Tuberculous lymphadenitis at Penang general hospital, Malaysia

To evaluate the incidence, treatment and clinical outcomes of tuberculous [TB] lymphadenitis at Penang General Hospital, Malaysia. Penang General Hospital is the referral center for all tuberculosis patients in the state of Penang. Patient records were reviewed to identify patients with confirmed diagnosis of TB lymphadenitis between January 2006 and December 2008. Data were analyzed using SPSS version 15. Of 1,548 tuberculosis cases, 109 [7.0%] patients had TB lymphadenitis. The mean age was 36.4 +/- 12.87 years and of the 109 patients with TB lymphadenitis, 35 [33.0%], 37 [34.0%] and 36 [33.0%] were observed for 2006, 2007 and 2008, respectively. Ethnically, 45 [41.3%] were Malay followed by 37 Chinese [33.9%]. Among risk factors for TB lymphadenitis, HIV and diabetes mellitus were seen in 17 [15.6%] and 11 [10.0%] patients, respectively. Cough and fever were the most frequently reported symptoms. In a majority of cases [n = 90, 82.5%] positive results were obtained for fine-needle aspiration [FNA]. Directly observed therapy was given to all patients. Sixty-two [56.9%] patients were successfully treated, and 5 [4.6%] patients died during the treatment. There was no increase in the incidence of TB lymphadenitis over the 3-year study period. The incidence was slightly higher in male than female gender and in Malay [ethnic group]. Diabetes mellitus and HIV were the most commonly reported risk factors. FNA is the most reliable diagnostic test

Sputum Bacteriology And In - Vitro Antibiotic Susceptibility In Hospitalized Patients With Community Acquired Pneumonia In A State Tertiary - Referral Hospital – A Retrospective Study

Introduction: To review the sputum bacteriology and its in-vitro antibiotic susceptibility in patients hospitalized with community-acquired pneumonia (CAP) in a state tertiary-referral Hospital (Penang hospital, Malaysia) in order to determine the most appropriate empiric antibiotics. Methods : From September 2006 to May 2007, 68 immunocompetent adult patients [mean age: 52 years (range 16-89); 69% male] admitted to respiratory wards for CAP with positive sputum isolates within 48 hours of admission were retrospectively identified and reviewed. Results: 62 isolates were Gram(-) bacilli (91%) & 6 were Gram(+) cocci (9%). The two commonest pathogens isolated were Pseudomonas aeruginosa (n=20) and Klebsiella pneumoniae (n=19) together constituted 57% of all positive isolates. Among the Pseudomonas isolates, 84.2% were fully sensitive to cefoperazone and cefoperazon/sulbactam; 95% to ceftazidime, cefepime, piperacillin/tazobactam, ciprofloxacin and amikacin, and 100% to gentamycin, netilmycin, imipenem and meropenem. Among the Klebsiella isolates, 5.3% were fully sensitive to ampicillin; 84.2% to amoxicillin, ampicllin/sulbactam, cefuroxime and ceftriazone; 89.5% to piperacillin/ tazobactam; 93.3% to cefoperazon/sulbactam and 100% sensitive to ceftazidime, cefepime, ciprofloxacin, all aminoglycosides and carbopenems. Conclusion : In view of the high prevalence of respiratory Pseudomonas aeruginosa, ampicillin/ sulbactam, currently the most prescribed antibiotic to treat CAP in our respiratory wards, may not be the most appropriate empiric choice. Higher generation cephalosporins with or without beta-lactamase inhibitors, ciprofloxacin or carbapenem may be the more appropriate choices. The lack of information on patients’ premorbidities such as recent hospitalization and prior antibiotic exposure, limits the interpretation of our findings and may have biased our results towards higher rates of Gram negative organisms.