Ventilator-associated pneumonia in critically ill patients with intensive antibiotic usage

Objective: Ventilator-associated pneumonia [VAP] is an infection with high mortality and morbidity that prolongs the length of stay in the intensive care unit [ICU] and hospitalisation. VAP is one of the most common infections in critically ill patients. This study aimed to prospectively determine the VAP rate and associated factors in critically ill patients with intensive antibiotic usage during a one-year period

Methods: In total, 125 out of 360 patients admitted to the intensive care unit during the one-year study period [September 2010-2011] were included for follow-up for VAP diagnosis. Demographic data, APACHE II scores, diagnoses on admission, clinical pulmonary infection scores [CPIS], CRP, procalcitonin, risk factors for infection, time to VAP diagnosis, and bacteriological culture results were recorded. All data were assessed in terms of ICU, hospital and 28-day mortality

Results: In total, 56 [45%] out of 125 patients were diagnosed with VAP. In addition, 91% of patients diagnosed with VAP were administered antibiotics before diagnosis. In the VAP patients, the mortality rates were 48, 68 and 71% for 28-day, ICU and hospital mortality, respectively

Conclusion: The coexistence of clinical and microbiological parameters should not be sought when diagnosing VAP in patients who use antibiotics intensively. VAP can be diagnosed when CPIS

prognostic value of trauma scoring systems for gunshot injuries

We aimed to evaluate the trauma scoring systems on gunshot injured patients to predict trauma severity. All patients with gunshot injury admitted to the emergency department [ED] from January 2007 through January 2009 were enrolled in the study. The demographic characteristics of patients such as age, gender, cause of the injury, type of the weapon used, the injured body parts, Glasgow Coma Scale [GCS], Shock Index [SI], the length of stay in the hospital and mortality were recorded from the patient charts. Injury Severity Score [ISS], Revised Trauma Score [RTS] and Trauma and Injury Severity Score [TRISS] have been calculated. The differences between the groups for these parameters were compared using the Mann-Whitney U test. The mean age of patients was 33.2 +/- 16.1 and 79 of 87 patients were male. The causes of GSIs were homicidal in 73.6% and bullet cartridge in 51.7%. Calculated GCS, ISS, RTS, TRISS and SI were 13.8 +/- 2.9, 13.0 +/- 9.3, 7.38 +/- 1.1, 93.9 +/- 14.9% and 1.9 +/- 0.9 respectively. GCS, RTS and TRISS scores for survivors were significantly higher than non-survivors [p<0.001]. ISS score and SI for survivors were significantly lower than non-survivors [p<0.001]. There were no statistically significant differences between the groups in terms of the length of stay in hospital [p>0.05]. There was no statistically significant correlation of the length of stay in hospital with GCS, RTS and TRISS [p>0.05]. The length of stay in hospital was found to correlate with ISS and SI positively [p<0.001]. It is concluded that Gun Shot Injury [GSI] is much more likely in young males than the other types of trauma in the population. We recommend that trauma scoring systems should be used to show trauma severity and mortality