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
Objective: To compare short term mortality in non-diabetic ischemic stroke patients with or without stress hyperglycemia
Study Design: Cohort study
Place and Duration of Study: This study was carried out at Neurology Department of Military Hospital, Rawalpindi from Jan 2010 to Jul 2012 for a total duration of six months
Material and Methods: Non-diabetic ischemic stroke patients were included in the study and they were divided in two groups. Each group had 75 patients. Group 'I' [Normoglycemic or control group] had normal blood glucose level while group 'II' [Hyperglycaemic or cohort] had hyperglycaemia on presentation or over next 72 hours. Prognosis in terms of patient either being dead or alive was determined within or at 4 weeks of admission in both groups. Data were entered and analysed using Statistical Package for Social Sciences SPSS version 10. Descriptive statistics were calculated for both qualitative and quantitative variables. For comparison of short term mortality in hyperglycaemic and normoglycemic stroke patients, chi-square test was applied. p-value <0.05 was considered statistically significant
Results: Short term mortality was higher in cohort [hyperglycemic] group as compared to control [normoglycemic] group [34.7% vs. 14.7%]. Relative risk was 2.36. The groups had a statistically significant difference in the short term mortality within four weeks with a Chi-Square 'p' value of 0.004 [p=0.004]
Conclusion: Short term mortality in non-diabetic ischemic stroke patients with stress hyperglycemia is higher than those patients who do not have stress hyperglycemia