الفهرس 
PneumoniaOnly 14 pages are availabe for public view
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Abstract
The current study was conducted on 20 mechanically ventilated patients clinically suspected with VAP at Abbassia chest hospital respiratoy intensive care unit (RICU) comparing the microbiologic results of endotracheal aspiration (ETA) using conventional method (catheter tip) and mucus extractor (mucus trap device).
All patients were subjected to :Full history taking , Clinical examination Radiological examination, Full laboratory investigations.
ETA samples were collected with mucus trap catheter and with conventional method ( catheter tip ) and sent immediately for microbiological culture and sensitivity.
Most of the patients in the present study (85%) were males. Their ages ranged from 33 to 83 years old with a mean of 64.85±10.1 years. Smokers were (75%) of the study population, while (25%) of the patients had no special habits and (15%) were addicts.
Seventy five percent (75%) of the patients enrolled had more than one co-morbidity while cardiovascular diseases represented 70% of comorbidities.
COPD was the commonest underlying chest disease nectitating the need for mechanical ventilaton accounting for 75% of the patients
All of the ventilated patients (100%) presented with cough and expectoration of purulent secretions, fever was present in (95%) of them and wheezes in (25%) also , TLC ranged from 15.9 to 32.8 with a mean of 21.35±4.41(x109).
New CXR infilterates was found all of the included patients , right sided consolidation was 30% and left sided consolidation 30% while bilateral consolidation 40%
The hospital stay duration of the patients ranged from 7 to 43 days with a mean of 16.95±9.64 days. The duration of MV ranged from 6 to 41 days with a mean of 15.1 ±9.15 days.
The incidence of early versus late onset VAP was 45% for the former versus 55% for the later.
In the present study, results showed that the conventional method of ETA (catheter tip) succeeded in detecting two organisms in 10 % of the studied specimens; meanwhile by the new method (mucous extractor ) two organisms were detected in 65% with highly significant statistical difference between both methods (p≤0.01).
Pathogens that were most commonly isolated by conventional method were (Acintobacter 30%), (Klebsiella 30%), (Pseudomonas 20%) while the most common isolated organisms by the mucus extractor were (Acintobacter 50%), (Klebsiella 35 %), (Pseudomonas 25%).
Although the difference in frequency of isolation between both techniques was statistically insignificant (p>0.05) but the frequency of isolation was higher in all the samples taken by the mucus extractor technique
Isolates were multi drug resistant to penicillins, cephalosporins, fluoroquinolones, aminoglycosides, piperacillin/tazobactum, carbapenems and vancomycin, whereas all isolates were sensitive to linezolid with no significant statistical differences as regards drug susceptibility testing of specimens taken by both methods (p>0.05).
In conclusion, ETA via mucus extractor device is a relatively inexpensive technique, requires lesser expertise and can simply be performed by resident doctors and paramedics (nurses) posted at the ICU after a small demonstration, and may be a useful method for the serial evaluation of suspected nosocomial pneumonia in patients on mechanical ventilation.