BackgroundEffective empirical antibiotic therapy for community acquired pneumonia (CAP), based on frequently updated data about the pattern of bacterial distribution and their antimicrobial susceptibilities, is mandatory.AimTo identify the bacterial etiology of CAP in adults and their antibiotic susceptibility patterns and to evaluate the response to initial empirical antibiotic therapy in an Egyptian university hospital.Settings and designA cross-sectional hospital-based study.Patients and methodsCAP cases were selected by systemic random sampling from those admitted to the chest department. All were evaluated at admission and 4 days after starting empiric therapy. Typical bacteria were isolated, identified and tested for their antibiotic susceptibility. An indirect IF assay was used to diagnose atypical bacteria. Clinical response to initial empiric antibiotic therapy was clinically, laboratory and radiologically evaluated.ResultsTwo hundred and seventy CAP patients were included. Bacteria represented 50.4% of them. Klebsiella pneumoniae was the most prevalent bacterium (10.37%) followed by Streptococcus pneumoniae and P. aeruginosa (7.78% each). Overall, 76.2% of isolates showed a multidrug resistant phenotype: 82.61% (19/23) S. pneumoniae, 89.66 % (26/29) K. pneumoniae, 65.22% (15/23) Pseudomonas aeruginosa, 87.50% (7/8) Escherichia coli and 81.25 % (13/16) Staphylococcus aureus. Broad spectrum β-lactams, especially carbapenems, and moxifloxacin showed in vitro efficacy on most of the tested isolates. Forty-three cases (15.9%) were nonresponders, 37 (86%) of them showed bacterial etiology. The highest rate of nonresponsiveness (30.43%) was observed in cases receiving antipseudomonal/antipneumococcal β-lactam plus a fluoroquinolone for suspected P. aeruginosa infection.ConclusionMultidrug resistance in bacteria causing CAP and high frequency of isolation of hospital pathogens are prominent features of this study. Azithromycin containing regimens were associated with the lowest rates of nonresponsiveness. Development and implementation of an antibiotic stewardship program are highly recommended for CAP management.

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Background: Chronic obstructive pulmonary disease is a significant disease which can affect public health and classified as 3 rd cause of death ,and described as a preventable and treatable disease associated with air flow limitation which is not completely reversible. 40% to 50% of the duration of the mechanical ventilation (MV) support period can be spent in weaning. So the target of this study to evaluate weaning practice in mechanically ventilated patients with COPD disease due to acute exacerbation. Methods: 24 COPD patients admitted to the ICU due to hypercapnic respiratory failure and who required invasive positive pressure mechanical ventilatory support were eligible for enrollment. After the acute phase, all eligible patients were subjected to an initial weaning trial. Results: As regard previous history of ventilator support and source of referral there was statistically non significant difference between the patients who failed and succeed weaning. As regard ventilator machine trade name there was statistically non significant difference for weaning success. There was statistically non-significant difference for weaning success regarding diaphragmatic ultrasound parameters (TDI, End inspiratory TDI and end expiratory TDI), but regarding diaphragmatic excursion there was significant difference. As regard Pi max and PaO 2 /FiO 2 there was statistically significant difference for weaning success but regarding rapid shallow breathing index (RSBI) there was statistically non-significant difference. There was statistically non-significant difference for weaning success as regard method of weaning. Conclusion: Weaning success is very high in specialized tertiary ICU; 91.7%. Pimax, P a O2/ FIO 2 and diaphragmatic excursion are a good predictor for weaning success.

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