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Title: The study of microbiological recommendations for the diagnostic and therapeutical treatment in the patients with hospital- acquired pneumonia from the Intensive Care Unit

Abstract:

The purpose of investigation was to study of microbiological recommendations for the diagnostic and therapeutical treatment in the patients with hospital- acquired pneumonia from the Anesthesiology and Intensive Care Unit of Rydygier’s hospital in Cracow. The investigation was conducted in a group of 36 patients, consisting of 26 males (72,2%) and 10 females (27,8%) with clinically recognized pneumonia. HAP was microbiologically confirmed in the group of 31 patients, on the base of isolation from endotracheal aspirate bacteria in concentration of ≥106 CFU/ml. The most frequent isolated aetiologic agents of pneumonia were Gram- negative non- fermenting bacilli: Pseudomonas aeruginosa and Acinetobacter baumannii strains. Isolated in the pathological concentration P. aeruginosa strains demonstrated low Carbapenems sensitivity (Imipenem, Meropenem), respectively 27,3% and 31%. High activity in vitro, revealed Piperacillin/ Tazobactam, which could be an alternative antimicrobial drug in the therapy of HAP due to P. aeruginosa strains, as well as new, registered in Poland, Carbapenems, for example Doripenem. Among Acinetobacter baumannii strains, which were isolated at the concentration of ≥106 CFU/ml, noticed high resistance to ciprofloxacin (97%), which was often applied in the conjugate therapy. There is desirable to remove chemoterapeutic and to implement diverse antibiotic, for example from Aminoglycosides group: Netylmicin 74,2% and Tobramicin 73,1%, which revealed high activity in vitro. Obtained result of pharmacokinetics and pharmacodynamics (PK/PD) investigation, which was conducted among 10 patients, showed, that in order to apply the appropriate dose of antibiotic (chemotherapeutic) in the HAP therapy, it is relevant to monitor the concentration of antimicrobial drug in serum of patient blood. In research observed too high doses of Carbapenems which were applied in the group of 3 patients. It was probably result of renal failure, excretion defect and accumulation of drug in the organism. Among 4 patients were applied too low doses of antibiotics. There weren’t achieved the optimal parameters PK/PD. In one patient was changed an applied antimicrobial drug to Piperacillin/ Tazobactam because there wasn’t reported desirable microbiological and therapeutical effect of therapy. In the genetic investigation the high genetic diversity was showed in the group of 10 P. aeruginosa strains, which were aetiologic agents of pneumonia in different patients. Investigated isolations probably came from the one hospital strain which has undergone evolutionary divergence phenomenon in time, as a result of medicine application and changing conditions of the hospital environment. However, there was observed higher degree of homology between A. baumannii isolates (14). All strains have hospital nature, except isolate number 7. A lack of high similarity degree with the rest of strains, could indicate posthospital origin. Resuming, in the ICU of the Rydygier’s Hospital, diagnostic and therapeutical modifications are desirable, in order to obtain better result of treatment. The clinical material for the microbiological investigation should be taken from the respiratory tract of patients in the day of clinical recognition of pneumonia. The quantitative inoculation of material should be carried out before antibioticotherapy implementation. The relevant affair is the change of politics of antibiotics usage (Carbapenems- Imipenem and Meropenem) in infections due to P. aeruginosa. Obtained results of pharmacokinetics/ pharmacodynamics investigation showed advantages of the monitoring of antimicrobial drug concentrations in patients blood. It is the condition of correct dosage selection.

Level of degree:

2 - studia doktoranckie

Degree discipline:

mikrobiologia

Degree grantor:

Wydział Farmacji

Promoter:

Alicja Budak

Date issued:

2009

Format:

application/pdf

Identifier:

oai:dl.cm-uj.krakow.pl:781

Call number:

ZB-111793

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Access rights:

tylko w bibliotece

Location of original object:

Biblioteka Medyczna Uniwersytetu Jagiellońskiego - Collegium Medicum

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Last modified:

Oct 3, 2019

In our library since:

Nov 21, 2012

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All available object's versions:

http://dl.cm-uj.krakow.pl:8080/publication/781

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ZB-111793 Oct 3, 2019
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