Patients enrolled in the basic neurological

Although aspiration is a frequent condition in patients hospitalized in the ICU, the frequency of aspiration pneumonia in the general

pneumonia is inaccurate: (

1), in some works of aspiration pneumonia (

) only condition was studied and its distribution among all pneumonia was defined (

2) In most series study of pneumonia, aspiration pneumonia were either excluded (

) or not clearly defined (), (3) Finally, in some publications (,

), diagnostic aspiration pneumonia caused only when the etiological studies were negative. Among the few studies

desire for attention of all community acquired pneumonia admitted to ICU (,,

), the frequency of this disease is about 15%. In this paper, the incidence reached 24%. This high rate can be explained

specific study sites where the reception of patients suffering from neurological disorders were frequent. Indeed, in our series, more than half of the patients were initially adopted in intensive care for major neurological disorders and

aspiration pneumonia diagnosis was delayed. Data on the microbiological diagnosis of aspiration pneumonia incommensurable. Most previous studies involved patients seen

relatively late, when complications such as necroziting pneumonia, lung abscess or empyema has already occurred (,

). In a recent publication, Mier and colleagues (

) studied the bacteriology of early aspiration using a protected brush. Positive results were obtained for

only nine of 42 patients. 14-pathogenic S. recovery were

Pneumonia (28. 5%), other streptococci

. (21. 4%),

Staphylococcus aureus (14. 3%) and gram-negative bacteria (35. 7%). In our study, cultures were positive in 70 (60%) patients. The most common aerobic pathogens

were S. pneumonia

(23%)

bacteria genus Staphylococcus. (29%) and Gram-negative bacteria (40%). Large selection of anaerobic bacteria in patients with lower

respiratory infections requires special methods of sampling and proper working conditions of transportation and specific nutrient media. Design of our study, retrospective and prospective multicenter data collection does not allow such a bacteriological research. Thus, in our series, accurate data on anaerobes in the etiology of aspiration pneumonia was not available. Weather aspiration pneumonia varies considerably from one study to another. In a study of Cameron and colleagues (

), for example, mortality was 62% on average and up to 90% when patients had more than one lobe of the lung involved. In numerous series, most of the deaths was due to the desire, not the disease leads to a desire

(,,

). In the fine and associated publications (,

), aspiration pneumonia was defined as factors of adverse outcomes and mortality. In contrast, in previous work >> << our group to determine the prognostic index of severe pneumonia, aspiration was >> << predictor of survival (

). In Hickling and publications colleagues (

), the mortality rate appears low (21%), and death often associated with underlying disease, not desire. This low mortality rate does not seem to understand differences in the severity of the patients, as in this study

(

), the average predicted mortality derived from APACHE II (

) was 43 ± 24% . In our study, mortality was 22% and after excluding patients who died due to disease

leads to aspiration-related deaths associated with pneumonia was 11%. This mortality was significantly lower than that observed in the

nonaspiration pneumonia (28%). In an attempt to explain this is due to low mortality, we divided patients

show aspiration pneumonia according to the health of land, providing ICU. Patients enrolled in the basic neurological

violations related mortality was low (5%). In patients with pure desire, admitted to respiratory failure, mortality

speed was quite higher (17%) but lower than in nonaspiration pneumonia (28%). However, due to small number of patients

in each group, aspiration pneumonia and usual criteria for statistical analysis, the significance of differences in

related mortality among patients according to the mechanism of pneumonia (group 3 compared with group 1) or

Major Medical land underlying the desire to (group 1 compared with group 2) is difficult to assess. Thus, in our series, even if

aspiration pneumonia was associated with a significant decrease in mortality rates than nonaspiration pneumonia, including patients suffering from

severe neurological disorders with apparently mild pneumonia may explain this feature. Thus, further research

, including a larger number of patients, it seems you have to say about mortality clean >> << aspiration pneumonia, compared with severe pneumonia nonaspiration. We have determined using monovariate analysis, 17 prognostic factors. Most of them were previously described in the prognostic

research on severe community acquired pneumonia (,,

). Among all the variables collected within 24 hours after admission buy strattera online, only four were independent predictors of mortality. Three witnesses

initial severity of lung infection, positive blood culture, a large X-ray of the chest and part of the initial shock and only

reflected a concomitant diseases, chronic respiratory failure. When all the variables collected in the ICU were introduced in

unique stepped analysis, only one of these early predictors maintained as an independent predictor of mortality, the positive blood culture

due to three factors collected in the ICU: use of inotropic support, ineffective initial antibiotic therapy

and of nosocomial lower respiratory tract superinfection. These results indicate

Some observations: first, whatever the initial presentation of patients with aspiration pneumonia, the doctor

ability to identify low versus high-risk patients seems questionable. Second, the effectiveness of initial antimicrobial therapy appears

as initial prognostic factors. However, as recently emphasized by Torres and El-Ebiary (

), the following criteria based on clinical evaluation 48-72 hours after initiation of treatment, it is difficult to define and various

assessment between physicians may likely occur that leads to misevaluation and potential errors of clinical deterioration >>. << Finally, bad as nosocomial lower respiratory tract superinfection should be emphasized. What do almost all uncontrolled studies have shown a higher mortality rate among patients who have ventilator-associated pneumonia

, than in patients who do not, some recent studies (

) suggest that nosocomial pneumonia only the air ' originated with a significant increase in mortality when infection was associated with

high-risk microorganisms such as P. sticks,

Acinetobacter SPP. Or

X. maltophila. In our study, the results were quite the opposite, but multivariate analysis. Paired case studies

may need to definitely assess the prognostic significance of superinfection occurring during aspiration pneumonia >>. << Thus, our study highlights the rapid introduction of effective antibiotic therapy as soon as the diagnosis

suspected to achieve low mortality in severe pneumonia aspiration. According to our data biological and

results of the previous literature, which emphasizes that the main causal anaerobes in pulmonary infections (

Peptostreptococcus, Bacteroides, Prevotella,

, and Fusobacterium species) tend to β-lactam same agents ( ,

), we can assume that the most effective therapy in an effort to patients is different from that in other patients with severe

community acquired pneumonia, as well as β-lactam antibiotics is the cornerstone of initial antimicrobial >> < <therapies. .