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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Background:Patients with chronic obstructive pulmonary disease(COPD) often present with acute and severe exacerbations requiring hospital admission and treatment. However, the identification of the factors which may predict for in-hospital mortality of such patients are not clear up to days and early detection of risk factors for in-hospital mortality may help clinicians for reducing of the mortality rate in hospitals.Objective: The aim of this study was to identification of risk factors for in-hospital mortality in patients with acute exacerbations of COPD.Methods:We have analysed 598 patients with acute exacerbations of COPD who have been admitted to the pulmonary medicine department of university from October 2013 to November 2018 .Patient age,smoking,BMI,co-morbidity,long-term oxygen therapy,forced spirometric parameters,pulmonary arterial pressure,d-dimer test,and arterial blodd gas tensions have been assessed.The mean age (SD) of patients was 65(11) years and forced expiratory volume in one second was 49(21)%.Results:The in-hospital mortality (pulmonary medicine and ICU departments) was 11.5%(69 of 598).Frequent exacerbations(with three or more exacerbations during last year) was greatest in-hospital mortality for patients(p=0.005).Arterial carbon dioxide tension was independent risk factor for in-hospital mortality(p<0.001).Co-morbidity Charlson index >_2 although was associated with highest mortality rate compared to survival patients (OR 3.27[0.98-6.34),CI 95%;p<0.003).One of interesting findings was high d-dimer level (>_1.0mg/l) in patients which was significantly higher in non-survival compared to survival(OR 7.54[2.65-12.35];p=0.0001) and the presence of Cor pulmonale and high pulmonary arterial pressure(PAP>_ 35mmHg) was independent risk factor increased risk of in-hospital mortality(OR 6.34(1.96-10-49);p<0.001).Conclusions:Several risk factors have been assessed as risk factors for in-hospital mortality in acute exacerbations of COPD .However ,most important of them were high level of arterial blood carbon tension ,frequent exacerbations of the disease ,co-morbidity ,high d-dimer level ,and presence of Cor pulmonale and pulmonary arterial hypertension which were associated with highest in-hospital mortality rate. Early recognition and identification of risk factors for in-hospital mortality may help for their preventing and modifying and reducing mortality in patients with acute exacerbations of COPD.