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

Antibiotic Associated Diarrhea: Retrospective Evaluation of 30 Cases

Antibiotic associated diarrhea may develop due to several causes. Here, we report the cases with diarrhea syndrome developed during the use of oral antibiotics for the treatment of community-acquired infections. Thirty hospitalized patients (15 male, 15 female) with bloody diarrhea were included in this study. The mean age was 40.8 years (range 16-85). Twenty-six of the cases had history of ampicillin/sulbactam usage before the onset of diarrhea, whereas remaning four cases mentioned use of amoxycilline/clavunate (2), azitromycine (1) or ampicillin/sulbactam + ornidazole (1). The time from onset of antibiotic use before the appearance of symptoms varied from 1 day to 8 days (median ± SEM, 3.73 ± 0.34 days). The frequencies of defecation were 3-9 times/day in six cases, 10-20 times/day in 15 cases and ≥ 20 times in nine cases. The presence of Clostridium difficile toxin in feces was assessed in 10 patients, and was weak positive in one patient. No enteric pathogen was isolated from feces culture. The diarrhea was regressed within two to six days (median ± SEM, 3.96 ± 0.18 days) after starting metronidazole (4 x 250 mg/day, oral, 10 days) treatment. In conclusion, cephalosporins and clindamycine, which are the most common causes of antibioticassociated colitis worldwide, were not responsible for the diarrheas observed in our cases. This may be due to the fact that ampicillin/sulbactam is commonly used for the treatment of community-acquired infections in our country

Three Probable Cat Scratch Disease Cases Treated with Azithromycin

The cat scratch disease is often characterized by local lymphadenopathy and/or systemic involvement. In this study, three cat scratch disease cases and their treatments are discussed

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

Community-Acquired Sepsis: Retrospective Evaluation of 125 Cases

Introduction: There are only a few studies regarding community-acquired sepsis and its epidemiology. We aimed to evaluate the cases diagnosed as community-acquired sepsis and followed in our clinic. Patients and Methods: In this study, epidemiological and clinical features of 125 adult patients with community-acquired sepsis followed in our clinic during the period 1989-2005 were retrospectively evaluated. Results: The mean age was 52.7 years; 58 patients (46.4%) were male and 67 (53.6%) were female. Anatomic site of infections included urinary tract in 56 patients (45%), respiratory system in 23 (18%), intraabdominal in 12 (9.6%), and skin and soft tissue in 6 (5%). No anatomic site of infection was found in 28 (22.4%) patients. Of the blood culture isolates, 64% were gram-negative bacteria. In-hospital mortality was 30% in patients with sepsis. The mortality rate was found to be 4.25% in 47 patients with sepsis, while it was 35.9% in 78 patients with severe sepsis on admission (p< 0.001). Conclusion: New and large studies are needed to understand the epidemiology of community-acquired sepsis