Murat KAYA * Oğuz KILINÇ * Türkan GÜNAY ** *Department Of Chest Diseases, Faculty Of Medicine, Dokuz Eylül Universit

1. RELATIONSHIP BETWEEN SELECTED INITIAL TREATMENT OF HEALTHCARE ASSOCIATED PNEUMONIA WITH CHANGING TREATMENT, INTENSIVE CARE REQUIREMENT, HOSPITALIZATION PERIOD AND DEATH RATE Murat KAYA * Oğuz KILINÇ * Türkan GÜNAY ** *Department Of Chest Diseases, Faculty Of Medicine, Dokuz Eylül University ** Department Of Public Health, Faculty Of Medicine, Dokuz Eylül University

2. Aim: The aim of the study is finding relationship between selected initial treatment with duration of hospitalization, changing treatment regimens, intensive care unit requirements and mortality in Health Care Associated Pneumonia(HCAP) cases

3. Methods HCAP cases -according to Turkish Toracic Society 2009 guideline- were evaluated in terms of age, comorbidities, initial treatment regimens, revision of treatment, additional antibiotics requirements, microbiological spectrum, intensive care requirements and death rate retrospectively

4. 105 HCAP cases, 61 men and 44 women were evaluated

5. Male : 68.8 (±13.3) Female : 77.5 (±15.8) All Cases : 71.4 (±14.7)

6. Alive : 70 (±15.4) Exitus : 75 (±12.2) p=0.164

7. Criteria for HCAP Criteria Cases %

9. In the patients infected with multiple microoorganisms, requirement of changing therapy and additional antibiotherapy were increased (p<0.05 and p<0.05) but there were no significant difference in death rate and intensive care unit requirements (p=0.50 and p=0.09)

12. No significant difference were observed in intensive care requirement, death rate and mean hospitalization time between the cases with aspitarion history or not. (p= 0.49, p=0.86 and p=0,16)

18. %64,8 %35,2

19. 35 33 21 16 There were no significant difference in revision of treatment between CAP and HAP protocols(p=0.60)

20. Additional treatment requirements in the HAP group was significantly more than the CAP group(p=0.047)

21. Intensive care requirements in the HAP group was significantly more than the CAP group(p=0.042)

22. There were no significant difference between two groups (p=0.217)

23. The patients who required complete change in treatment, intensive care requirement increased significantly(p<0.0001), but no significant difference was observed in death rate(p=0.133)

24. Initial therapy in patients who used additional antibiotherapy , death rate and ICR were increased(p<0.001 and p<0.0001).

25. No significant difference between two groups in duration of hospitalization(p=0.08)

26. The patients who required complete change in treatment and additional antibiotics, duration of hospitalization was increased( p<0.0001 and p< 0.0001)

27. Duration of Hospitalization (Median) Criteria Day

28. Initial Treatment Criteria CAPHAP

29. The Patients Who Required Complete Change in Treatment Criteria Cases%

30. Changing Treatment Completely When the Initial Treatment was CAP % Criteria

31. Intensive Care Requirements There were no significant difference between criterias

32. Death Rate There were no significant difference between criterias in death rate but in the cases who requires intensive care unit, death rate was increased significantly (p<0,0001)

33. In culture (+) cases, death rate and intensive care requirement increased significantly(p=0.014 ve p<0.0001).

34. Death rate was significantly increased in patients who were older than 65 years old (p<0.05)

35. There were no significant difference in intensive care requirement and death rate between the cases infected with multi drug resistant organisms or not ( p=0,45 and p=0,98)

36. In cases with neurological comorbidies intensive care requirements were significantly less than the others(p<0.05)

37. In the cases with neurological comorbidies death rate was significantly less than the others (p= 0.016 )

38. Discussion : • Health Care Associated Pneumonia ; because of the influence of age group and patients with additional health problems , it is a high morbidity and mortality disease group • At diagnosis time or follow up, because of arising intensive care needs of patientsis affectedmortalityclosely , particularly close monitoring of patients aged over 65 is gaining importance

39. Discussion 2 • In follow-up of patients,taking culture for isolatingfactor and sometimes invasive procedures for directing treatment to the right way, has been effective in reducing hospitalization time and mortality • When necessary, in this direction underwent bronchoscopy is provided for identificationthe causative agent at 36.8% of our cases that multiply.

40. Discussion 3 • We think that mortality and treatment success in this patients maybe not only related with selected initial treatment but also depends on the severity of infection, intensive care requirement at the time of diagnosis, interventional procedures in the process of hospitalization or complication by nosocomial infections

41. Discussion 4 • Because of high mortality in patients who produced factors, almost all of produced organisms that cause infections with high mortality have been associated with hospital pathogens • With all these factors taken into account in follow-up of patients, a larger case series, prospective multicenter studies are needed to the choice of treatment and determine the risk factors