Frequency of hospital acquired pneumonia and its microbiological etiology in medical intensive care unit.

OBJECTIVE: The objectives were to assess the frequency of hospital acquired pneumonia (HAP) in patients admitted to intensive care unit (ICU) and to determine the frequencies of different etiological organisms in these patients. METHODS: This was descriptive cross sectional study, which was carried out in medical ICU of Shifa International Hospital Islamabad from January 2013 to January 2014. A total of 1866 patients were admitted in the department of medicine including medical ICU. They were evaluated for HAP and the causative organisms were cultured from these patients. Identification was carried out by standard biochemical profile of the organisms. RESULTS: The total number of patients admitted in medical ICU for any reason were 346. HAP was diagnosed in 88 patients (25.4%). The average age of patients admitted in Medical ICU with HAP was 48 years with the range of 16 to 82 years. 56 were male and 32 females. 42 patients (47.7%) died in medical ICU with HAP. Microbiological analysis showed that Pseudomonas aeruginosa were 27 (30.6%), Acinetobacter spp. were 12 (13.6%), Candida albicans were 12 (13.6%), Klebsiellapneumoniae were 9 (10.2%), Streptococcus spp. were 9 (10.2%), Escherichia coli were 5 (5.6%), Stenotrophomonas spp. were 4(4.5%), Methicillin Resistant Staphylococcus Aureus (MRSA) were 4 (4.5%) others organisms 6 (6.8%). CONCLUSION: The frequency of HAP in Medical ICU of our hospital is 88 out of 346 (25.4%). The commonest organism identified was Pseudomonas aeruginosa (30.6%) followed by Acinetobacter and Candida albican (13.6% each).

Non-dermatophyte moulds as pathogens of onychomycosis.

OBJECTIVE: To determine the role and pattern of non-dermatophyte moulds as causative agents of onychomycosis. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Department of Microbiology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from November 2009 to July 2010. METHODOLOGY: Nail clippings and nail scrapings were obtained from abnormal looking nails with treatment and detection failure for onychomycosis. Microscopic (40% potassium hydroxide mounts) examination and culture on Sabouraud's dextrose agar (SDA), SDA containing chloramphenicol, and SDA containing actidione and chloramphenicol were used for species identification. RESULTS: Non-dermatophyte moulds were isolated from 32 out of the total 47 culture positive cases (68%). Alternaria alternata was the commonest species (46%). Dermatophytes were isolated from only 7 patients (15%) belonging to genus Trichophyton. Yeasts were isolated in 8 (17%). There was no fungal growth in 53% of cases. CONCLUSION: The non-dermatophytes should be considered important in evaluating the culture negative cases for dermatophytes as well as those cases ending up in treatment failure after empirical treatment for dermatophyte infections.