VAT increases the rates of progression to VAP, the need for tracheostomy, and the incidence of mortality in ICUs. Most bacterial agents of VAT are MDR. Preventive policies for VAP, including the use of ventilator care bundle, and appropriate empirical antibiotic therapy for VAT may reduce the incidence of VAP.

Purpose: Because of uncertainty in the pathophysiological process, the treatment of cardiac syndrome X (CSX) is still under study. Addressing the effects of cardiac rehabilitation (CR) can help promote the prescription of this modality as an adjuvant therapy for these patients. Methods: This study was performed on 30 patients with effort-induced angina pectoris using a positive exercise test and/or myocardial perfusion scan in the absence of obvious stenosis or a stenosis of <50% on coronary angiography. The patients were divided into the CR and usual care (UC) groups and underwent cardiopulmonary exercise testing with gas exchange analysis before and after the study. The Duke Treadmill Score was used to compare prognosis and survival estimates of patients. Results: An increase in peak oxygen uptake ( JOURNAL/jcprh/04.03/01273116-202001000-00008/8FSM1/v/2023-09-11T232142Z/r/image-gif o 2) was significantly higher in the CR group than in the control group (P = .017). Resting JOURNAL/jcprh/04.03/01273116-202001000-00008/8FSM1/v/2023-09-11T232142Z/r/image-gif o 2 was also increased in the CR group, but its difference with the UC group was not statistically significant. Resting O2 pulse was increased in the CR group, which significantly differed between groups (P = .041). Exercise test duration and the Duke Treadmill Score significantly increased in the CR group as compared with the UC group (P = .003 and P = .002, respectively). Also, recovery heart rate in the first minute was significantly improved in CR group. Conclusion: Adding a 4-wk course of CR to UC for patients with CSX not only increased the Duke Treadmill Score and exercise test duration but also improved the resting O2 pulse, peak JOURNAL/jcprh/04.03/01273116-202001000-00008/8FSM1/v/2023-09-11T232142Z/r/image-gif o 2, and first-minute recovery heart rate.

Pseudomonas aeruginosa is one of the most important opportunistic pathogens responsible for various types of hospital infections. High prevalence of antibiotic resistance in P. aeruginosa strains of human clinical samples cause more severe diseases for a longer period of time. The current research was done in order to study the distribution of blaIMP-1 gene among the imipenem-resistant P. aeruginosa strains isolated from burn and urinary tract infections of hospitalized patients. Two-hundred and forty-three P. aeruginosa isolates recovered from the cases of burn and urinary tract infections of inpatients and outpatients were analysis for antibiotic resistance pattern using the disk diffusion method. Then, imipenem-resistant isolates were further analyzed for distribution of blaIMP-1 gene using the PCR. Of 243 P. aeruginosa isolates, 146 strains (60.08%) were taken from outpatients and 97 strains (39.91%) were taken from inpatients. P. aeruginosa isolates harbored the highest levels of resistance against streptomycin (100%), nalidixic acid (100%), aztreonam (100%), cotrimoxazole (95.47%), ciprofloxacin (88.47%), cefotaxime (84.36%) and gentamycin (83.95%). Inpatients had a relatively higher levels of antibiotic resistance. One-hundred and twenty-one out of 126 (96.03%) imipenem-resistant P. aeruginosa isolates harbored the blaIMP-1 gene. Inpatients also had a relatively higher prevalence of blaIMP-1 gene. High prevalence of blaIMP-1 gene and also imipenemresistant P. aeruginosa are important public health issue. Clinical laboratories should consider the detection of the blaIMP-1 gene among the P. aeruginosa isolates of clinical samples.

Background: Ventilator-associated tracheobronchitis (VAT) is an important cause of mortality and morbidity in the hospitalized patients in the ICUs. Appropriate and early onset antibiotic therapy leads to better outcome. This study was conducted to determine the frequency of bacterial agents and antimicrobial resistance, clinical course and response to treatment of VAT in the hospitalized patients in a surgical and a medical intensive care unit (ICU) of teaching hospitals in Hamedan, Iran.Methods & Materials: In a cross-sectional study in 2014, hospitalized patients who had the criteria for the diagnosis of VAT in medical ICU of Sina Hospital and surgical ICU of Besat Hospital in Hamedan were enrolled. Tracheal samples of patients were investigated in terms of smear, culture and antibiotic sensitivity. Furthermore, demographic characteristics, underlying diseases, clinical aspects, progression to pneumonia and response to the treatment were collected by checklist. Data were analyzed by using SPSS-16.Results: In this study, 69 patients were included, of whom, 28 patients (40/6%) were female and 41 (59/4%) were male. The incidence of VAT was 6/44%. The mean age of the patients was 55/92 ± 21/98 years. The most isolated bacteria consisted of Acinetobacter baumannii (30/4%), Pseudomonas aeruginosa (20/3%), and Enterobacter (13%). In surgical ICU, Pseudomonas aeruginosa and Enterobacter spp. were the most common isolates. In medical ICU, Acinetobacter baumannii and Klebsiella pneumoniae were the most common bacteria. Over all, 63/3% of the isolates were multidrug resistant, out of which 71% related to the medical ICU and 29% to the surgical ICU. All the isolates of Acinetobacter baumannii and Citrobacter freundii were multidrug resistance. Also, 23 patients (33/3%) progressed to pneumonia. The mean time of response to treatment was 4/98 ± 4.7 days, and 27/5% of the patients were discharged after tracheostomy. Thirty-eight patients (98.6%) died in spite of antimicrobial therapy.Conclusion: Multidrug resistant pathogens are common causes of VAT. A high proportion of VAT patients lead to pneumonia and death. Considering the difference between the kind of pathogens and antibiotic resistance in different ICUs, it is necessary to uti-lize the intended data of each region for defining the appropriate empirical treatment protocol.