Hospital-Acquired Pneumonia

Key points Hospital-acquired pneumonia has a major impact in terms of mortality and morbidity. Empirical treatment approach is still the best course of action. Prevention is of critical importance. Educational aims To improve knowledge of HAP management. To better understand the epidemiological basis for the correct empirical therapy of HAP Summary HAP still has a major impact in terms of mortality and morbidity among hospitalised patients. Early appropriate antibiotic therapy is associated with a reduction in mortality and improved outcome. Although, in most cases, an empirical approach is still the rule, taking into account the risk factors, the severity of illness and length of stay before the pneumonia onset can better target antibiotic therapy. The patient9s follow-up course, in terms of microbiological, clinical and radiological monitoring, is important. Prevention strategies are of critical importance and are based on the understanding of the epidemiology and pathogenesis of HAP. Routine efforts for the prevention of HAP should be directed towards obtaining effective surveillance and infection-control programmes, including staff education, use of proper isolation techniques and infection-control practices. This review aims to increase understanding of these points to allow improved knowledge and treatment of HAP

Identification of Beta-Lactamase Enzymes by Isoelectrical Focusing Method in Acinetobacter baumannii

There has been an important resistance problem to various beta-lactam antibiotics in Acinetobacter baumannii strains which cause nosocomial infections. In this study, isoelectric points of beta-lactamase enzymes of 60 strains of A. baumannii isolated from various clinical specimens were investigated by polyacrylamid gel electrophoresis (PAGE). Beta-lactamase enzymes of the isolates were estimated by evaluating their susceptibility to beta-lactam group antibiotics and isoelectric points (pI). The presence of beta-lactamase enzymes was detected in all of the A. baumannii species included in the study. Beta-lactamase band was observed in 50 species by IEF method, but couldn’t be shown in the other 10 isolates. However, the presence of betalactamase which shows spreading type around loading space without band formation was detected in all of the strains. Isoelectric points in 29 of the 50 isolates with band formation were 5.4, 8 were 6.3 and 13 were 6.3 and 5.4. According to antibiotic susceptibility and isoelectric points, 6 phenotypes were observed. We suggest that phenotype 1 was either ACE + TEM-1 or PER-1; phenotype 2 was ACE + CARB-5; phenotype 3 was ACE; phenotype 4 was either an over synthesis of ACE or a new beta-lactamase; phenotype 5 was ACE + TEM-1; phenotype 6 was either ACE + TEM-1 or PER-1 + CARB-5. Every phenotype was divided into subgroups according to their resistance to imipenem, except phenotype 5. As well as beta-lactamases, changes in porins and penicillin binding proteins were considered to be responsible for the resistance of A. baumannii strains to beta-lactam antibiotics

Hospital Acquired Pneumonia

In this study, we present hospital acquired pneumonia cases hospitalized at Uluda¤ University School of Medicine in 1997. In the clinics covered by the surveillance system 10 983 patients were followed up, and hospital acquired pneumonia was observed in 163 (1.4%) patients. Hospital acquired pneumonia was found to be the second common cause of nosocomial infections with the rate of 23.9%. Ventilator-associated pneumonia was found in 70% of all the cases involved in the study. Hospital acquired pneumonia was seen in 9.5% of cases in ICU, whilst only 0.5% of the cases was from other clinics

Comparison of C-Reactive protein, procalcitonin and serum amyloid A levels in diagnosis of bacterial infection in children Çocuklarda bakteri enfeksiyonlari{dotless}ni{dotless}n tani{dotless}si{dotless}nda C-Reaktif protein, prokalsitonin ve serum Amiloid-A düzeylerinin karşi{dotless}laşti{dotless}ri{dotless}lmasi{dotless}

Objective: The aim of the study was to compare C-reactive protein (CRP), procalcitonin (PCT) and serum amyloid A (SAA) levels in children with bacterial infection. Material and Methods: In this prospective study, 120 pediatric patients who were hospitalized with bacterial infection in the Uludag University Medical Faculty Pediatric Clinic between June 2009 and June 2011 were included. Patients were evaluated in 5 groups as sepsis, pneumonia, meningitis, pyelonephritis and other infection groups. Before initiating the antimicrobial therapy, blood samples for whole blood count, blood culture, CRP, PCT and SAA were obtained from children with bacterial infection. This procedure was repeated three times at 48 h, 7 and 10 days. Whole blood count was performed using an automated counter, Cell Dyn 3700 (Abbott Diagnostics Division, Santa Clara, CA, USA). CRP and SAA were determined by an immunonephelometric method using BN II device (Dade Behring Marburg GMBH, Marburg, Germany). PCT was measured by Enzyme- Linked Fluorescent Assay (VIDAS PCT; Brahm Diagnostica GMBH, Lyon, France). Results: Of the patients, 66 (55%) were male and 54 (45%) were female. The median age was 37.5 months (1-209). PCT levels of the sepsis group was significantly higher than those of the pneumonia and other infection groups (respectively, p=0.001, p=0.003). SAA levels were higher in the meningitis group than those of the pneumonia group (p=0.007). When patients were divided into two groups as invasive bacterial infection group and localised bacterial infection group; PCT levels were found significantly higher in the invasive bacterial infection group than those of the localised bacterial infection group. Also, percentage change of PCT at the 48th hour, 7 and 10 days was determined as significantly higher in the invasive bacterial infection group than that of the localised bacterial infection group. Conclusion: In this study, PCT seems to be a more valuable parameter in diagnosing invasive bacterial infections. © 2013 by Pediatric Infectious Diseases Society