61.5%) and 40 cases (38.5%); skin and soft tissue infection (SSTI) — 93 cases (57.4%) and 69 cases (42.6%); surgical site infections (SSI) — 69 cases (82.1%) and 15 cases (17.9%) in 2018 and 2019, respectively. The drug resistance index (DRI) for the most clinically significant strains of the causative agents of HAI was: Klebsiella pneumoniae — 0.14, Acinetobacter baumannii — 0.22, Klebsiella spp. — 0.11, Enterobacter cloacae — 0.15, Enterococcus faecalis — 0.18, Enterococcus faecium — 0.21. Conclusion. The proposed measures for the implementation of the SCAT program at the level of a medical organization reduce the incidence of HAI and the local level of the drug resistance index.

Comparative analysis of the effect of steroid therapy and blood pressure maintenance on the mid-term outcomes of spinal cord injury

Objective. To analyze the dynamics of neurological symptoms and the structure of complications when using methylprednisolone and the method of maintaining target values of mean arterial pressure during surgical treatment of patients in the acute period of spinal cord injury (SCI). Material and Methods. The study included 110 patients in the acute period of SCI with compression of spinal cord segments who were admitted to the clinic from January 2012 to March 2018 and underwent decompression and stabilization surgery within the first 2–3 hours after admission. In order to improve the blood supply to the damaged segments of the spinal cord and to prevent multiple organ failure, the main direction of intensive care in two groups of patients was to maintain the target blood pressure at the level of 85–90 mm Hg during the first 7–10 days. The MPD group included 43 patients who received methylprednisolone as a neuroprotector at a dose of 30 mg/kg bolus within the first hour after admission, followed by infusion at a dose of 5.4 mg/kg/h for 23 hours; and the MAP group included 67 patients who did not receive methylprednisolone. Non-invasive monitoring of central hemodynamic parameters was carried out on the basis of impedance cardiography data. The objective status of patients and data of X-ray diagnostics at the time of preoperative examination and during instrumental studies, as well as in 3–14 day intervals and in the mid-term (up to 4–6 months) postoperative period were analyzed. Results. In the MPD group, 22 patients had ASIA type A neurological deficit, and an increase in ASIA grade was observed only in 4 (18 %) of them. There were 18 patients with incomplete injury in this group, and 9 of them (50 %) had a positive trend. In the MAP group, 38 patients had ASIA type A, out of them 11 (29 %) improved, and 28 patients had ASIA type B, C or D, out of them 17 (61 %) showed positive dynamics of neurological symptoms. No statistically significant differences were found. In the MPD group, complications such as nosocomial pneumonia and acute endobronchitis were observed three times more often, pulmonary embolism and decubital soft tissue ulcers – four times more often, and sepsis, acute respiratory distress syndrome and surgical site infection – two times more often. There were statistically significant differences in the incidence of nosocomial pneumonia and acute endobronchitis between MPD and MAP groups (p = 0.004 and p = 0.002, respectively.) Conclusion. Maintaining mean arterial pressure at 85–90 mm Hg during the first 7–10 days after admission to the hospital allowed achieving a greater number of cases of improvement in the neurological status of patients, in contrast to the use of methylprednisolone. The use of methylprednisolone in patients with acute SCI increased the risk of nosocomial pneumonia or acute endobronchitis by 2.91 times (p = 0.003).

Effect of Early Tracheostomy on Mortality of Mechanically Ventilated Patients with Guillain-Barré Syndrome: A Nationwide Observational Study.

BackgroundPatients with Guillain–Barré syndrome (GBS) who require mechanical ventilation (MV) are regarded as candidates for early tracheostomy because of the high risk of prolonged MV; however, the association between early tracheostomy and favorable outcomes in patients with GBS remains unclear. In this study, we evaluated the association between early tracheostomy and outcomes in mechanically ventilated patients with GBS.MethodsThis retrospective observational study included adult patients with GBS identified in the Japanese Diagnosis Procedure Combination national inpatient database from July 1, 2010, to March 31, 2018, who initiated MV within the first week of admission and who received MV for more than 1 week. Early tracheostomy was defined as tracheostomy performed within 7 days of MV. The primary outcome was in-hospital mortality, and the secondary outcomes were 28-day mortality, nosocomial pneumonia, length of hospital stay, length of intensive care unit (ICU) stay, duration of MV, duration of sedation, duration of analgesia, duration of delirium, and total hospitalization costs. Propensity scores for early tracheostomy were calculated using a logistic regression model on the following variables: age; sex; body mass index; Japan Coma Scale status at admission; Charlson comorbidity index score; comorbidity of chronic pulmonary disease; complication of pneumonia at admission; complication of hyponatremia at admission; neurological presentation at admission; ambulance use; referral from other hospitals; treatment year; days from hospital admission to MV initiation; ICU admission until the day of MV initiation; and treatments until the day of MV initiation. Stabilized inverse probability of treatment weighting analyses was performed to compare the outcomes between patients with and without early tracheostomy.ResultsAmong 919 eligible patients, 654 patients (71%) underwent tracheostomy, with 136 patients (15%) receiving early tracheostomy. Overall, the median time from initiation of MV to tracheostomy was 12 days (interquartile range 8–15 days). After stabilized inverse probability of treatment weighting, early tracheostomy was not associated with lower in-hospital mortality (risk difference 0.4%; 95% confidence interval − 5.6 to 6.7%) compared with patients without early tracheostomy. There were no significant differences in 28-day mortality (risk difference − 1.3%; 95% confidence interval − 3.5 to 0.9%) and incidence of nosocomial pneumonia (risk difference − 2.6%; 95% confidence interval − 9.1 to 4.2%) between the two groups. None of the other secondary outcomes differed significantly between the groups.ConclusionsEarly tracheostomy was not significantly associated with decreased mortality or morbidity in patients with GBS requiring MV for more than 1 week.

Analysis of Long-Term Dynamics of Incidence of Healthcare-Associated Infections in the Irkutsk Region

Introduction.Healthcare-associated infections incidence is one of the most pressing issues in modern healthcare due to their high abundance as well as economic loss they cause.The aimis to study regional features of the incidence of healthcare-associated infections.Methods.We conducted a retrospective epidemiological analysis of nosocomial morbidity in hospitals of the Irkutsk region within 2006-2017 years. We used data, presented in the following state reports: “On the state of sanitary and epidemiological welfare of the population in the Russian Federation”, “On the state of sanitary and epidemiological welfare of the population in the Irkutsk region”.Results and discussion.According to the results of the conducted analysis, it was shown that the average long-term prevalence of healthcare-associated infections in the Irkutsk region was 41.94 ± 2.040/00000 (Russian Federation – 17.49) with a tendency to stabilization in recent years. The therapeutic and prophylactic organizations of the surgical profile have the highest epidemiological significance (over 51 %). At the same time, the share of postoperative complications during the study period decreased by 1.5 times. We have noted a rising trend line with a positive rate of increase in the incidence of nosocomial pneumonia, which in the last two years has taken a leading position in the structure of healthcare-associated infections. The incidence of infections in newborns in the Irkutsk region ranks the third, with a specific weight of 11.54 %. Moreover, if before 2013 purulent-septic diseases of the newborns were the predominant nosological form, in recent years pneumonia has firmly taken over the leadership. During the study period we revealed an increase in the incidence of postpartum endometritis in puerperas. It has been shown that the registration of sepsis, urinary tract infections in the region is low.

Evaluation of airway care score as a criterion for extubation in patients admitted in neurosurgery intensive care unit.

Background and Aims:Early extubation in neurocritical patients has several potential benefits. Glasgow Coma Scale (GCS) is a crude measure of neurologic function in these patients and a low GCS score does not necessarily mean contraindication for extubation. Data on patients with neurosurgical or neurological pathology undergoing early extubation utilizing the airway score criteria is limited. Hence, this study was conceived to assess the usefulness of modified airway care score (ACS) as a criterion for successful extubation of neurocritical patients whilst comparing various outcomes.Material and Methods:One hundred and twenty four patient who underwent endotracheal intubation in the neurocritical care unit were enrolled in this prospective observational study over a period of 12 months. Patients were randomly enrolled into either the study group patients (S), who were extubated immediately after a successful spontaneous breathing trial (SBT) and an ACS ≤7 or into the control group (N), wherein patients were extubated/tracheostomized at discretion of the attending neurointensivist. Both groups were observed for comparison of preset outcomes and analyzed statistically.Results:Patients of study group experienced a statistically significant shorter extubation delay (3.28 h vs 25.41 h) compared to the control group. Successful extubation rate was significantly higher and reintubation rate was significantly lower in study group (6.6% vs 29.3%). Incidence of nosocomial pneumonia, duration of ICU stay and overall duration of mechanical ventilation were significantly lower in the study group. ACS and GCS had a negative correlation at the time of extubation.Conclusion:ACS can be used as a criterion for successful early extubation of neurocritical patients.

Early hydrocortisone for multiple trauma patients may lower the incidence of nosocomial pneumonia

Background Early post-traumatic pneumonia increases the duration of mechanical ventilation (MV), hospitalization, and risk of death. In this study, the efficacy of hydrocortisone therapy in the prevention of nosocomial pneumonia in multiple trauma patients has been assessed. Patients and methods Six hundred patients who were admitted with multiple trauma were randomly assigned into two groups. The early hydrocortisone (EH) group consisted of 300 patients who received intravenous hydrocortisone 200 mg/day within 24 h from admission or trauma for 5 days and 100 mg, 50 mg on the following 2 days, respectively. The no early hydrocortisone group consisted of 300 patients who received placebo. All patients were followed up for the incidence of noscomial pneumonia. The days of ICU stay, MV, and mortality rates were calculated in both groups as secondary outcomes. Results The incidence of nosocomial pneumonia in the EH group was significantly lower than the no early hydrocortisone group [120 (40%) vs. 240 (80%), P Conclusion The use of early intravenous stress dose of hydrocortisone in patients with multiple trauma may be associated with lower incidence of nosocomial pneumonia but with no difference in mortality.

Continuous lateral rotational therapy in trauma-A systematic review and meta-analysis.

The purpose of this study was to evaluate the impact of continuous lateral rotational therapy (CLRT) on respiratory complications and mortality in patients suffering from trauma. The literature databases PubMed®/Medline® and the Cochrane Library® were systematically searched for prospective controlled trials comparing continuous lateral rotational therapy to conventional manual positioning in trauma patients. A total of 8 publications (n= 422 patients) with comparable age and injury severity were included in the meta-analysis. A significant reduction in the incidence of nosocomial pneumonia (OR: 0.33, [95%CI: 0.17, 0.65], p=0.001) was observed in patients treated prophylactically with continuous lateral rotational therapy. When used with therapeutic intention, CLRT had no impact on the incidence of pneumonia. There were no significant differences in mortality, duration of mechanical ventilation, or ICU length of stay. Analogous to studies evaluating CLRT in medical or mixed patient collectives, CLRT reduced the rates of nosocomial pneumonia in trauma patients. This, however, had no impact on overall mortality. The level of evidence of the studies included was limited by several factors. An adequately powered, well-designed multi-centre randomised controlled trial is required, to validly assess the utility of CLRT for the prevention and treatment of pulmonary complications in patients suffering from trauma. Systematic review and meta-analysis, level III.

Incidence of nosocomial pneumonia and causative bacteria among chronically ill patients admitted in a general hospital a

Incidence of nosocomial pneumonia and causative bacteria among chronically ill patients admitted in a general hospital a

Incidence of Hospital-Acquired Bacterial Pneumonia and Its Resistance Profiles in Patients Admitted to Intensive Care Unit

&lt;p&gt;Hospital-acquired bacterial pneumonia (HABP) is one of the most important causes of morbidity, mortality and economic problems especially for patients admitted in the intensive care unit (ICU) ward. The aim of this study was to determine the incidence of nosocomial pneumonia in ICU, identify the causative bacteria and their resistance profiles. This cross sectional study was performed on 214 patients who were admitted in the ICU ward of a general hospital requiring mechanical ventilation for at least 48 h. Identification of HABP was based on the clinical signs manifested 48 h or more after admission, new chest X-ray infiltrates and microbiologic examination of endo tracheal secretion. Data were analyzed using SPSS 21 to perform the descriptive statistics. The isolated gram negative bacteria were &lt;em&gt;Klebsiella pneumoniae&lt;/em&gt; (50%), &lt;em&gt;Staphylococcus aureus&lt;/em&gt; (18.7%), &lt;em&gt;Acinetobacter baumannii&lt;/em&gt; (12.5%), &lt;em&gt;Escherichia coli&lt;/em&gt; (12.5%) and &lt;em&gt;Pseudomonas aeroginosa&lt;/em&gt; (6.3%). The maximum antimicrobial resistance of gram negative bacteria was to Cefazolin (100%) and Ampicillin (84.6%), while antimicrobial resistance to Clindamycin, Azithromycin, Amoxycillin+clavulanate, Trimethoprim+sulfamethoxazole and Ciprofloxacin was 33.3%. No resistance was seen towards carbapenems.The most frequent gram negative isolated bacterium was &lt;em&gt;K. pneumoniae, &lt;/em&gt;and maximum antimicrobial resistance rate was observed for Cefazolin and Ampicillin, which is due to betalactamase production.&lt;/p&gt;

Respiratory Disorders in Complicated Cervical Spine Injury

Objective. Evaluating the results of respiratory therapy in patients with complicated traumatic injury of the cervical spine. Materials and methods . A retrospective comparative analysis of the clinical course was carried out in 52 patients with complicated traumatic injury of the cervical spine: group A: complete spinal cord injury (ASIA A), 37 patients and group B: incomplete injury (ASIA B), 15 patients. The severity of patients' status on integral scales, parameters of the respiratory pattern and thoracopulmonary compliance, gas composition, and acidbase status of the blood were assessed. Data on patients who required prolonged mechanical ventilation, duration of mechanical ventilation, incidence of nosocomial pneumonia, duration of stay in the ICU, time of hospital treatment, and mortality were included in the analysis. Results. The average APACHE II and SOFA scores were higher in group A patients. The development of the acute respiratory failure required longterm mechanical ventilation (more than 48 hours) in 91.4% of group A patients and in 53.3% of group B patients. Ventilatorassociated pneumonia complicated the disease in 81.3% of group A patients and 62.5% of group B patients and was accompanied by sepsis in 25% and 12.5% of cases, respectively. Statistically significant deterioration of biomechanical properties and gas exchange function of the lungs was observed in patients complicated with septic pneumonia. Conclusion. Patients with complicated ASIA A and ASIA B cervical spine injuries demonstrate the presence of respiratory failure of neurogenic origin. In addition, the infectious bronchopulmonary complications aggravated respiratory failure in patients with ASIA A injury in 70.3% versus 33.3% in patients with ASIA B. Development of pulmonogenic sepsis led to deterioration of the biomechanical and gas exchange functions of the lungs and increased the likelihood of unfavorable outcome of the disease in 77.8% of cases. The high incidence of respiratory disorders in patients with complicated cervical spine injury requires timely decision on ventilatory support, especially in patients with complete spinal cord injury.

Nosocomial pneumonia in non-invasive ventilation patients: incidence, characteristics, and outcomes

Nosocomial pneumonia occasionally occurs in non-invasive ventilation (NIV) patients. To report the incidence, characteristics, and outcomes of nosocomial pneumonia in NIV patients. A prospective observational study was performed in a respiratory intensive care unit (ICU). After admission, patients who received NIV for more than 48 h were enrolled. Pneumonia was considered nosocomial when it occurred after at least 48 h of NIV. Between January 2012 and August 2014, we enrolled 520 NIV patients. Nosocomial pneumonia occurred in 16 patients (3.1%). The nosocomial pneumonia rate was 4.5 cases per 1000 NIV-days. The most common pathogen was Acinetobacter baumannii (81%). At the initiation of NIV, there were no differences in age, gender, diagnosis, disease severity, or arterial blood gas findings between patients with and without nosocomial pneumonia. Compared to patients without nosocomial pneumonia, nosocomial pneumonia patients had a longer duration of NIV (8.4 vs 5.0 days, P < 0.01), a longer ICU stay (10.8 vs 7.9 days, P = 0.01), a longer hospital stay (25.9 vs 15.3 days, P = 0.04), a higher intubation rate (63% vs 21%, P < 0.01), and higher hospital mortality (75% vs 25%, P < 0.01). Nosocomial pneumonia was an independent risk factor for intubation (OR: 6.74; 95% CI: 2.24-20.28) and death (7.65; 1.34-43.72). The incidence of nosocomial pneumonia in NIV patients in this population was 3.1%. Nosocomial pneumonia increased the time that NIV was required, length of ICU stay, length of hospital stay, intubation rate, and hospital mortality.

β-Blockers, Pneumonia, and Outcome After Ischemic Stroke

Increased sympathetic drive after stroke is involved in the pathophysiology of several complications including poststroke immunudepression. β-Blocker (BB) therapy has been suggested to have neuroprotective properties and to decrease infectious complications after stroke. We aimed to examine the effects of random pre- and on-stroke BB exposure on mortality, functional outcome, and occurrence of pneumonia after ischemic stroke. Data including standard demographic and clinical variables as well as prestroke and on-stroke antihypertensive medication, incidence of pneumonia, functional outcome defined using modified Rankin Scale and mortality at 3 months were extracted from the Virtual International Stroke Trials Archive. For statistical analysis multivariable Poisson regression was used. In total, 5212 patients were analyzed. A total of 1155 (22.2%) patients were treated with BB before stroke onset and 244 (4.7%) patients were newly started with BB in the acute phase of stroke. Mortality was 17.5%, favorable outcome (defined as modified Rankin Scale, 0-2) occurred in 58.2% and pneumonia in 8.2% of patients. Prestroke BB showed no association with mortality. On-stroke BB was associated with reduced mortality (adjusted risk ratio, 0.63; 95% confidence interval, 0.42-0.96). Neither prestroke BB nor on-stroke BB showed an association with functional outcome. Both prestroke and on-stroke BB were associated with reduced frequency of pneumonia (adjusted risk ratio, 0.77; 95% confidence interval, 0.6-0.98 and risk ratio, 0.49; 95% confidence interval, 0.25-0.95). In this large nonrandomized comparison, on-stroke BB was associated with reduced mortality. Prestroke and on-stroke BB were inversely associated with incidence of nosocomial pneumonia. Randomized trials investigating the potential of β-blockade in acute stroke may be warranted.

Role of Early Immune Replacement Therapy in Reducing the Rate of Nosocomial Pneumonia in Severe Polytrauma

Objective: to evaluate the efficiency of early immune replacement therapy (EIRT) in patients with severe polytrauma (SCI). Subjects and methods . Two hundred and twentyfive victims aged 35.5±14.1 years with SCI (ISS&gt;30 scores), including 158 cases of nosocomial pneumonia, were examined. According to the use of EIRT with donor immunoglobulin (IgG) (daily within the first three days), the patients were divided into two groups: 1) standard intensive treatment was added by EIRT (n=126) and 2) that without EIRT (n=99). Immunological examination was performed on days 1, 3, 6, and 9 after injury. The investigators determined the relative and absolute counts of major lymphocyte populations: T (CD3+) and B (CD19+) lymphocytes, those of T cell populations: (CD4+) helper T cells and (CD8+) cytotoxic T lymphocytes, the concentrations of the immunoglobulins A, O, and M classes (IgA, IgG and IgM), neutrophil absorptive and bactericidal activ ities, and the serum levels of large, middle, and small circulating immune complexes, Creactive protein, and procalcitonin. The incidence of nosocomial pneumonia and sepsis and the outcome of injury were analyzed in both groups. Results. The performed investigation indicated that EIRT in Group 1 victims resulted in a 27.6% decline in the number of patients who had received mechanical ventilation (MV) for more than 3 days and reduced the rate of earlyonset pneumonia and sepsis by 24.3 and 5.2%, respectively, and the intensive care unit length of stay from 20.2 to 12.5 days, mortality rates by 12.1%, and deaths by 1%. Conclusion. EIRT used to treat victims with SCI could decrease the duration of MV and the incidence of nosocomial pneumonia, which in turn reduced mortality rates in the examined groups.

Incidence of nosocomial pneumonia and risk of recurrence after antimicrobial therapy in critically ill lung and heart–lung transplant patients

Little is known about the resolution of symptoms of nosocomial pneumonia (NosoP) after lung and heart-lung transplantation. The aim of this study was to describe the clinical response to antimicrobial therapy in (ICU) patients with NosoP after lung or heart-lung transplantation. Between January 2008 and August 2010, 79 lung or heart-lung transplantations patients were prospectively studied. NosoPwas confirmed by quantitative cultures of bronchoalveolar lavage or endotracheal aspirates. Clinical variables, sequential organ failure assessment (SOFA) score, and radiologic score were recorded from start of therapy until day 9. Thirty-five patients (44%) experienced 64 episodes of NosoP in ICU. Fourteen patients (40%) had NosoP recurrence. Most frequently isolated organisms were Enterobacteriaceae (30%), Pseudomonas aeruginosa (25%), and Staphylococcus aureus (20%). Sequential organ failure assessment (SOFA) score improved significantly at day 6 and C-reactive protein level at day 9. SOFA and radiologic scores differed significantly between patients with and without NosoP recurrence at day 3 and 9. The ICU mortality rate did not differ between patients with and without NosoP recurrence, and free of NosoP (14.3%, 9.5%, 11.4%, respectively) (p=0.91). Severities of illness and lung injury were the two major risk factors for NosoP recurrence. Occurrence of NosoP has no impact on ICU mortality.