Background: Ventilator-associated pneumonia (VAP) remains a common case of intensive care unite (İCU) and hospital morbidity and mortality despite advances in diagnostic techniques and manegment. One of most important point for such patients is identification of predictors for mortality in term for futher their modification and reduction of mortality rate.Objective: We aimed to determine the most important risk factors for short-term mortality in patients with VAP in mechanically ventilated patients Methods: This retrospective study was carried out from February 2014 to January 2019. One hundred twenty one adults patients with VAP maintained on mechanical ventilation for more than 48 h in our ICU department were enrolled in the study. VAP was diagnosed as new persistent pulmonary infiltrates on chest radiographs and a least two of following: (1) Fever of ≥38.3C(2) leukocytosis of ≥ 12.000/mm 3 and (3) purulent tracheobronchial secretions. Endotracheal aspirate (ETA) samples and blood samples of suspected case were collected and processed as per standard protocols. Results:The primary underlying diagnosis and comorbidities were acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in 42 patients, congestive heart failure in 32, neurological disease in 28, and renal disease in 19 patients. Gram-negative agents were the major of finding pathogen (Acinotebacter baumannii accounting for 37.1 %). This infection in 43 case (95.5%) was multi-dying resistant (MDR) pathogen and associated with significantly higher length of ventilation (LOV) and the length of ICU stay (LOS icu ) (p=0.01 respectively). Severe sepsis/septic shock, acute respiratory distress syndrome (ARDS), malnutrition, pulmonary complications such as pleural effusions and bilateral, multi-lobar lung infiltrates were most common findings in VAP patients which were associated with higher mortality (p<0.01) .Acinotebacter baumanii MDR pathogens was associated with higher mortality rate compare with other MDR pathogens (p<0.01) Conclusion:Ventilator-associated pneumonia is a serious ICU complication that is associated with increased in hospital mortality.In patients with VAP malnutrition ,severe sepsis/septic shock, ARDS, MDR Acinotebacter baumannii infection ,bilateral pulmonary infiltrates ,and underlying chronic obstructive pulmonary disease(COPD) are associated with increased risk in-hospital mortality in such patients. Identification of risk factor for in hospital mortality in such patents is important in term on further their modification and reduction of mortality rate

To study the mean predictors of acute exacerbation of chronic obstructive pulmonary disease(AECOPD) for hospitalization and intensive care unit (ICU) admission.

Background:Secondary bacterial co-infections are not common in patients with COVID19.However ,the rate of bacterial pneumonia is high in critically ill patients with COVID19 and there is increased risk of joining bacterial infection by increasing of severity of COVID19 and achieving maximal rate in intubated patients.And there is increased rate of overuse of broad-spectrum antibiotics in patients admitted to the intensive care unit(ICU) department.Objective:The aim of our investigation was to evaluate the rate of secondary bacterial co-infection in critically ill patients with COVID19 and its impact to the mortality rate in such patients.Method and measurements:Of 129 COVID-19 patients admitted in our ICU from 21 April 2020 to 15 August 2020,93 have been mechanically ventilated.BALF was performed in 68 patients during ICU stay and all were suspected of bacterial pneumonia.Bacterial cultures of BALF positively defined in case of grew with significant amount of bacteria(ie,>_10 4 colony-forming units/ml).All pneumonia cases in intubated patients was assessed as Ventilator -associated pneumonia(VAP) and was defined as eraly-onset and late onset as pneumonia diagnosed before and after 5 days of mechanical ventilation,respectively.Results:In 51% (n=35) of 78 patients was obtained bacterial cultires and just in 5(7.4%) of 68 patients was evaluated the early-onset VAP and in remaining 63 patients (92%) of patients was detected late-onset VAP.VAP in patients commonly was associated with ARDS compared to non-VAP patients(OR 3.57[0.89-7.92]CI 95%;p=0.001) and although late -onset VAP in patients significantly often was associated with kidney failure (OR 2.95[075-6.32]CI 95%;p=0.003) and septic shock 3.68[1.05-8.21] CI95%;p=0.001).In all early -onset pneumonia patients ,bacterial pathogens were most commonly gram positive bacteria(100%) and 80%(4/5) were susceptible to cefotaxime,cefepime,piperacillin-tazobactam,and meropenem.Conversely,in late-onset VAP,most bacterial pathogens were gram-negative bacteria(29/30) and muti-drug resistant (MDR)pathogens(14/30).Among MDR gram-negative bacteria causing late-onset VAP,most commonly was obtained Acinotebacter baumannii(9/30),followed Pseudomonas aeruginosa(6/30),folowed Klebsiella pneumoniae (5/30) and Escherichia coli(5/30) and Aspergillus fumigates(5/30).And just 13% of patients with late-onset VAP were susceptible to piperacillin-tazobactam,17% were susceptible to cefepime and 34% were susceptible to meropenem.Late-onset VAP was associated with high mortality rate among intubated compared to early-onset VAP and non-VAP patients ( OR 4.87[1,] CI95%;p=0.001;OR 6.33[1.58-14.25] CI 95%;p=0.0008).Conclusions:Secondary bacterial co-infection is common in intubated critically ill patients with COVID19 and most commonly presentation of bacterial infection is late-onset VAP causing by multi-drug resitant pathogens which are associated commonly with ARDS,kidney failure and septic shock.In patients with late-onset VAP MDR pathogens may predict high mortality rate

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