ABSTRACT
Objective: To determine the frequency of different causative bacteriological organisms and their antibiotic sensitivity from Endotracheal Aspirate [EA] of patients suffering from Ventilator Associated Pneumonia [VAP]. Study Design: Prospective cross sectional study. Place and Duration of Study: Intensive Care Unit [ICU], Combined Military Hospital [CMH] Lahore, from May 2013 to Nov 2013
Material and Methods: A total of 180 cases of VAP, fulfilling the ?nclusion criteria and admitted in the ICU, were included in the study using the non-probability consective sampling technique. A written informed consent was obtained from the family. All these patients underwent endotracheal aspirate for microscopy and culture. Antibiotic sensitivity was determined using standard antibiotics regimens
Results: Out of 180 patients, 165 [91.7%] were culture positive while 15 [8.3%] were culture negative. Gramnegativebacilli accounted for about 70% of all isolates. The most common organism isolated was Pseudomonas aeruginosa 25% [n=45] followed by MRSA 18.9% [n=34], Klebsiella 15.6% [n=28], Actinobacter spp 13.3% [n=24], E.coli 11.7% [n=21] and Citrobacter spp 4.4% [n=8]. Carbapenem was the most sensitive drug that was seen in our setup but still 43.9% of the isolates showed resistance against it and resistance was noted still higher with Actinobacter spp, where 83% isolates were resistant. Quinolones showed resistance in 100% of the isolates of Actinobacter, MRSA and Citrobacter. While more than 50% strains of Pseudomonas, E.coli and Klebsiella were also resistant to quinolones. Cephalosporins showed excellent sensitivity towards gram negative bacteria which included Citrobacter [100% sensitive] and E.coli [80% sensitive]. Polymxins showed more than 50% sensitivity to Pseudomonas aeruginosa, Actinobacter, E. coli and Klebsiella
Conclusion: VAP remains a very important hospital-acquired infection. The most prevalent etiological organism in our study was Pseudomonas aeruginosa and the most effective antibiotics were carbapenems
ABSTRACT
The study was conducted to determine the Frequency and determinants of oral substance abuse among patients seeking dental care at Department of Periodontology, Dr. Ishrat-ul- abad Khan, Institute of Oral health Sciences, Dow University of Health Sciences, Karachi. Across session study was conducted during January to June 2011.Atotal of 2259 patient were interviewed from a structured questionnaire at Department of Periodontology, Dr. Ishrat-ul- abad Khan, Institute of Oral health Sciences, Dow University of Health Sciences, Karachi. The questionnaire was based on demographic data along with risk factors resulting in use of substance abuse. The substance abuse included Pan and cigarettes, Niswar, betel nut, Pan, cigarettes, Niswar and Betel nut and gutka. The data was collected on the performa and analyzed using SPSS windows version 17. Frequencies and percentages were calculated for categorical variables including age, gender, education, type of substance used. Stratification was done with substance user and non-user to see the effect on their oral health. Chi-square was used to compare the categorical variables at 5% level of significance between substance user and non-user. There were 2259 respondents consented for interview regarding use of substance abuse by them. Most of the patients 1362 [60.3%] belonged to younger age group 18-25 years. Female respondents were 1384[61.3%]. Most of the dental care seekers were graduates 984 [43.6%] out of 2259, there were 884 [39.1%] substance abuser. The type of substance abused mostly were pan and cigarettes both 1375 [60.9%] and cigarettes, niswar, beetle nuts all together in 483 [21.4%]. On examination the oral health status was good only in 582 [25.8%].Mostly substance abuse was started on self basis 433[49%] compared to others 45 [51%]. It was also found that unemployment 300[33.9%]was the major reason for substance abuse. The frequency of oral substance abuse was found in 39.1% of the patients seeking medical advice at the dental and oral institute. The commonest determinants of substance user were younger age group between 18- 25 years, commoner in male than female, one third were graduates and unemployed were found more addicted to substance use. The study found that the type of substance abuse at the time of interview were multiple variety of substance. Pan along with cigarettes was used by maximum number of participants. Pan and cigarettes along with Niswar and betel nuts were used by quarter of the sample