الفهرس 
Community Acquired PneumoniaOnly 14 pages are availabe for public view
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Abstract
Community-acquired pneumonia (CAP) is acute infection of the lungs that develops outside the hospital setting in a patient who has not been recently hospitalized. Important variations are found according to patient severity and used diagnostic tools. The emergence of new diagnostic tests improved the recognition of pathogens compared with previous tests. Although the diagnostic criteria for CAP seem relatively straightforward, making the correct diagnosis can be difficult. A thoughtful history and physical examination with close attention to the actual respiratory rate and core temperature, as well as careful interpretation of chest radiographs, are required. This caution is especially true in the elderly. Endocan, formerly known as endothelial cell-specific molecule 1 (ESM-1), is a novel soluble proteoglycan that was first discovered in human umbilical vein endothelial cells (HUVECs). Since most of its secretion and functions takes place in the activated vascular endothelium, it was later renamed to endocan in 2001. Because of its involvement in inflammation and endothelial dysfunction, there has been an increasing interest in exploring endocan’s utility as a biomarker in a wide spectrum of pathological states such as sepsis, acute respiratory distress syndrome (ARDS), arterial hypertension and several cardiovascular diseases. The aim of this study was to detect the organisms causing CAP, determine the antibiotic susceptibility pattern of the isolated organisms, measure the plasma level of endocan in CAP patients by ELISA, and to findcorrelations between plasma level of endocan and bacteriological etiology of CAP, severity of the disease, and antibiotic response. This is a observational case-control clinical study that was performed at the Medical Microbiology and Immunology Department, Faculty of Medicine, Tanta University, patients were recruited from the Chest Department, Tanta University Hospitals. This study included 43 patients with CAP who were recruited during the period of the study and10 age and sex matched healthy individuals were included as a control group for comparison. Out patients receiving antibiotics for the preceding 7days prior to sampling, patients with other inflammatory or chronic diseases, patients with separate hospitalization within, and immunocompromised patients were excluded from the study. Patients and control groups were subjected to full history taking, clinical examination including Pneumonia Severity Index (PSI) assessment. Radiological examination was performed in the Radiology department and interpreted by experienced radiologists. Diagnosis of a suspected CAP established considering the typical chest X-ray or chest CT patterns. For microbiological studies, sputum samples were collected from the patients and transported as soon as possible to the laboratory of microbiology department. The specimens were cultured onto MacConkey, blood, and chocolate agar plates and colonies were identified by morphology, gram film. , and biochemical reactions. Antibiotic susceptibility were performed on Mueller-Hinton agar plates by Kirby-Bauer disc diffusion method. Laboratory assessment of Endocan levels was performed using the commercially available ELISA kit. Endocan levels were expressed as pg/m. Datamanagement and analysis: data was tabulated and introduced into a PC using Statistical Package for Social Science (SPSS) version 26.0. The patients’ age ranged from 38 to 88 years with a mean of 59.9 years ± 9.8 (SD) and the controls age ranged from 38 to 85 years with a mean of 55.3 years ± 16.2 (SD). There was male predominance in the patients group, with 79.1% and 80% of the patients and controls were males, respectively. No statistically significant differences were found between patient and control groups in age or sex (p=0.95 and 0.36, respectively). Forty six organisms were isolated and identified. In order of prevalence, these were Pneumococci (30.4%), Klebsiella pneumoniae (19.6%), Staphylococcus aureus and Streptoccocus pyogenes (17.4%), E-coli (10.9%), Stomatoccoci (4.3%). Forty patients had monomicrobial infection, and three patients had polymicrobial infections, two of them had Klebsiella pneumonia with E-coli and one had Streptoccocus pyogenes with Stomatoccoci. Thirty two organisms (69.6%) were gram positive, while 14 organisms (30.4%) were gram negative bacteria. The PSI of the study patients (n=43) revealed that 16 patients (37.2%) had PSI of 1, eighteen patients (41.9%) had PSI of 2, five patients (11.6%) had PSI of 3, and four patients (9.3%) had PSI of 4. The PSI of the study patients ranged from 1 to 4 with a median of 2. Comparison between the patients and the control group in the pretreatment phase showed statistically high significant difference was demonstrated (p<0.001). The mean endocan levels in the patients group was higher than the control group (8.5 ± 1.5 vs. 2.3 ± 0.5). Analysis of the association of endocan levels with the patient age, sex, bacterial gram reactionand the PSI showed that no statistically significant differences were found in the endocan level according to the patients’ sex and the bacterial gram stain (p=0.38 and 0.78, respectively). No statistically significant correlation between the endocan levels and the patients age or PSI (p=0.45 and 0.56, respectively). Testing different antibiotics against the gram positive and gram negative bacteria showed that linezolid, vancomycin, tigecycline, and quinupristin / dalfopristin were sensitive against all isolated gram positive bacteria. Imipenen, meropenem, aztreonam, and cefepime showed the highest sensitivity against the isolated gram negative bacteria (100%, 92.9%, 78.6%, and 71.4%, respectively). Comparison between the endocan levels before and after treatment revealed statistically high significant difference was demonstrated (p<0.001). The mean endocan levels after treatment was lower than before treatment (4.3± 1.4 vs. 8.5 ± 1.5). Roc analysis for the endocan levels to predict CAP revealed that endocan levels could diagnose CAP with AUC of 0.967. The cutoff value was 4.55 with a sensitivity of 97.7% and specificity of 90%.