1 / 14

Hospital-acquired pneumonia in patients receiving immunosuppressive therapy

Hospital-acquired pneumonia in patients receiving immunosuppressive therapy. Cakir Edis E, Hatipoglu ON, Yilmam I, Eker A, Tansel O, Sut N, Tekgunduz E, Demir M. Background.

haruki
Download Presentation

Hospital-acquired pneumonia in patients receiving immunosuppressive therapy

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Hospital-acquired pneumonia in patients receiving immunosuppressive therapy Cakir Edis E, Hatipoglu ON, Yilmam I, Eker A, Tansel O, Sut N, Tekgunduz E, Demir M.

  2. Background • Despite structured empirical antimicrobial treatments using algorithms and the many invasive and non-invasive methods for pathogen isolation and the use of wide-spectrum antibioticsin patients receiving immunosuppressive therapy, hospital-acquired pneumonia (HAP) is still an important cause of morbidity and mortality.

  3. Objectives • The aims of this study were to find the pathogens, clinical success rates, effect of pathogen isolation and neutropenia on the treatment’s success rate, risk factors related to mortality, and survival in patients who had developed HAP while receiving immunosuppressive therapy.

  4. Material- Methods • Adult patients that had developed HAP while receiving immunosuppressive therapy for solid organ tumors, hematological malignancies and rheumatological diseases at the Trakya University Medical Faculty Hospital between March 2005 to February 2006, were included in this prospective study. Patients with fever and neutropenia but without new infiltration in the chest X-ray were excluded from the study.

  5. Material- Methods-II • When the pathogen could not be isolated, empiric anti-pseudomonal treatment was initiated using national and international guidelines. • All patients were re-evaluated in 3-5 days for the success of the empirical treatment. • All of the patients were evaluated by a team of physicians from pulmonary and infectious disease specialties, as well as the physicians responsible for the patient.

  6. Results-I • A total of 45 patients [28 male (62,2%)] were included in the study. The mean age was 56.29±15.87 years. • Of the patients, 27 were receiving immunosuppressive therapy for hematological malignancy, 16 for solid tumorsand 2 patients for rheumatological diseases. • 20 patients were neutropenic and 25 were non-neutropenic at the time of diagnosis.

  7. Results-II • Of the patients, 43 were given empirical treatment. • Of the 43 patients, 41 was started on empirical anti-pseudomonal treatment • One patient who was non-neutropenic and had developed HAP early, had been suspected with aspiration and therefore, was started on parenteral ampicillin-sulbactam. The other patient had a suspect atypical pathogen and was given ceftriaxone plus clarithromycin.

  8. Results-III • The pathogen was isolated in 18 (40%) out of 45 patients. The most commonly isolated pathogens were Acinetobacter spp., E. coli • Glycopeptides were begun in 10 patients and antifungal therapy was begun using guidelines in 18 patients not responding to the initial antibiotic treatment.

  9. Results-IV • The clinical success rate at the end of the treatment was achieved in 30 (66.7%) patients and clinical success rate at the end of the sixth week was achieved in 25 (55.6%) patients. • When 18 patients with isolated pathogens and 27 patients with non-isolated pathogens were compared, the difference in the rates of clinical success at the end of treatment was almost significant.The difference between the clinical success rates at the end of the follow-up period was also significant (p=0.014). The success rate was higher in patients in whom the pathogen could not be isolated.

  10. Results-V • When 20 patients with neutropenia and 25 patients with non-neutropenia were compared, the difference in the rates of clinical success at the end of treatment was significant (p=0.034), whereas the difference between the clinical success rates at the end of the follow-up period was not significant (p=0.202). • The success rate at the end of treatment was higher in patients who were not neutropenic.

  11. Survival analysis • Nineteen (42%) out of 45 patients had died at the end of the six-week follow-up period. According to the Kaplan Meier survival analysis, the survival rates for the 3rd, 14th, 42nd and 365th days were 97%, 82%, 58% and 20%, respectively.

  12. Results-VI • Three patients suffered form pneumonia attacks in one year while they were in the hospital for the second time to receive immunosuppressive therapy. Two patients developed community-acquired pneumonia in one year and 11% of patients developed recurrent pneumonia in one year.

  13. Results-VII • Urea (p=0.031), FBG (p=0.023), K (p=0.035) were found to be the independent factors affecting survival. • elevated levels of urea OR=1.007 (%95 CI: 1.001- 1.014), • FBG OR=1.011 (%95 CI: 1.001- 1.021) and the • reduced levels of potassium OR=0.549 (%95 CI: 0.314- 0.960) were the independent risk factors adversely affecting survival.

  14. Discussion • Consequently, the mortality rates in patients receiving immunosuppressive therapy who had developed HAP were high and their one-year survival rates were low. Further studies are required to determine whether patient-related or pathogen-related factors play a more important role in the rates of treatment success.

More Related