[Comparison of ampicillin-sulbactam/macrolide dual therapy versus fluoroquinolone monotherapy in hospitalized patients with community-acquired pneumonia]. / Toplumda gelisen pnömoninin tedavisinde ampisilin-sulbaktam/makrolid kombinasyonu ile tek basina florokinolon tedavilerinin karsilastirilmasi.

INTRODUCTION: For hospitalized patients, monotherapy with a respiratory Fluoroquinolone (F) and dual therapy combination a ampicilline-sulbactam + a macrolide (AS+M) are extensively used in the treatment of community-acquiredpneumonia (CAP). In this study, empirical AS + M combination therapy versus F monotherapy was compared in hospitalized adult CAP patients. PATIENTS AND METHODS: This retrospective study, patients with CAP hospitalized in Akdeniz University Hospital, Pulmonology Clinic between October 2009 and May 2013 were included in the study. RESULTS: During the study period, 123 patients received AS + M and 75 received F. Mean age was 66 years. The most frequent comorbidities were diabetes mellitus, chronic obstructive pulmonary disease and cardiovascular disease. Disease severity, age, sex, comorbid diseases, smoking history, laboratory findings, CURB-65 and PSI scores were similar for the two treatment groups at admission. The clinical success rate cure was similar for both groups (82.1% vs 88%; p= 0.314). Length of hospital stay (5.6 ± 3.9 days vs 5.9 ± 3.9 days, p= 0.223) and hospital cost (1.963 ± 3.723 TL vs 1.965 ± 7.172 TL, p= 0.975) were also nonsignificant in both groups. In-hospital, 30-day and 90-day mortality rates were not different in AS + M and F group (5.6% vs 6.6; 8.1% vs 8%; 20.3% vs 19%; 31.7% vs 26.9%, respectively). CONCLUSIONS: In conclusion, our study has showed ampicilline-sulbactam and macrolide combination and fluoroquinolone monotherapy have comparable clinical efficacy as well as mortality rates in hospitalized patients with CAP.

[Health-care associated pneumonia]. / Saglik bakimiyla iliskili pnömoni.

INTRODUCTION: Health-care associated pneumonia (HCAP) is defined as pneumonia that develops in patients with a history of recent hospitalization, hemodialysis as an outpatient, residence in a nursing home, outpatient intravenous therapy and home wound care. MATERIALS AND METHODS: We retrospectively assessed patients who have been hospitalized in Department of Chest Diseases, Akdeniz University, Faculty of Medicine due to HCAP between 1 January 2009 and 1 June 2012. Of the total 195 pneumonia cases, 76 (38.9%) was HCAP and 119 (61.1%) was CAP. RESULTS: Among HCAP cases, 61 (80.3%) had recent hospitalisation in the last 90 days, 7 (9.2%) went under hemodialysis in the last 30 days, 3 (3.9%) had a history of decubitus management in house, 1 (1.3%) had a long term accomodation in social-care center and 1 (1.3%) had a history of infusion therapy at home. Comorbidity in HCAP group was higher than CAP group (94.6% vs resp. 73.1%; p< 0.001) and mean PSI scores were also higher in HCAP group (104.4 - 90.2; p< 0.05). A causative microorganism was detected in 18 HCAP (23.6%) and in 11 CAP (9.2%) cases. It was determined that appropriate treatment was started in 73.7% of HCAP cases and 98.3% of CAP cases according to national and international guidelines (p< 0.001). Both mean hospitalization duration (12.7 ± 1.1 vs 7.8 ± 0.5 days, resp; p< 0.05) and mortality rates (22.4% vs 4.2%; p< 0.001) were higher in HCAP group. Furthermore, mean cost of hospitalization was also greater for HCAP group than CAP group (4150.6 ± 892 TL vs 2078.7 ± 571 TL; respectively p< 0.05). CONCLUSION: In conclusion; patient characteristics, comorbidity status, causative organisms, duration and cost of hospitalization and prognosis of patients with HCAP was different from patients with CAP.

Microbial variations in sputum cultures among hospitalized patients with community-acquired pneumonia: differences in sputum microbiota between asthma and COPD patients.

OBJECTIVE: To assess differences in the sputum microbiota of community-acquired pneumonia (CAP) patients with either COPD or asthma, specifically focusing on a patient population in Turkey. METHODS: This retrospective study included hospitalized patients > 18 years of age with a diagnosis of pneumonia between January of 2021 and January of 2023. Participants were recruited from two hospitals, and three patient groups were considered: CAP patients with asthma, CAP patients with COPD, and CAP patients without COPD or asthma. RESULTS: A total of 246 patients with CAP were included in the study, 184 (74.8%) and 62 (25.2%) being males and females, with a mean age of 66 ± 14 years. Among the participants, 52.9% had COPD, 14.2% had asthma, and 32.9% had CAP but no COPD or asthma. Upon analysis of sputum cultures, positive sputum culture growth was observed in 52.9% of patients. The most commonly isolated microorganisms were Pseudomonas aeruginosa (n = 40), Acinetobacter baumannii (n = 20), Klebsiella pneumoniae (n = 16), and Moraxella catarrhalis (n = 8). CAP patients with COPD were more likely to have a positive sputum culture (p = 0.038), a history of antibiotic use within the past three months (p = 0.03), utilization of long-term home oxygen therapy (p < 0.001), and use of noninvasive ventilation (p = 0.001) when compared with the other patient groups. Additionally, CAP patients with COPD had a higher CURB-65 score when compared with CAP patients with asthma (p = 0.004). CONCLUSIONS: This study demonstrates that CAP patients with COPD tend to have more severe presentations, while CAP patients with asthma show varied microbial profiles, underscoring the need for patient-specific management strategies in CAP.

Serum procalcitonin and C-reactive protein kinetics as indicators of treatmentoutcome in hospitalized patients with community-acquired pneumonia.

BACKGROUND/AIM: There has been growing interest in the use of serum procalcitonin (PCT) and C-reactive protein (CRP) in patients with community-acquired pneumonia (CAP). The aim of this study was to investigate whether an assessment of fever, leukocyte count, and serum CRP and PCT levels on admission and during follow-up (day 3) provides any information about the clinical outcome in hospitalized patients with CAP. MATERIALS AND METHODS: Patients with a diagnosis of CAP who were admitted to and followed at four university hospitals were evaluated retrospectively using the Turkish Thoracic Society Pneumonia Database. RESULTS: A total of 103 hospitalized CAP patients (57 males, mean age: 61.5 ± 16.7 years) were enrolled in the study. Treatment failure (TF) was observed in 20 patients (19.4%). Pneumonia Severity Index scores, serum CRP levels, and PCT levels on admission were significantly higher in the TF group. There were significant decreases in CRP and PCT levels between admission day and day 3 in the treatment success group. CONCLUSION: In patients with CAP, the body temperature and leukocyte count on admission do not predict outcome. Monitoring levels of CRP and PCT may be useful as a predictor of treatment outcome.

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.