Bacterial spectrum and antibiotic sensitivity in patients with late onset hospital acquired pneumonia which have not high risk of infection by multi drug resistance microorganisms and/or increased risk of mortality,have mild-moderate clinic presentation

Introduction:Hospital-acquired pneumonia (HAP) is defined as pneumonia that occurs 48 hours or more after admission, which was not incubating at the time of admission. Microorganisms that may cause HAP vary by underlying comorbid diseases, risk factors and time of onset of pneumonia. While, pneumonia that occurs within the first 4 days of hospitalization is defined as early onset of HAP; pneumonia that occurs 5 or more days of hospitalization is defined as late onset of HAP. Common pathogens that may cause early onset HAP are Streptococcus pneumoniae, Haemophilus influenzae and meticiline sensitive Staphylococcus aureus. While 55-85 % of all pathogens that may cause late onset HAP are gram negative bacili such as Pseudomonas aeruginosa, Acinetobacter spp, Enterobacter spp, Klebsiella pneumonia, 20-30 % of these pathogens are gram positive coccus, particularly meticiline resistant Staphylococcus aureus. Late-onset HAP are more likely to be caused by multidrug-resistant (MDR) pathogens, and are associated with increased patient mortality and morbidityPurpose:İn this study, our aim is to determine bacterial spectrum and antibiotic sensitivity in patients with late onset HAP which have not high risk of infections by (MDR) microorganisms and/or increased risk of mortality, are mild-moderate in clinical severity and are classified as group 2 at consensus reports of Turkish Thorax Society in 2002 and 2008.Method: According to the consensus reports of Turkish Thoracic Society in 2002 and 2008, classified as Group 2 patients with HAP were evaluated prospectively and retrospectively. They had APACHE II score less than 16 that was calculated within the first 24 hours of diagnosis. Before antibiotherapy, expectorant sputum, inducte sputum, blood and non broncoscopic endotracheal aspirate samples were taken from patients included. Qualitative culture of blood and sputum samples, quantitative culture of endotracheal aspirate sample were perfomed.Antibiotic sensitivite of microorganisms which growth in culture and which were accepted as agent was evaluated. Comparison between appropiate of antibiotherapy which were recommended by clinic approach and antibiotic sensitivite of microorganisms which growth in culture was performed. Clinical approach to treatment response in patients started empirical antibiotic therapy, treatment 3 and 7 days between the clinical pulmonary infection score (CPIS), PaO2 / FiO2, C reactive protein (CRP) values and clinical improvement in symptoms of pneumonia, microbiological eradication was assessed taking into account the criteria ensuring. As a result of treatment of pneumonia in terms of prognosis, full remission, treatment failure, relapse and death was recorded as.Result: Thirty-nine patients with HAP were evaluted. 34 patients which have clinic feature of group 2 HAP were included in our study. 12 pathogen microorganisms were growth in culture of blood,sputum,tracheal aspirate samples of 11 patients. Gram negative bacilli were growth in all samples. Klebsiella pneumonia (25%), E. coli(25%), Pseudomonas aeruginosa (25%), Pseudomonas fluorescens (8.3%), H. İnfluenzae (8.3%) and Enterobacter spp (8.3%) as the causes of group 2 HAP were growth in quantitative and qualitative culture of samples. Both Klebsiella pneumonia and Enterobacter spp were growth in culture of sputum sample in one of 11 patients (9%). Extended spectrum beta-lactamase (ESBL) activity was determined in one (33.3%) of E. Coli isolates, induced b-lactamase activity was determined in two (66.6%) of Pseudomonas aeruginosa isolates, induced beta-lactamase activity was determined in Enterobacter spp isolate (100%). We found that 10 (83.4%) of 12 pathogen microorganisms were not be MDR. İn our study, mortality rate was found as 6% (2/34).Conclusion: The microorganisms that isolated as causes of group 2 HAP in our study were similar to the microorganisms which had not high mortality risk and/or MDR and defined as causes of group 2 HAP according to the consensus reports of Turkish Thoracic Society in 2002 and 2008. Therefore, empirical antibiotherapy recommended for patients with group 2 HAP at the consensus report of Turkish Thoracic Society is appropriate as initial therapyKey words: Hospital acquired pneumonia, Mortality risk, Multi drug resistance, Bacterial spectrum, Susceptibility to antibiotics