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Linezolid versus Vancomycin for the Treatment of Methicillin Resistant Staphylococcus aureus in Hospital Acquired, Ventilator Associated, and Healthcare Associated Pneumonia at Tertiary Care Hospital

Linezolid versus Vancomycin for the Treatment of Methicillin Resistant Staphylococcus aureus in Hospital Acquired, Ventilator Associated, and Healthcare Associated Pneumonia at Tertiary Care Hospital

Aim: To evaluate morbidity and mortality rate, clinical cure rate and cost of linezolid versus vancomycin in patients who have hospital-acquired pneumo- nia (HAP), ventilator-associated pneumonia (VAP) or Healthcare-associated pneumonia (HCAP) caused by methicillin-resistant Staphylococcus aureus (MRSA). Methods: Retrospective analysis data. Data were collected for adult patients admitted to King Faisal Specialist Hospital and Research Centre- Jeddah (KFSH & RC-J) from January 2010 to May 2015. Method: A total of 88 patients with HAP, VAP and HCAP caused by MRSA treated with vanco- mycin (IV) or linezolid (IV or PO) either as empirically or directed therapy ≥ 7 days. They are retrospectively evaluated and analyzed. The primary end points are morbidity and mortality rate as well as clinical cure rate. The sec- ondary end point is the cost analysis for each medication. Results: A total of 40 patients (ICU, n = 13 (32.5% and non ICU, n = 27 (67.5%)) were included in the study. Among vancomycin, n = 21 (52.5%); age (54.95 ± 18.255) and linezolid, n = 19 (74.5%); age (48.684 ± 25.593), there was no statistical dif- ferences in mortality and morbidity rate ( P = 0.375). Clinical cure rate (fever improvement, 12 (57.1%) vs 12 (63.2%); P = 0.698, leukocytosis improvement, 15 (71.4%) vs 14 (73.7%); P = 0.873, purulent sputum improvement, 6 (28.6%) vs 4 (21.1%); P = 0.429, dyspnea improvement, 8 (38.1%) vs 3 (15.8%); P = 0.115,cough improvement 4 (19.0%) vs 4 (21.1%); P = 0.592, microbiological eradication of MRSA from sputum culture, 2 (9.5%) vs 6 (31.6%); P = 0.089 and improvement of radiographic finding (pulmonary infiltration), 17 (81.0%) vs 16 (84.2%); P = 0.559) of vancomycin vs linezolid, respectively. The cost How to cite this paper: Hamdan, E.M. and
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Application and comparison of scoring indices to predict outcomes in patients with healthcare associated pneumonia

Application and comparison of scoring indices to predict outcomes in patients with healthcare associated pneumonia

adverse outcome rate increased steadily from low to high, meeting the criteria for all scores. The average LOS increased steadily from low to high, either for risk class or meeting criteria. PSI can offer moderate discriminating ability for separating patients between survivors and non- survivors at 30 days, as well as for predicting the need for ICU admission. The performance of each index in predict- ing 3-day and 14-day ICU admission and 30-day mortality were also determined (Tables 6 and 7). PSI (>90) has the highest sensitivity to predicting mortality (AUC: 0.70), fol- lowed by CURB-65 ( ≥ 2) (AUC: 0.66), and SCAP (>9) (AUC: 0.71). For predicting ICU admission (Day 3 and Day 14), modified ATS (AUC: 0.84, 0.82), SMART-COP (AUC: 0.84, 0.82), SCAP (AUC: 0.82, 0.80) and IDSA/ATS (AUC: 0.80, 0.79) performed better (statistically significant difference) than PSI, CURB-65, SOAR and SMRT-CO. Table 1 Background of patients with healthcare-associated pneumonia
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Original Article Early prognostic factors of mortality in patients with severe healthcare-associated pneumonia in the intensive care unit

Original Article Early prognostic factors of mortality in patients with severe healthcare-associated pneumonia in the intensive care unit

Abstract: Introduction: Healthcare-associated pneumonia is a new classification of pneumonia, which is lack of studies to evaluate the predictive factors of mortality on ICU admission. We construct a model and tried to find the factors predicting mortality. Method: This was a retrospective study of prospectively collected data from all consecu- tive patients with severe HCAP who were admitted to the hospital through the ICU of a university hospital between May 2013 and May 2015. Results: A total number of 145 patients with severe healthcare-associated pneumonia were evaluated. Bivariate analysis of serum biomarkers showed high mortality in patients with low serum albumin and hemoglobin concentrations, as well as in patients with high AST, BUN, SCR. The other prognostic factors related to increased mortality by bivariate analysis included age, gender, respiratory rate, median CURB-65 score, co-mor- bid of COPD or coronary artery disease and acute heart failure, acute renal failure, and the presence of septic shock on admission. The total ICU mortality was the mortality rate was 33.8% (49 patients). Multivariate analysis of the risk factors generated a new predictive model of mortality applicable within 24 h after ICU admission. Conclusions: CURB severity score 3-5, the underlying disease of COPD or coronary artery disease, and the co-morbids of acute renal failure or the presence of septic shock during the first 24 h of ICU admission were found to be independent predictors of mortality in sever HCAP. Significantly higher AST, BUN and SCR levers, and lower ALB and HGB levels were found in non-survivors. Sever HCAP patients showed an aetiological pattern not far from the typical hospital acquired pneumonia (HAP) microbiology in China.
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Healthcare associated pneumonia among hospitalized patients in a Korean tertiary hospital

Healthcare associated pneumonia among hospitalized patients in a Korean tertiary hospital

In 2005, the American Thoracic Society (ATS)/Infec- tious Diseases Society of America (IDSA) documented healthcare-associated pneumonia (HCAP) as a new cate- gory of pneumonia [9]. However, only a few studies on HCAP have included patients who met the criteria of the 2005 ATS/IDSA guidelines [10]. Previous HCAP studies have revealed a diverse composition of partici- pants because this new HCAP category includes various criteria for heterogeneous conditions, such as nursing home residence, previous antibiotic therapy, or regular attendance at a dialysis clinic [11-13]. Since the criteria for defining HCAP have not been standardized between these studies, and due to the existence of geographically different etiologies, more data are required for a better characterization of unified HCAP and for redefining HCAP.
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Comparison of Methicillin Resistant Staphylococcus aureus Community Acquired and Healthcare Associated Pneumonia

Comparison of Methicillin Resistant Staphylococcus aureus Community Acquired and Healthcare Associated Pneumonia

Purpose: Methicillin-resistant Staphylococcus aureus (MRSA) is recognized as an important cause of not only healthcare-associated pneumonia (HCAP) but also community-acquired pneumonia (CAP). We determined the impact of MRSA on differences in clinical characteristics, courses, and outcomes between CAP and HCAP. Materials and Methods: We conducted a retrospective observational study on 78 adult patients admitted with MRSA pneumonia at a university-affiliated ter- tiary hospital between January 2008 and December 2011. We compared baseline characteristics, chest radiographs, treatment outcomes, and drug resistance patterns between the CAP and HCAP groups. Results: Of the 78 patients with MRSA pneu- monia, 57 (73.1%) were HCAP and 21 (26.9%) were CAP. MRSA infection history in the previous year (29.8% vs. 14.3%, p=0.244) tended to be more common in HCAP than in CAP. Despite similar Pneumonia Severity Index scores (151 in CAP vs. 142 in HCAP), intubation rates (38.1% vs. 17.5%; p=0.072) and intensive care unit admission (42.9% vs. 22.8%; p=0.095) tended to be higher in the CAP group, while 28-day mortality was higher in the HCAP group (14.3% vs. 26.3%; p=0.368), although without statistical significance. All patients showed sensitivity to vanco- mycin and linezolid; meanwhile, HCAP patients showed greater resistance to gen- tamicin than CAP patients (58.3% vs. 16.6%; p=0.037). The median total hospital charges were 6899 American dollars for CAP and 5715 American dollars for HCAP (p=0.161). Conclusion: MRSA pneumonia showed significantly differences in baseline characteristics, chest radiographs, treatment outcomes, and medical ex- penses between HCAP and CAP groups.
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Validation of sputum Gram stain for treatment of community acquired pneumonia and healthcare associated pneumonia: a prospective observational study

Validation of sputum Gram stain for treatment of community acquired pneumonia and healthcare associated pneumonia: a prospective observational study

Results: Of 670 patients with pneumonia, 328 were CAP and 342 were HCAP. Sputum samples were obtained from 591 patients, of these 478 samples were good quality. The sensitivity and specificity of sputum Gram stain were 62.5% and 91.5% for Streptococcus pneumoniae, 60.9% and 95.1% for Haemophilus influenzae, 68.2% and 96.1% for Moraxella catarrhalis, 39.5% and 98.2% for Klebsiella pneumoniae, 22.2% and 99.8% for Pseudomonas aeruginosa, 9.1% and 100% for Staphylococcus aureus. The diagnostic yield decreased in patients who had received antibiotics or patients with suspected aspiration pneumonia. Pathogen-targeted treatment provided similar efficacy with a decrease in adverse events compared to empirical treatment.
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The prevalence of healthcare associated infections among adult inpatients at nineteen large Australian acute-care public hospitals: a point prevalence survey

The prevalence of healthcare associated infections among adult inpatients at nineteen large Australian acute-care public hospitals: a point prevalence survey

This is the first Australian multicentred national HAI point prevalence study for 34 years. Importantly this study reveals that on any given day, one in every ten acute adult inpatients has at least one HAI. Further- more, one in every ten acute adult patients is colo- nised or infected with a multi-resistant organism. Similar to the results from ECDC prevalence surveys, the three most common HAIs identified were surgical site infection, healthcare associated pneumonia and urinary tract infection [5]. These data also clearly demonstrate that patients with vascular, urinary and respiratory devices have a higher prevalence of HAI, and the prevalence of infection in the acute care set- ting increases with age.
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The Difference in Clinical Presentations between Healthcare Associated and Community Acquired Pneumonia in University Affiliated Hospital in Korea

The Difference in Clinical Presentations between Healthcare Associated and Community Acquired Pneumonia in University Affiliated Hospital in Korea

Purpose: Healthcare-associated pneumonia (HCAP) has been proposed as a new category of pneumonia. However, epidemiological studies for HCAP in South Ko- rea are limited. This study aimed to reveal the differences between HCAP and com- munity-acquired pneumonia (CAP), especially in elderly patients, in university-af- filiated hospital in South Korea. Materials and Methods: We conducted a retrospective observational study of patients with HCAP and CAP (older than 60 years old) who were hospitalized between January 2007 and December 2008. We compared the baseline characteristics, comorbidities, severity, pathogen distribu- tion, antibiotics, and clinical outcomes. Results: A total of 210 patients were evalu- ated, including 35 patients with HCAP (17%) and 175 with CAP (83%). The most common causative organism was Streptococcus pneumoniae in CAP (33.3%), whereas, Staphylococcus aureus was most common pathogen in HCAP (40.0%). Initial inappropriate antibiotics (6.3% vs. 22.9%; p < 0.005) and initial treatment failure (15.4% vs. 31.4%; p = 0.018) were more frequent in HCAP than CAP. How- ever, mortality (11.4% vs. 5.7%; p = 0.369) was not different between the two groups. Conclusion: The present study provides additional evidence that HCAP should be distinguished from CAP, even in elderly patients, in South Korea. Physi- cians should consider S. aureus and MDR pathogens in selecting initial empirical antibiotics of HCAP in South Korea.
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Validation of the prediction rules identifying drug-resistant pathogens in community-onset pneumonia

Validation of the prediction rules identifying drug-resistant pathogens in community-onset pneumonia

7. Garcia-Vidal C, Viasus D, Roset A, et al. Low incidence of multidrug- resistant organisms in patients with healthcare-associated pneumonia requiring hospitalization. Clin Microbiol Infect. 2011;17(11):1659–1665. 8. Grenier C, Pepin J, Nault V, et al. Impact of guideline-consistent therapy on outcome of patients with healthcare-associated and community- acquired pneumonia. J Antimicrob Chemother. 2011;66(7):1617–1624. 9. Jeong B-H, Koh W-J, Yoo H, et al. Risk Factors for Acquiring Potentially Drug-Resistant Pathogens in Immunocompetent Patients with Pneumo- nia Developed Out of Hospital. Respiration. 2014;88(3):190–198. 10. Yu VL. Guidelines for hospital-acquired pneumonia and health-care-
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Risk factors to predict drug resistant pathogens in hemodialysis associated pneumonia

Risk factors to predict drug resistant pathogens in hemodialysis associated pneumonia

healthcare-associated pneumonia (HCAP) in 2005, and their guidelines included the risk of drug-resistant path- ogens (DRPs) and recommended broad spectrum antibi- otics therapy as the treatment of hospital-acquired pneumonia [4]. Hemodialysis patients were close to healthcare facilities. Therefore, according to the 2005 ATS/IDSA guidelines, hemodialysis-associated pneumo- nia (HDAP) could be considered as a part of HCAP. However, HCAP is a heterogeneous disease entity. Sev- eral studies have reported risk factors for DRPs in HCAP, including previous antibiotics exposure, poor ac- tivity of daily living or prior residence in a long-term care facility [5]. Although it is clear that hemodialysis patients are at a high risk of blood-stream infections with DRPs [6], the impact of hemodialysis on the risk of DRPs have some arguments. Some studies suggested
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Childhood pneumonia increases risk for chronic obstructive pulmonary disease: the COPDGene study

Childhood pneumonia increases risk for chronic obstructive pulmonary disease: the COPDGene study

We acknowledge that our strategy may lead to poten- tial recall bias, where adult subjects with respiratory dis- ease may be more likely to recall childhood illness. This analysis included a separate assessment for recall bias, focusing only on subjects who did not report a known COPD diagnosis, and thus were less likely to be biased in recalling childhood respiratory problems. In this sub- set analysis, childhood pneumonia remained associated with reduced lung function. Therefore, it is unlikely that overall study results were influenced by recall bias. Childhood pneumonia was not associated with COPD in this analysis, though this is not surprising given that the subset includes nearly all those with normal lung func- tion, while being most likely to remove subjects with more severe COPD.
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Comparative study of incidence, risk factors, etiological agents and outcome of early and late ventilator associated pneumonia in paediatric intensive care unit at a tertiary care centre

Comparative study of incidence, risk factors, etiological agents and outcome of early and late ventilator associated pneumonia in paediatric intensive care unit at a tertiary care centre

Background: Ventilator Associated Pneumonia (VAP), the nosocomial pneumonia developing in mechanically ventilated patients after 48 hours of mechanical ventilation, is the second most common nosocomial infection in the paediatric intensive care unit (PICU). VAP occurring within 96 hours of initiation of mechanical ventilation is termed as early VAP and later than that is known as late VAP. The aim of this study was to determine the incidence rate, risk factors and bacteriological profile and outcome of early and late ventilator associated pneumonia in PICU.
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Prospective comparative study on etiologic diagnosis of ventilator associated pneumonia

Prospective comparative study on etiologic diagnosis of ventilator associated pneumonia

our cases and the high prior use of antibiotics. However mortality during ICU stay (33%) was much lower when compared to other Brazilian study (44.3%) (Guimarães 2006) and compatible with the predicted severity score. We observed 34% of inadequate initial antibiotic therapy, defined by bacteria resistant to the antibiotic prescribed empirically. Piskin et al (2012) found as predictor of inadequate initial antibiotic therapy the previous admission to a surgical ward, a fact associated with longer hospital stay and mechanical ventilation. These factors were also demonstrated by our sample, which obtained previous use of antimicrobials and trauma admission in 96% and 57% of the time, respectively. These patients however did not show different mortality from those in which the bacteria were sensitive. There is concern that the previous use of antibiotics, as well as the current use of it, can interfere with what is found in culture. However, a meta-analysis showed a reduction in accuracy of bronchial brushing, did not find the same change in the result of the LBA. (Gupta et al 2018). The clinical diagnosis of VAP aims prompt recognition and early treatment, since the delay in its start may worsen the prognosis (Iregui 2002). However the use of clinical criteria or prognostic scores is nonspecific methods (Koulenti et al 2009), although the literature has already shown good correlation with histopathology (Fabregas et al. 1999). Clinical scores have been used in an attempt to improve the accuracy of clinical method but studies are contradictory regarding their usefulness, sometimes showing benefits in guiding the appropriate antibiotic (Shan et al. 2011), other times showing poor results for diagnosis and therapeutic decision (Zilberberg and Shorr 2010).
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Healthcare-Associated & Hospital Acquired Infection and its Infection Control

Healthcare-Associated & Hospital Acquired Infection and its Infection Control

In India, accurate estimates of the burden of healthcare associated infections are limited by the absence of reliable and routine standardised surveillance data. Published reports of healthcare associated infections are mostly from individual health facilities and include short term prospective studies and point prevalence surveys conducted in selected patient units of large hospitals. [28-32] These indicate a prevalence of healthcare associated infections ranging from 7 to 18 per 100 patients, which is similar to that reported from other low and middle income countries. As in other settings, healthcare associated infections in India are associated with longer hospital stays, increased mortality, and added costs. [29,30,32]
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Characteristics of an ideal nebulized antibiotic for the treatment of pneumonia in the intubated patient

Characteristics of an ideal nebulized antibiotic for the treatment of pneumonia in the intubated patient

Perhaps the key advantage of administering antibiotics by inhalation rather than via IV infusion is the poten- tial to deliver high concentrations of antibiotic directly to the site of lung infection [28, 29]. Animal studies in ventilated piglets have demonstrated that nebulized antibiotics achieved high deposition in infected lung parenchyma with concentrations far above the MICs for most Gram-negative strains [30], and indeed, the effi- ciency of bacterial killing in piglets inoculated with E. coli was greater after nebulization compared with intra- venous administration [31]. Furthermore, clinical stud- ies have shown that inhaled tobramycin, for example, can achieve high bronchial concentrations, and inhaled amikacin can reach epithelial lining fluid (ELF) concen- trations far in excess of the MICs for Gram-negative strains usually responsible for pneumonia [32, 33]. These concentrations may also exceed the MICs for MDR pathogens.
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A translational approach to ventilator associated pneumonia

A translational approach to ventilator associated pneumonia

The management of Ventilator Associated Pneumonia (VAP) presents many difficulties because of the heterogeneity of the disease; the way the immunocompromised host and the aggressive ICU environment interact is only partially discovered, the available biomarkers for diagnosis are not sufficient to ensure prompt differentiation between sick patients and patients at risk, the microbiological cultures require invasive techniques and time consuming methods. A translational medicine and bio-informatics approach can enable the identification of the main players of pathology, which may represent novel therapeutic targets or biomarker candidates. Analysis of proteome i.e. allows to individuate proteins that act as biomarkers, for patient-centered research strategies. Similarly, the genomic approach has proved useful to individuate those patients who are prone to develop VAP, and, in the future, we could be able to immunomodulate their responses to save them from nosocomial infections.
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Selective decontamination of the digestive tract reduces mortality in critically ill patients

Selective decontamination of the digestive tract reduces mortality in critically ill patients

controversial [6,7]. Although SDD has received considerable attention in European ICUs, North American intensivists have been uniformly resistant to the incorporation of SDD as standard care [8,9]. One of the main concerns is the fear of emergence of selection for resistant organisms. Furthermore, in the guidelines for the prevention of nosocomial pneumonia published in 1997, the Centers for Disease Control and Prevention stated that available data do not justify the routine use of SDD in ICU patients [10].

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Pneumonia Prevention Strategies for Children With Neurologic Impairment

Pneumonia Prevention Strategies for Children With Neurologic Impairment

We conducted a comparative effectiveness study of a retrospective cohort of children with NI enrolled in California Children ’ s Services (CCS), the largest Title V program in the United States, a federal block grant program supporting state delivered maternal and child health services. CCS provides health care services for children with special health care needs (CSHCNs) in California on the basis of qualifying diagnosis and family income. 13,14 CCS data include all inpatient care and all outpatient episodes including primary care, specialty care, and pharmacy. We included children aged 0 to 21 years enrolled in CCS between July 1, 2009, and June 30, 2014, the period for which we have high-quality data. We chose a cutoff age of 21 years, the age at which CCS coverage ends for children. We included children with NI and $1 pneumonia
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Health care-associated infections &ndash; an overview

Health care-associated infections &ndash; an overview

7. Desikan R, Krauss MJ, Dunagan WC, et al. Reporting of Adverse Drug Events: Examination of a Hospital Incident Reporting System. In: Henriksen K, Battles JB, Marks ES, et al, editors. Advances in Patient Safety: From Research to Implementation (Volume 1: Research Findings). Rockville (MD): Agency for Healthcare Research and Qual- ity (US); 2005. Available from: https://www.ncbi.nlm.nih.gov/books/ NBK20453/. Accessed April 1, 2018.

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Clinico-laboratory profile and outcome of edematous severe acute malnutrition in children aged 6 months to 5 years

Clinico-laboratory profile and outcome of edematous severe acute malnutrition in children aged 6 months to 5 years

Conclusions: Majority of the patients they were in WHO z-score of <-3SD and <-4SD z-score but extremes are also occurring up to <-8SD z-score Pneumonia and tuberculosis are the affected co morbidities for outcome of E-SAM children. Disappearance of edema, and length of stay are little bit longer than usual WHO guideline recommendations and they had a significant association with grade of edema. Percentage of wt. fall also had association with grade of edema.

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