Author: Admin

Sputum Bacteriology And In-Vitro Antibiotic Susceptibility In Hospitalized Patients With Community Acquired Pneumonia In A State Tertiary-Referral Hospital – A Retrospective Study

Authors: Yow-Wen Chin, Li-Cher Loh, Thim-Fatt Wong, Abdul Razak Muttalif.

ABSTRACT

Introduction: To review the sputum bacteriology and its in-vitro antibiotic susceptibility in patients hospitalized with community-acquired pneumonia (CAP) in a state tertiary-referral Hospital (Penang hospital, Malaysia) in order to determine the most appropriate empiric antibiotics.

Methods: From September 2006 to May 2007, 68 immunocompetent adult patients [mean age: 52 years (range 16-89); 69% male] admitted to respiratory wards for CAP with positive sputum isolates within 48 hours of admission were retrospectively identified and reviewed.

Results: 62 isolates were Gram(-) bacilli (91%) & 6 were Gram(+) cocci (9%). The two commonest pathogens isolated were Pseudomonas aeruginosa (n=20) and Klebsiella pneumoniae (n=19) together constituted 57% of all positive isolates. Among the Pseudomonas isolates, 84.2% were fully sensitive to cefoperazone and cefoperazon/sulbactam; 95% to ceftazidime, cefepime, piperacillin/tazobactam, ciprofloxacin and amikacin, and 100% to gentamycin, netilmycin, imipenem and meropenem. Among the Klebsiella isolates, 5.3% were fully sensitive to ampicillin; 84.2% to amoxicillin, ampicllin/sulbactam, cefuroxime and ceftriazone; 89.5% to piperacillin/tazobactam; 93.3% to cefoperazon/sulbactam and 100% sensitive to ceftazidime, cefepime, ciprofloxacin, all aminoglycosides and carbopenems.

Conclusion: In view of the high prevalence of respiratory Pseudomonas aeruginosa, ampicillin/sulbactam, currently the most prescribed antibiotic to treat CAP in our respiratory wards, may not be the most appropriate empiric choice. Higher generation cephalosporins with or without beta-lactamase inhibitors, ciprofloxacin or carbapenem may be the more appropriate choices. The lack of information on patients’ premorbidities such as recent hospitalization and prior antibiotic exposure, limits the interpretation of our findings and may have biased our results towards higher rates of Gram negative organisms.

Keywords: Antibiotic sensitivity, Community-acquired pneumonia, Penang hospital, Sputum bacteriology.

Citation: IeJSME 2007: 1 (2): 74-79

DOI: https://doi.org/10.56026/imu.1.2.74

Case Report On Haemolytic Uraemic Syndrome And Cardiovascular Complication

Author: Dennis Nyuk Fung Lim

ABSTRACT

A 66 year old Caucasian female presented with haemolytic uraemic syndrome (HUS) following a prodrome of diarrhoea. During the course of her illness, she developed acute heart failure secondary to myocardial ischaemia. Cardiovascular complications associated with HUS involving children have been reported in the literature. The mortality of adult patients with acute heart failure is significantly higher even with the initiation of therapeutic plasma exchange.

Keywords: Haemolytic uraemic syndrome, Cardiovascular complication.

Citation: IeJSME 2007: 1 (2): 80-82

DOI: https://doi.org/10.56026/imu.1.2.80

Efficacy Of Anti-Tuberculosis Treatment Alone On Resolution Of Tuberculosis Pleural Effusions

Authors: V S Selvarajah, S Samudram, L T Chua, D Siti Yuhana, B K Lim, S Wan Yusuf, L C Loh.

ABSTRACT

To determine the degree of resolution in pleural effusions treated with anti-tuberculosis treatment alone without thoracentesis, 62 eligible adult cases [mean age (SD), 46 (17) yrs; 77% male] of tuberculosis pleural effusions treated in two urban-based university teaching hospitals were retrospectively reviewed for changes in effusion size at 2, 6 and 12 months after initiation of treatment. The proportions of patients in whom resolution were complete, partial and unchanged were 64.5%, 27.4% and 8.1%. Effusions with size smaller than three tenth of hemithorax were at three-fold increased likelihood of complete resolution, compared with those with larger effusions [Odds ratio (95% CI): 3.295 (1.033 to 10.514); p=0.04]. Consideration for thoracentesis is therefore still important in certain patients.

Keywords: Tuberculosis, pleural effusions, chemotherapy,  Malaysia.

Citation: IeJSME 2007: 1 (2): 83-86

DOI: https://doi.org/10.56026/imu.1.2.83

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