Pneumonia was considered to be HAP if the onset had occurred > 48 h after hospital admission and was judged not to have been incubating before hospital admission. Some of the HAP patients had ventilator-associated pneumonia (VAP), which was diagnosed if the onset had occurred > 48 h after the initiation of mechanical ventilation and was judged not to have been incubating before the initiation of mechanical ventilation.
All microbiological specimens were taken before the initiation of therapy with antibiotics. AB was considered as a “definite pathogen” if it was cultured from blood or pleural fluid. AB was considered as a “probable pathogen” if it was cultured in the sputum culture or tracheal aspirate before the initiation of antibiotic therapy. A valid specimen needed to have > 25 neutrophils present on a Gram stain and < 10 epithelial cells per high-power field. generic claritin
Clinical, laboratory, radiologic, and microbiological data were collected. Clinical data included age, sex, underlying disease, Charlson comorbidity score, prior treatment (including hospitalization, surgery, and steroid and antibiotic use for > 1 day within 1 year of pneumonia), clinical presentation, pneumonia severity index, acute physiology and chronic health evaluation (APACHE) II score, complications, and mortality. Laboratory data included hematologic tests, biochemical tests, arterial blood gas analysis findings, and culture and sensitivity results from appropriate clinical specimens. Radiologic data included the presence of consolidation and/or pleural effusion on chest radiograph (CXR). The CXR was reviewed for the presence of lobar consolidation or bronchopneumonic changes. Microbiological data included antimicrobial susceptibility and the presence of other pathogens cultured in the same specimen. Growth was categorized semi-quantitatively as “scanty,” “moderate,” or “heavy” according to standardized criteria. Antimicrobial susceptibility testing was performed using disk diffusion according to the National Committee for Clinical Laboratory standards. The antimicrobial agents tested were as follows: ciprofloxacin; cotri-moxazole; gentamicin; tobramycin; amikacin; piperacillin; ticar-cillin-clavulanate; ampicillin-sulbactam; cefoperazone-sulbactam; and imipenem. Empirical antibiotics were given according to prevailing guidelines.,,