The interrelations of radiologic findings and mechanical ventilation in community acquired pneumonia patients admitted to the intensive care unit: a multicentre retrospective study.

BACKGROUND: We evaluated patients admitted to the intensive care units with the diagnosis of community acquired pneumonia (CAP) regarding initial radiographic findings. METHODS: A multicenter retrospective study was held. Chest x ray (CXR) and computerized tomography (CT) findings and also their associations with the need of ventilator support were evaluated. RESULTS: A total of 388 patients were enrolled. Consolidation was the main finding on CXR (89%) and CT (80%) examinations. Of all, 45% had multi-lobar involvement. Bilateral involvement was found in 40% and 44% on CXR and CT respectively. Abscesses and cavitations were rarely found. The highest correlation between CT and CXR findings was observed for interstitial involvement. More than 80% of patients needed ventilator support. Noninvasive mechanical ventilation (NIV) requirement was seen to be more common in those with multi-lobar involvement on CXR as 2.4-fold and consolidation on CT as 47-fold compared with those who do not have these findings. Invasive mechanical ventilation (IMV) need increased 8-fold in patients with multi-lobar involvement on CT. CONCLUSION: CXR and CT findings correlate up to a limit in terms of interstitial involvement but not in high percentages in other findings. CAP patients who are admitted to the ICU are severe cases frequently requiring ventilator support. Initial CT and CXR findings may indicate the need for ventilator support, but the assumed ongoing real practice is important and the value of radiologic evaluation beyond clinical findings to predict the mechanical ventilation need is subject for further evaluation with large patient series.

Community-acquired pneumonia in patients with chronic obstructive pulmonary disease requiring admission to the intensive care unit: risk factors for mortality.

PURPOSE: The aims of this study are to identify factors predicting mortality in patients with chronic obstructive pulmonary disease (COPD) and community-acquired pneumonia (CAP) requiring intensive care unit (ICU) admission and to examine whether noninvasive ventilation treatment reduces mortality. MATERIALS AND METHODS: An analysis was performed on data from patients with CAP hospitalized in the ICUs of 19 different hospitals in Turkey between October 2008 and January 2011. Predictors of mortality were assessed by both univariate and multivariate statistical analyses. RESULTS: Two hundred eleven patients with COPD and CAP were included. The overall ICU mortality was 23.9%. Noninvasive ventilation treatment (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.03-0.49; P = .003), hypertension (OR, 0.13; 95% CI, 0.02-0.93; P = .042), bilateral infiltration (OR, 13.92; 95% CI, 2.94-65.84; P = .001), systemic corticosteroid treatment (OR, 0.19; 95% CI, 0.35-0.96; P = .045), length of ICU stay (OR, 0.65; 95% CI, 0.47-0.89; P = .007), and duration of invasive mechanical ventilation (OR, 1.11; 95% CI, 1.01-1.22; P = .032) were independent factors related to mortality. CONCLUSION: Noninvasive ventilation, hypertension, systemic corticosteroid treatment, and shorter ICU stay are associated with reduced mortality, whereas bilateral infiltration and longer duration of invasive mechanical ventilation are associated with increased risk of mortality in patients with COPD and CAP requiring ICU admission.

Mortality indicators in community-acquired pneumonia requiring intensive care in Turkey.

BACKGROUND: Severe community-acquired pneumonia (SCAP) is a fatal disease. This study was conducted to describe an outcome analysis of the intensive care units (ICUs) of Turkey. METHODS: This study evaluated SCAP cases hospitalized in the ICUs of 19 different hospitals between October 2008 and January 2011. The cases of 413 patients admitted to the ICUs were retrospectively analyzed. RESULTS: Overall 413 patients were included in the study and 129 (31.2%) died. It was found that bilateral pulmonary involvement (odds ratio (OR) 2.5, 95% confidence interval (CI) 1.1-5.7) and CAP PIRO score (OR 2, 95% CI 1.3-2.9) were independent risk factors for a higher in-ICU mortality, while arterial hypertension (OR 0.3, 95% CI 0.1-0.9) and the application of non-invasive ventilation (OR 0.2, 95% CI 0.1-0.5) decreased mortality. No culture of any kind was obtained for 90 (22%) patients during the entire course of the hospitalization. Blood, bronchoalveolar lavage, and non-bronchoscopic lavage cultures yielded enteric Gram-negatives (n=12), followed by Staphylococcus aureus (n=10), pneumococci (n=6), and Pseudomonas aeruginosa (n=6). For 22% of the patients, none of the culture methods were applied. CONCLUSIONS: SCAP requiring ICU admission is associated with considerable mortality for ICU patients. Increased awareness appears essential for the microbiological diagnosis of this disease.

Withdrawal of Staphylococcus aureus from intensive care units in Turkey.

BACKGROUND: In the past, Staphylococcus aureus infections have displayed various patterns of epidemiologic curves in hospitals, particularly in intensive care units (ICUs). This study aimed to characterize the current trend in a nationwide survey of ICUs in Turkey. METHODS: A total of 88 ICUs from 36 Turkish tertiary hospitals were included in this retrospective study, which was performed during the first 3 months of both 2008 (period [P] 1) and 2011 (P2). A P value ≤.01 was considered significant. RESULTS: Although overall rates of hospital-acquired infection (HAI) and device-associated infection densities were similar in P1 and P2, the densities of HAIs due to S aureus and methicillin-resistant S aureus (MRSA) were significantly lower in P2 (P < .0001). However, the proportion of HAIs due to Acinetobacter was significantly higher in P2 (P < .0001). CONCLUSIONS: The incidence of S aureus infections is declining rapidly in Turkish ICUs, with potential impacts on empirical treatment strategies in these ICUs.

[Evaluation of epidemiological characteristics and risk factors of candidemia in adult patients in a tertiary-care hospital]. / Bir üçüncü basamak hastanesinde eriskin kandidemi olgularinin epidemiyolojik özellikleri ve risk faktörlerinin degerlendirilmesi.

Candida species which are currently the fourth most common cause of nosocomial bloodstream infections, are associated with a significant morbidity and mortality. The aim of this retrospective case-control study which included adult patients was to determine the epidemiology of candidemia and to evaluate risk factors for the development of candidemia and mortality at a tertiary-care education hospital over a 1-year period. A total of 38 candidemia cases (23 were male; age range: 17-82 yrs; mean age: 61.4 ± 13.5 years) were identified among 22.507 patients hospitalized during the study period (January 1-December 31, 2008) and the overall incidence was found as 16.8 per 10.000 hospital admissions. Control group (n= 36; 22 were male; mean age: 60.9 ± 16.3 years) was selected among patients who had no signs and symptoms of candidemia and had negative blood cultures during the study period. Thirty-six (95%) patients with candidemia were identified as nosocomial infection. The most frequently isolated species were C.albicans (55.2%) and C.parapsilosis (28.9%) and the primarily identified origin of infection was central venous catheter use (39%). Candida spp. Isolation was most frequent in patients hospitalized in intensive care units (13/38; 34.2%), followed by surgery (n= 8; 21%) and chest diseases (n= 5; 13). Univariate analysis revealed that presence of a central venous catheter [odds ratio (OR): 4.33; 95% confidence interval (CI): 1.63-11.47, p= 0.003] and the length of hospitalization (OR: 0.97; CI: 0.94-1.00, p= 0.01) were the most frequently associated factors with an increased risk of candidemia compared to controls. However, multivariate analysis exhibited presence of a central venous catheter (OR: 2.90; CI: 1.04 8.11, p= 0.04) as the only independent risk factor for the development of candidemia. Therapy was initiated with intravenous fluconazole (mean duration of therapy 13.2 ± 6.25 days) and in three patients following fluconazol use step-up therapy was initiated. Total mortality rate was 58% (22/38) in our case series. Risk factors for mortality due to candidemia in the univariate analysis were detected as no response to antifungal treatment (OR: 0.23; CI: 0.11-0.51, p< 0.001), underlying disease other than trauma (OR: 0.06; CI: 0.003-1.24, p= 0.02), and high Charlson index (OR: 0.60; CI: 0.38-0.93, p= 0.03), however those factors were not found significant by multivariate analysis. There was also a statistically significant correlation between Charlson index and treatment response (mean Charlson index was 3.5 ± 1.9 in therapy-responded patients and 4.8 ± 1.8 in non-responders; p= 0.03). Since the risk of developing candidemia was significantly higher in severely diseased patients using central venous catheter or with prolonged hospitalization, response to antifungal therapy may be insufficient, leading to higher mortality.

[Staphylococcus aureus hepatic abscess associated with cervical lymphadenitis]. / Servikal lenfadenit esliginde gelisen Staphylococcus aureus'un etken oldugu karaciger apsesi.

Pyogenic liver abscesses usually develop secondary to biliary tract and intraabdominal infections and members of the Enterobacteriaceae family are usually implicated as the etiologic agents. In this report a case of hepatic abscess devoloped secondary to cervical lymphadenitis caused by Staphylococcus aureus, was presented. Twenty-one years old male patient was admitted to the hospital with complaints of fever, swelling and pain at the right side of the neck and difficulty in swallowing. Physical examination revealed painful submandibular lymphadenopathy with hyperemia. Upon demonstration of cystic lymphadenopathy by magnetic resonance imaging of the neck, the mass was aspirated. Gram-positive cocci with abundant leucocytes were detected in Gram stained smears of the aspiration material and methicillin-susceptible S. aureus (MSSA) was identified in the culture. Treatment with ampicillin/sulbactam (4 x 1.5 g/day) was initiated. However, since patient still had fever and abdominal pain, nausea and vomitting were also added to his complaints, abdominal ultrasonography and computerized tomography (CT) were done and abscesses were demonstrated in liver. The abscesses were drained under CT guidance and the fever of the patient resolved. Treatment with ampicillin/sulbactam was continued for 6 weeks. Although it was considered that the hematogenous spread of MSSA that led to cervical lymphadenitis caused the hepatic abscesses, the agent was neither isolated from the blood culture nor from the hepatic abscess material. It should always be taken into consideration that liver abscesses might accompany distant infections and antibiotic therapy alone might not be sufficient for the complete resolution of such infections.

Brucellosis triggering hemolytic anemia in glucose-6-phosphate dehydrogenase deficiency.

OBJECTIVES: To present a case of acute brucellosis triggering acute hemolytic anemia in a subject with glucose-6-phosphate dehydrogenase (G6PD) deficiency. CLINICAL PRESENTATION AND INTERVENTION: A 17-year-old male patient presented with fever, malaise and jaundice. His blood and bone marrow cultures yielded Brucella species. In addition, he was found to have acute hemolytic anemia due to previously undiagnosed G6PD deficiency. He was started on folic acid supplementation and given a combination of doxycycline and rifampicin for 6 weeks. His response to antibiotic therapy was optimal; the hemolytic anemia resolved. There were no further episodes of hemolysis. CONCLUSION: This case showed that the differential diagnosis of acute hemolytic anemia in subjects with G6PD deficiency should include brucellosis, especially in regions where the infection is endemic.

[Retrospective evaluation of the cases prediagnosed as viral encephalitis in Trace University Hospital between the period of 2000-2005]. / Trakya üniversitesi tip fakültesi hastanesinde 2000-2005 yillari arasinda viral ensefalit ön tanili olgularin retrospektif degerlendirilmesi.

In this study, a total of 17 adult patients ((> or =18 years old; 12 male, 5 female) with encephalitis followed up in neurology and infectious diseases clinics of Trace University Hospital between the years 2000-2005 were retrospectively analyzed. The most common signs and symptoms were confusion (n: 13; 76.4%), nausea and vomiting (n: 13; 76.4%), disorientation (n: 12; 70%), fever and headache (n: 11; 64.7%), amnesia (n: 10; 58.8%), convulsions (n: 9; 52.9%), agitation (n: 7; 41%), dysphasia and aphasia (n: 6; 35.2%), nuchal stiffness (n: 5; 29.4) and focal neurological signs (n: 1; 5.8%). Six of the patients were admitted to the hospital during summer, six during winter, four during spring and one during autumn. Eleven (64.7%) of the patients had electroencephalographic signs compatible with encephalitis. Encephalitis related signs were detected in 83.3% (10/12) of the patients by cranial magnetic resonance imaging and in 58.3% (7/12) by computerized tomography. Cerebrospinal fluid (CSF) examination revealed low glucose levels in 17.6% (3/17), high protein levels in 47% (8/17) and increased white blood cells with a predominance of lymphocytes in 41.2% (7/17) of the cases. CSF findings were within normal limits in 23.5% (4/17) of the patients. Empirical acyclovir treatment was given to all patients. One patient died at the acute phase of the infection while all the other 16 recovered. Since none of the CSF samples yielded bacterial growth, all of the patients were diagnosed as viral encephalitis. However, no investigation was performed to identify the viral etiology and this was the major limitation owing to the inadequacy of laboratory facilities during the study period and/or unawareness of the physicians about viral identification methods.