الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 177 |  |  |
| | | from | 177 | | |
Abstract
This study included 40 ventilated patients with lower respiratory tract infections. Each Patient in that study was subjected to routine and special investigations for 3 sets of samples, except for ELISA was done at the 3rd set, The first set of sampling was done for 40 patients at the time of admission, The second set of sampling was done after three days of admission and administration of empirical antibiotic (cefotriaxone and clrathramycin) according to ICU protocol for all patients. The third set of sampling was done after 3 days of starting of specific antibiotic therapy) (7th day of admission) for only 14 patients according to antibiotic sensitivity tests(AST), as 26 patients discontinued due to either discharge or death. Ten apparently healthy individuals(with normal TLC and CRP) were sampled as negative control for neutrophilic CD64.
ETA was positive in all patients at the first sample, while in the second time ETA was positive in 90% and negative in 10% of patients . ETA was positive at the third sample in 85.7% of patients and negative in 14.3% of patients. There was significant difference in the frequency of positive ETA of the first sample when compared with the second sample, with p value(0.046).
Regarding gram negative organisms, klebsiella pneumoniae was the predominant organism(20) isolates in ETA cultures especially in 1st samples and 2nd samples. Most of those klebsiella pneumoniae were sensitive to meropenem followed by amikacin, cefoxtin, ciprofloxacin and levofloxacin respectively, while all isolates were resistant to ampicillin, SXT, ceftazidime, cefotriaxone, cefazolin and cefepiem.
Regarding gram positive organisms, streptococcus viridans was the predominant organism(14) isolates through the 3 sets of samples, especially in 2nd samples. All of those streptococci were sensitive to linezolid and vancomycin, while most of them were sensitive to ciprofloxacin and levofloxacin in response, most of streptococcal isolates were resistant to ampicillin, then tetracyclin and tigecyclin, followed by benzyl pencillin and oxacillin in resistance.
The frequency of infection with MDR organisms was increasing during hospital stay. MDR organisms were isolated from 60% of 1st ETA culture samples , while it was isolated from 65%. of 2nd ETA culture samples and 71.4%, of 3rd ETA culture samples.
16SrRNA, was positive in 90% of cases during the 1st sample, and negative in 10% of patients. 16SrRNA, was positive in 70% of cases at the 2nd sample and negative in 30% of cases . At the third sample 16SrRNA was positive in 71.4% of cases and was negative in 28.6% of cases, there was significant difference between the frequency of positive cases of 16SrRNA in the first sample when compared with the second one, with p value(0.021).
16srRNA at the 2nd sample was found to have a higher specificity (100% ) , While the Sensitivity of 16srRNA was(77.8%), 16srRNA showed NPV of (33.3%), PPV of 100%,with significant p value(0.012), 16srRNA at the 3rd sample showed specificity of (100%) ,sensitivity of (83.3%),NPN of (50%) and PPV of (100%),with p value was (0.068).
TLC of the 1st sample ranged between(4.1 - 42.7cell/mm3) with median (14.6) and IQR(9.4-17.8). while in the second sample TLC ranged between(3.5—38.37cell/mm3) with median (11.3) and IQR(6.5-14.6). At the third sample TLC ranged between(4—18.17cell/mm3) with median (12.9) and IQR(4.5-16.4).TLC, was significantly higher during the first sample when compared with the second sample with P value( 0.002).
CRP in the first sample ranged between(4-71mg/dl) with median (17) and IQR(12-39), While in the second sample ranged between(0.9-72 mg/dl) with median(10.5) and IQR(4.5-22.5), in the third sample CRP ranged between(3-41 mg/dl) with median (6) and IQR(4-22).CRP was significantly higher in the first sample when compared with the second sample with p value(0.002). CRP was significantly higher at the first sample when compared with the third sample with p value (0.009).
CD64 in the first sample ranged between(3.5-24.4%) with median (8.7) and IQR(5-12.4), While in the second sample ranged between(3.5-25.3%) with median(9.7) and IQR(7.3-13.2), in the third sample CD64 ranged between(3.2-13.7%) with median (9.7) and IQR(5.5-10.3). CD64 was significantly higher at the second sample when compared with the third one with p value (0.012). There was no significant difference in CD64 at the first sample when compared with the second one with p value (0.237). and there was no significant difference of CD64 of the first sample when compared with the third one with p value (0.729). CD64 had a higher sensitivity (100% ) . While the specificity of CD64 was(50%). The ppv was (80%) and the NPV was (100%).