Spectrum of culture positive hospital acquired Pneumonia in patients receiving Proton Pump inhibitors

Objective: To identify the spectrum of organisms in intensive care unit [ICU] in patients who were receiving proton pump inhibitors for stress ulcer prophylaxis and diagnosed as having hospital-acquired pneumonia [HAP]

Study Design: Cross sectional study

Place and Duration of Study: Shifa International Hospital Islamabad, from Apr 2016 to Aug 2016

Material and Methods: One hundred and forty eight patients [134 receiving PPI's and 14 not receiving] in MICU of Shifa International Hospital were included in this study. Hospital acquired pneumonia was defined as New chest infiltrates developing within 48 hours of admission, Fever of greater than 38 degrees Celsius and total leucocyte count of more than 11000 or less than 3500. In all patients tracheal cultures were followed at 24 and 48 hours and microbiologic spectrum was defined

Results: Out of 148 patients admitted to ICU during the study period, 45 patients [33.6 percent] developed HAP in PPI group compared to 1 in non PPI group. The initial tracheal cultures at admission were negative. Out of the 45 patients who fulfilled criteria for HAP 40 patients [89 percent] had positive tracheal cultures for gram negative bacteria which included Acinetobacter, Klebsiella and Escheria species. The cultures remained negative for 5 patients [11 percent] with HAP. The 89 patients who didn't fulfill the criteria for HAP, 25 patients still had positive tracheal cultures but more than fifty percent of the cultures yielded Candida Albicans. In the non PPI group only 1 patient developed HAP. HAP incidence was PPI group [p 0.042]

Conclusion: Gram negative bacteria was prevailed as the causative organism in patients who developed hospital acquired pneumonia [89 percent] and receiving proton pump inhibitors in medical intensive care unit with greater number incidence of HAP in PPI group

Spectrum of ventilator associated pneumonia with effect on intensive care unit's patient outcome

Objective: To evaluate the spectrum of ventilator-associated pneumonia [VAP] and relation of length of intensive care unit [ICU] stay, patient's age and gender on the likelihood of being discharged from the ICU

Study Design: A cross sectional study

Place and Duration of Study: Shifa International Hospital, Islamabad, Pakistan over a period of 12 months extending, from Apr 2015 to Apr 2016

Material and Methods: We included 470 patients out of whom only 106 patients were diagnosed with VAP while on mechanical ventilation in ICU for >48 hours. A positive culture of tracheo-bronchial secretions, with any one of these; >48-h infiltrate on chest radiograph, fever of >38.3[degree]C, leukocytosis of >12 x 10[9]/ml and increase in tracheo-bronchial secretions established the diagnosis of VAP

Results: The mean age of the male and female patients was 49.8 +/- 18 years and 50.6 +/- 21.4 years respectively with 16.6 +/- 13 days as the mean duration of ICU stay. About 30.2% VAP patients had Acinetobacterbaumanni with 96.8% sensitivity to colistin, 27.4% patients had Klebsiella pneumonia with 72% and 62% sensitivity to colistin and carbapenems respectively and 15.1% patients had methicillin-resistant Staphylococcus aureus with 100% sensitivity to vancomycin. There was an increased incidence 60.4% of late-onset VAP compared to 39.6% early onset VAP. The overall mortality in VAP patients was 28.6%

Conclusion: We recommend the empirical combination therapy of colistin, carbapenem, and vancomycin in VAP. No statistical significant association was found between length of ICU stay and patient's mortality. The odds of getting discharged were found to be 3.2 times greater for male participants as opposed to female patients. Decreasing age was associated with an increased likelihood of being discharged

What factors on admission influence icu mortality in adult patients admitted to the intensive care unit with severe pneumonia?

Objective: To identity the risk factors on intensive care unit [ICU] admission that are linked with ICU mortality in patients with severe pneumonia

Study Design: A retrospective observational study

Place and Duration of Study: Patients admitted to the medical ICU in Shifa International Hospital, Islamabad, between October 2013 and March 2014

Material and Methods: Adult patients admitted to the ICU with the suspected diagnosis of severe pneumonia were studied. In addition to the co-morbidities, presence or absence of septic shock and acute kidney injury, PaO2/FiO2 ratio and type of mechanical ventilation were recorded on ICU admission. This data was initially recorded on paper forms and latter entered in the SPSS. Bivariate analysis was performed to study the relationship between these risk factors and their effect on the ICU mortality

Results: We evaluated a total number of 82 patients with severe pneumonia. ICU mortality was 14.8% [12 patients]. Statistical analysis showed that patients with severe acute respiratory distress syndrome [ARDS], septic shock, history of chronic liver disease and human immunodeficiency virus [HIV] neutropenic sepsis and those who received invasive mechanical ventilation were at higher risk of mortality. We did not find any direct correlation between age, presence of acute kidney injury, history of diabetes mellitus and risk of death in the ICU

Conclusion: In adult patients, septic shock, severe ARDS, history of chronic liver disease, neutropenic sepsis and presence of HIV, and invasive mechanical ventilation are associated with a higher risk of ICU mortality in patients admitted with severe pneumonia

To determine the effect of wearing shoe covers by medical staff and visitors on infection rates, mortality and length of stay in intensive care unit

Intensive Care Units [ICUs] experience higher infection rates due to the severity of illness and frequent use of invasive devices. Use of personal protective equipment reduces the risk of acquiring an infection. This study has been conducted to determine the role of using shoe covers by medical staff and visitors on infection rates, mortality and length of stay in ICU. It is a descriptive study, performed in Shifa International Hospital, Islamabad from January 2012 to July 2012. The rates of infection [by checking patients for common ICU pathogens], mortality and length of stay of patients admitted in MICU and SICU from January 2012 to March 2012 were measured. Use of shoe covers was abandoned during this period. The same parameters were measured for the patients admitted from May, 2012 to July, 2012; the period during which shoe covers were strictly used by all the staff members and visitors. The data was then analyzed and compared using chi-square test with significance value at p < 0.05. A total of 1151 patients were studied in 06 months period. Among the two groups of patients, managed with and without using shoe covers in ICU, statistically significant decrease was seen in terms of length of ICU stay[as P value is less than 0.05] in patients managed in duration of shoe covers. However, the time period in which shoe covers were used the infections with three common ICU pathogens MRSA, VRE and acinetobacter were statistically significant more than the periods in which shoe covers were not used. There was no significant difference in mortality for both groups [P value = 0.146]. Use of shoe covers in critical care area is not helpful in preventing infections of common ICU pathogens and length of stay in ICU patients; nor has it decreased the mortality

Empysematous Gastritis - a case report with literature review

Emphysematous gastritis is a condition characterized by gas within the wall of the stomach and associated, systemic toxicity. We are reporting to our knowledge the first case of emphysematous gastritis in a 76 year old female from Islamabad, Pakistan. She was admitted with five day history of upper abdominal discomfort and vomiting. Diagnosis of emphysematous gastritis was made on CT scan. She was treated successfully with conservative management including IV antibiotics and few sessions of dialysis, and was discharged home within two weeks

Efficacy of non narcotic analgesia during first 24 post-operative hours

This study was conducted in 100 randomly selected hospitalized patients who underwent major surgical interventions during a period of 10 months. The objective was to evaluate the efficacy of non narcotic analgesia in relieving pain during first 24 hours after a major surgical procedure. The non narcotic analgesic diclofenac sodium was selected for the trial. For the efficacy assessment of the drug, the Pakistan Coin Pain Scale was selected. It was found that, in 87% of all patients included in the study, the pain was adequately relieved with non narcotic analgesia without any noticeable adverse effects