Prevalence of Gram-negative Bacteria Isolated from Patients with Ventilator-Associated Pneumonia in Intensive Care Units of Imam Khomeini Hospital, Ahwaz, Iran

Background: Ventilator-associated pneumonia (VAP) is a common nosocomial infection among hospitalized patients who have undergone intubation and mechanical ventilation for more than 48 hours. Patients admitted to the intensive care unit (ICU) are at risk of developing life-threatening VAP due to specific conditions, especially with Gram-negative pathogens with advanced drug resistance. Hereby, the control of these agents and its monitoring is of particular importance. In this study, the pattern of antibiotic resistance of Gram-negative bacteria isolated from tracheal culture of patients with VAP investigated in ICU of Imam Khomeini Hospital of Ahwaz.Materials and Methods: In this cross-sectional study, tracheal samples were collected during April 2016 to April 2017 from patients who were on mechanical ventilation in ICU of Imam Khomeini Hospital in Ahwaz, Khuzestan province, southwest of Iran. After isolation, bacterial strains were identified using biochemical tests. Then, antimicrobial resistance pattern of these isolates investigated using standard disc diffusion according to clinical and laboratory standards institute 2016 (CLSI 2016) guidelines.Results: A total of 111 bacterial isolates were identified which were as following; Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Stenotrophomonas maltophilia, and Serratia marcescens, with prevalence of 54%, 19.8%, 14.4%, 6.4%, 4.5%, and 0.9%, respectively. Antibiotic susceptibility test of isolates showed that almost all isolates had high resistance to treatment antibiotics and were multi-drug resistance (MDR). The A. baumannii isolates were resistant to ciprofloxacin and piperacillin-tazobactam, but ampicillin-tazobactam had a good effect.Conclusion: The results of this study showed that patients admitted to ICU due to their conditions of treatment are more likely to develop VAP by Gram-negative pathogens. The empirical treatment of VAP due to predominant bacterial causes and emerging drug resistance has become more challenging. It requires to use of multidrug regimens for routine clinical practice. It should be noted that in order to appropriate antimicrobial therapy, precise and correct diagnosis is very important

The effects of inhaled corticosteroid on insulin sensitivity in asthmatic patients

Asthma is an inflammatory disease, which causes airflow limitation and increase insulin resistance. The present study was carried out in order to investigate insulin resistance and the effect of inhaled corticosteroid (ICS) on insulin sensitivity in asthmatic patients. A registered (IRCT201605247411N2) interventional, quasi-experimental trial was performed from 2014 to 2015 in Imam Khomeini hospital Ahvaz, Iran. Patients with mild to moderate asthma participated in this study. Spirometry, fasting blood sugar (FBS), blood sugar 2 hour post prandial (BS2HPP), HbA1C, low density lipoprotein (LDL), high density lipoprotein (HDL), Insulin Level, and C reactive protein (CRP) were measured. Then Homeostatic Model Assessment-Insulin Resistance [HOMA-IR] Index calculated. Data were analyzed using paired t-test and McNemar’s test using SPSS 20.0 Software. The study consisted of 35 non-diabetic patients suffering from asthma (20 men and 15 women) with a mean age of 36.6 ±12.3 years. Inhaled corticosteroid had a significant effect on spirometric parameters, but it had no significant effect on other variables. At baseline, mean HbA1C, insulin level and HOMA-IR were 5.5%, 10.9 mIU/L and 2.7 respectively. None of these values changed significantly after treatment with inhaled corticosteroid for two months. The results indicated that there is no relationship between ICS and increased insulin resistance in asthmatic patients

Causes of pleural effusion in long-term hemodialysi s

Background and Objective: Pleuropulmonary complications, such as pleural effusion (PE) are encountered with an increased frequency among patients with end stage renal disease. Subjects and Methods: In the cross-sectional and prospective study we evaluated 253 patients who had received long- term hemodialysis between 2007 September and 2008 October for better understanding the incidence and causes of PE in this population. Results: The incidence of pleural effusion was 25 % (n= 63, mean age 48.09 ± 1.39 years, male to female ratio approximately 1.1). 66.6 % of the patients (n= 42) had transudative PE and 33.4% (n= 21) had exudative PE. Transudative PE resulted from heart failure in 64.3% (n= 27), hypervolemia in 33.3% (n= 14) and cirrhosis in 2.4% (n= 1). Parapneumonic effusion (n= 6), TB (n= 5), uremic pleurisy (n= 4), malignancy (n= 2), unknown (n= 2) and SLE (n= 1) accounted for causes of exudative PE. Conclusion: Pleural effusion is a common complication in hospitalized patients receiving long–tern hemodialysis. Since heart failure, hypervolemia and uremic pleurisy were the most common causes of pleural effusion, this problem should not be considered an obstacle in renal transplant recipients

Pulmonary Function Tests in Thunderstorm-associated Respiratory Symptoms: A Cross-sectional Study

Background: Epidemic thunderstorm asthma is an observed increase in cases of acute bronchospasm following thunderstorms. This study aimed to compare the frequency of obstructive airway disease or bronchial hyperresponsiveness in subjects with thunderstorm-associated respiratory symptoms with subjects with similar symptoms presented at other times.Methods: A cross-sectional study from June to November of 2013 was conducted on subjects with thunderstorm-associated respiratory symptoms living in Ahvaz City, Iran. Thunderstorm-associated subjects were presented with asthmatic symptoms in thunderstorms, and other patients presented with similar symptoms at other times. Baseline spirometry was performed on patients to examine the presence of obstructive airway disease. In all patients with normal spirometry, a provocation test was applied. A comparison of qualitative and quantitative variables was made using the Chi-square and independent t test, respectively. All analyses were carried out using SPSS Statistics Version 22. A P value less than 0.05 was considered statistically significant.  Results: Out of 584 subjects, 300 and 284 participants were in thunderstorm-associated and non-thunderstorm-associated groups, respectively. After the final analysis, 87 (30.6%) and 89 (33.3%) of the thunderstorm-associated subjects and non-thunderstorm-associated group, respectively, had pieces of evidence of airflow limitation (P=0.27). Among the patients with normal spirometry, 161 (81.72%) of the thunderstorm-associated patients and 100 (56.17%) patients of the non-thunderstorm-associated symptoms group had a positive methacholine challenge test result (P<0.001). Conclusion: Most of the patients with thunderstorm-associated respiratory symptoms had no obvious evidence of airflow limitation in spirometry

The relationship between the incidence of pancytopenia and disease prognosis in hospitalized patients with Covid-19

Background: With the spread of the Covid-19 epidemic, complications, coagulation symptoms, and pancytopenia caused by the disease were observed in patients. Objectives: This study aimed to determine the relationship between the incidence of pancytopenia and disease prognosis in hospitalized Covid-19 patients. Methods: This descriptive-analytical cross-sectional study was performed on 51 Covid-19 patients with pancytopenia and 109 patients without pancytopenia referred to a referral hospital in Ahvaz (Iran) in 2021. We used descriptive and analytical statistics such as the independent t-test and Mann-Whitney test. Results: During the one-year study period, 51 out of 1839 hospitalized Covid-19 patients (2.8%) were diagnosed with pancytopenia. The mean number of hospitalization days and the number of breaths, in the group of patients with pancytopenia (7.1±5.6 days and 22.84±9.2 per minute, respectively) were significantly higher than the group without pancytopenia (3.8 ±1.8 days and 19.8±3.6 per minute, respectively) (P &lt;0.05). In the group of patients with pancytopenia compared to the group without pancytopenia, we observed 13.7% vs. 0% of unconsciousness, 31.4% vs. 12.8% of severe lung involvement, 25.5% vs. 4.6% need for intubation, and 27.5% vs. 6.4 % death (P &lt;0.05)

Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study

Purpose In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes