RESUMO
Background: Ventilator-associated pneumonia [VAP] is a common nosocomial infection among hospitalized patients who have undergone intubation and mechanical ventilation for more than 48 hours. Patients admitted to the intensive care unit [ICU] are at risk of developing life-threatening VAP due to specific conditions, especially with Gram-negative pathogens with advanced drug resistance. Hereby, the control of these agents and its monitoring is of particular importance. In this study, the pattern of antibiotic resistance of Gram-negative bacteria isolated from tracheal culture of patients with VAP investigated in ICU of Imam Khomeini Hospital of Ahwaz
Materials and Methods: In this cross-sectional study, tracheal samples were collected during April 2016 to April 2017 from patients who were on mechanical ventilation in ICU of Imam Khomeini Hospital in Ahwaz, Khuzestan province, southwest of Iran. After isolation, bacterial strains were identified using biochemical tests. Then, antimicrobial resistance pattern of these isolates investigated using standard disc diffusion according to clinical and laboratory standards institute 2016 [CLSI 2016] guidelines
Results: A total of 111 bacterial isolates were identified which were as following; Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Stenotrophomonas maltophilia, and Serratia marcescens, with prevalence of 54 percent, 19.8 percent, 14.4 percent, 6.4 percent, 4.5 percent, and 0.9 percent, respectively. Antibiotic susceptibility test of isolates showed that almost all isolates had high resistance to treatment antibiotics and were multi-drug resistance [MDR]. The A. baumanniiisolates were resistant to ciprofloxacin and piperacillin-tazobactam, but ampicillin-tazobactam had a good effect
Conclusion: The results of this study showed that patients admitted to ICU due to their conditions of treatment are more likely to develop VAP by Gram-negative pathogens. The empirical treatment of VAP due to predominant bacterial causes and emerging drug resistance has become more challenging. It requires to use of multidrug regimens for routine clinical practice. It should be noted that in order to appropriate antimicrobial therapy, precise and correct diagnosis is very important
RESUMO
The relationship between gastroesophageal reflux [GERD] and airway diseases is still a matter of debate. Oscillometry is an objective, independent tool for the evaluation of airway resistance. The main purpose of this study is to compare spirometry and oscillometry results before and after treatment by a proton pump inhibitor [PPI] in a group of GERD patients who have no respiratory symptoms. This study was performed on patients with endoscopically diagnosed reflux esophagitis who had no pulmonary symptoms. Patients received omeprazole 40 mg, twice a day for 12 weeks. Spirometry and oscillometry were performed before and after treatment. Impulse oscillometry [IOS] was performed by a force oscillation instrument. We recorded respiratory resistance at 5 Hz [R5] and 20 Hz [R20], resonant frequency [Fres], and distal capacitive reactance [X5] for each patient. Included were 30 patients [17 males; 13 females] whose mean age was 32 years. According to the Los Angeles Classification, 16 patients had grades B or C esophagitis and 14 had grade A. Although all patients had normal spirometry results, 50% had increased airway resistance according to oscillometric findings. After treatment with omeprazole, only 16.3% had abnormal oscillometry results [p=0.004]. Spirometry results [forced expiratory volume at the first second [FEV1]; forced vital capacity [FVC]; FEV1/FVC; and mean forced expiratory flow 25%-75% [FEF 25%-75%]] showed significant further improvement compared to pretreatment normal values [p<0.001 for all]. Abnormal airway resistance may be present in GERD patients even when there is no obvious respiratory symptom. Oscillometry seems to be more sensitive than spirometry in reporting abnormal pulmonary function in patients with GERD