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Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are the most common hospital infections with the highest prevalence in intensive care units (ICU). The aim of this study was to investigate prevalence of bacterial pathogens isolated from ICU patients with HAP/VAP and reveal their susceptibility rates in order to establish a basis for empirical antibiotic therapy. Prospective cohort study was conducted in central ICU of Clinical Centre Kragujevac, Serbia, from January 2009 to December 2015, enrolling 620 patients with documented HAP (38.2%) or VAP (61.8%). Gram-negative agents were isolated in 95.2%. Generally, the most common pathogens were Acinetobacter spp. and Pseudomonas aeruginosa, accounting for over 60% of isolates. The isolates of Acinetobacter spp. in HAP and VAP had low susceptibility to the 3rd generation cephalosporins, aminoglycosides, fluoroquinolones (0-10%). The rate of susceptibility to piperacillin-tazobactam was below 15%, whereas for carbapenems and 4th generation cephalosporins it was about 15-20%. Isolates of P. aeruginosa from HAP and VAP showed low susceptibility to ciprofloxacin and gentamicin (below 10%), followed by amikacin (25%), while the rate of susceptibility to carbapenems and 4th generation cephalosporin was 30-35%. Furthermore, 86% of isolates of P. aeruginosa non-susceptible to carbapenems were also non-susceptible to ciprofloxacin. The highest level of susceptibility from both groups was retained toward piperacilin-tazobactam. In ICU within our settings, with predominance and high resistance rates of Gram-negative pathogens, patients with HAP or VAP should be initially treated with combination of carbapenem or piperacillin-tazobactam with an anti-pseudomonal fluoroquinolone or aminoglycoside. Colistin should be used instead if Acinetobacter spp. is suspected. Vancomycin, teicoplanin or linezolide should be added only in patients with risk factors for MRSA infections.

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Ageism is stereotyping and prejudice against individuals or groups because of their age. Robert Butler first used it in 1969, to express a systematic stereotyping and discrimination against elderly people. Available data appears to confirm that attitudes of children to the old age differ from that of adults. The study population consisted of 162 subjects (56 school children, 48 nurses and 58 elderly patients). Each subject in the survey was asked to respond to the following three questions: Question #1: “Is the old age unattractive ?”; Question #2: “How old is an old man? Question #3: “What should you do to have a long life (what is good for longevity)? The majority of polled children (33) gave positive statements about ageing in their responses to the first item, while most of the nurses gave condition answers, like: “It is not unattractive if you are healthy”. Elderly subjects made up a group with the majority of negative responses (in percentage), as only 33% of them answered that old age is not unattractive. All three groups of subjects demonstrated a good knowledge of what is considered good for longevity, and had a generally positive health attitude. Our results indicate that majority of children have positive perception and attitude about old age, which leads us to conclusion that ageism is adopted later in life.

Introduction: Hospital infections (HIs), which are frequently associated with hospital treatment, increase morbidity, mortality and treatment costs. The aim of this study was to establish the incidence of HIs in a neurological intensive care unit (nICU), and to determine the most prevalent causative agents and risk factors for HIs. Methodology: A cross-sectional study with nested case-control design was conducted between 1 July 2009 and 30 June 2010 at an 18-bed neurological intensive care unit at the Clinical Center Kragujevac, Serbia. Results: In total, 537 patients were enrolled in the study, with 6,549 patient-days. There were 89 patients with 101 HIs. The incidence of patients with HIs was 16.57%, and incidence of HIs was 18.81%, while density of HIs was 15.42 per 1,000 patient-days. The most frequent anatomical sites of HIs were urinary tract (73.27%), blood (10.89%), and skin and soft tissues (10.89%). The following risk factors were identified: co-morbidity (OR=3.9; 95% CI=1.9-7.9), surgical intervention in the last 30 days (OR=5.6; 95% CI=1.5-20.4), urinary bladder catheterization longer than seven days (OR=3.8; 95% CI=1.8-8.2), value of Glasgow coma scale  9 (OR=3.7; 95% CI=1-6.9), and longer hospital stay (OR=1.1; 95% CI=1.1-1.2). Conclusions: Hospitalization in an nICU bears high risk of HIs, especially of urinary tract infections caused by Gram-negative bacteria, in patients with longer hospital stay or co-morbidities, and in those who have had surgical interventions or prolonged use of a urinary bladder catheter. Special attention should be paid to these patients to prevent HIs.