Biomedical subjects

Abid Bhat

Publications and source records attributed to Abid Bhat.

5 recordsLinked to original sources

PubMed2004

Indicators of potentially drug-resistant bacteria in severe nursing home-acquired pneumonia.

BACKGROUND: Knowledge of the determinant factors responsible for the presence of antimicrobial-resistant pathogens in severe nursing home-acquired pneumonia (NHAP) is deemed essential for antibiotic selection. METHODS: Data for institutionalized patients with cases of severe pneumonia confirmed by culture of protected bronchoalveolar lavage fluid samples (> or =10(3) cfu/mL) during a 36-month period were analyzed. A classification tree with a sensitivity of 100% was developed using binary recursive partitioning to predict which patients are unlikely to have drug-resistant pathogen (DRP)-related pneumonia. RESULTS: Of the 88 patients who satisfied the inclusion criteria, 17 had at least 1 DRP recovered from the lower respiratory tract. The predictor variables were the Activity of Daily Living score and previous use of antibiotics. Prospective application of the model in 47 patients over a 24-month period yielded a sensitivity of 100% (95% confidence interval [CI], 71.3%-100%) and a specificity of 69.4% (95% CI, 51.9%-83.6%). CONCLUSIONS: The use of the tree may provide a more rational basis for selecting initial therapy for severe NHAP after it is validated in a large prospective study.

Aged↗

PubMed2004

Extubation failure in the elderly.

To determine the causes, risk factors and complications of planned extubation failure of critically ill elderly patients, we conducted a prospective study of 175 consecutive patients (> or = 70 years old) admitted with respiratory failure. Thirty-six (21%) failed extubation within 72 h after planned extubation. Compared to a younger age group (< 70 years old) matched for severity of illness, inability to handle secretions (20%) was the most common reason of airway causes leading to extubation failure in the elderly while upper airway obstruction (22%) was the predominant cause in the control group. As for nonairway causes, COPD related hypercapnic respiratory failure accounted for the majority of cases in both groups. After adjusting for severity of illness, elderly patients who required reintubation had a higher risk of developing nosocomial pneumonia. The presence of underlying pulmonary disease (odds ratio (OR), 2.9; 95% confidence interval (CI) 1.2-6.9), length of intubation > 4 days (OR, 4.3; 95% CI 1.8-10.2), and albumin levels < 2.5 g/dl (OR, 2.7; 95% CI 1.2-6.7) were independently associated with extubation failure in the old. Objective measurements of cough strength and secretion volume are needed to reduce the morbidity of elderly patients at risk for extubation failure.

Aged↗

PubMed2004

Colonization of dental plaques: a reservoir of respiratory pathogens for hospital-acquired pneumonia in institutionalized elders.

STUDY OBJECTIVES: Poor dental hygiene has been linked to respiratory pathogen colonization in residents of long-term care facilities. We sought to investigate the association between dental plaque (DP) colonization and lower respiratory tract infection in hospitalized institutionalized elders using molecular genotyping. METHODS: We assessed the dental status of 49 critically ill residents of long-term care facilities requiring intensive care treatment. Plaque index scores and quantitative cultures of DPs were obtained on ICU admission. Protected BAL (PBAL) was performed on 14 patients who developed hospital-acquired pneumonia (HAP). Respiratory pathogens recovered from the PBAL fluid were compared genetically to those isolated from DPs by pulsed-field gel electrophoresis. MEASUREMENTS AND RESULTS: Twenty-eight subjects (57%) had colonization of their DPs with aerobic pathogens. Staphylococcus aureus (45%) accounted for the majority of the isolates, followed by enteric Gram-negative bacilli (42%) and Pseudomonas aeruginosa (13%). The etiology of HAP was documented in 10 patients. Of the 13 isolates recovered from PBAL fluid, nine respiratory pathogens matched genetically those recovered from the corresponding DPs of eight patients. CONCLUSIONS: These findings suggest that aerobic respiratory pathogens colonizing DPs may be an important reservoir for HAP in institutionalized elders. Future studies are needed to delineate whether daily oral hygiene in hospitalized elderly would reduce the risk of nosocomial pneumonia in this frail population.

Aged↗

PubMed2003

Swallowing disorders post orotracheal intubation in the elderly.

OBJECTIVES: The purpose of this study was to assess the prevalence and recovery time of swallowing dysfunction after prolonged endotracheal intubation in critically ill elderly patients compared to a younger cohort. DESIGN: This was a prospective, interventional, clinical study set in a medical intensive care unit in a university-affiliated hospital. SUBJECTS: The study involved 42 consecutive elderly patients (>/=65 years old) and 42 controls (<65 years) matched for severity of illness requiring endotracheal intubation for more than 48 h. INTERVENTIONS: A fiberoptic endoscopic evaluation of swallowing (FEES) was performed within 48 h post-extubation and on days 5, 9, and 14 for those with evidence of aspiration. RESULTS. Swallowing dysfunction was assessed by the detection of test material below the true vocal cords. Aspiration was documented in 52% of the elderly and 36% of the control group (P=0.2). No significant difference in the co-morbidity index and the length of mechanical ventilation was found between aspirators and non-aspirators. None of the control group had swallowing deficits after 2 weeks, while 13% of the elderly participants showed persistent impairment in the swallowing reflex. By multivariate analysis, the preadmission functional status was the only determinant of a slowly resolving swallowing deficit (hazard ratio 1.68; 95% confidence interval 1.26-3.97). No post-extubation aspiration pneumonia was identified in either group. CONCLUSIONS: Critically ill elderly patients exhibit delayed resolution of swallowing impairment post extubation. FEES should be considered for those with impaired preadmission functional status.

Aged↗

PubMed2003

Microbiology of severe aspiration pneumonia in institutionalized elderly.

We sought to investigate prospectively the microbial etiology and prognostic indicators of 95 institutionalized elders with severe aspiration pneumonia, and to investigate its relation to oral hygiene in using quantitative bronchial sampling. Data collection included demographic information, Activity of Daily Living, Plaque Index, antimicrobial therapy, and outcome. Out of the 67 pathogens identified, Gram-negative enteric bacilli were the predominant organisms isolated (49%), followed by anaerobic bacteria (16%), and Staphylococcus aureus (12%). The most commonly encountered anaerobes were Prevotella and Fusobacterium species. Aerobic Gram-negative bacilli were recovered in conjunction with 55% of anaerobic isolates. The Plaque Index did not differ significantly between the aerobic (2.2 +/- 0.4) and the anaerobic group (2.3 +/- 0.3). Functional status was the only determinant of the presence of anaerobic bacteria. Although seven cases with anaerobic isolates received initially inadequate antimicrobial therapy, six had effective clinical response. The crude mortality was 33% for the aerobic and 36% for the anaerobic group (p = 0.9). Stepwise multivariate analysis identified hypoalbuminemia (p < 0.001) and the burden of comorbid diseases (p < 0.001) as independent risk factors of poor outcome. In view of the rising resistance to antimicrobial agents, the importance of adding anaerobic coverage for aspiration pneumonia in institutionalized elders needs to be reexamined.

Activities of Daily Living↗