الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
develops after more than 48 hours of initiation of endotracheal intubation and mechanical ventilation (MV).VAP is the most frequent ventilator-associated complication (VAC).
VAP represent a major cause of deaths, morbidity and resources utilization in hospitalized patients, most notably in those with sever underlying condition.
The pathogenesis of ventilator-associated pneumonia (VAP) is related to the number and virulence of microorganisms entering the lower respiratory tract and the response of the host (eg, mechanical, humeral, and cellular host defenses).The primary route of infection of the lungs is through micro aspiration of organisms that have colonized the oropharyngeal tract (or, to lesser extent, the gastrointestinal tract).
Diagnosis of VAP is dependent on the clinical criteria (CPIS more than 6), the microbiological criteria, and the radiological criteria and biomarkers which help diagnosis, assess prognosis, and to follow up treatment. Level of PTX3 in early diagnosis of VAP were studied and evaluated.
Appropriate antibiotic therapy significantly improves survival for patients with ventilator-associated pneumonia (VAP). When therapy is given, antimicrobial selection should be based upon risk factors for multidrug-resistant (MDR) pathogens, including recent antibiotic therapy, the resident flora in the hospital or intensive care unit (ICU), the presence of underlying diseases, and available culture data (interpreted with care). For patients with risk factors for MDR pathogens, empiric broad-spectrum, multi drug therapy is recommended. Once the results of pre therapy cultures are available, therapy should be narrowed based upon the susceptibility pattern of the pathogens identified.
The aim of this study is to assess the diagnostic value of level of PTX3 in diagnosis of VAP.
This study was conducted in critical care unit (ICU) at Menoufia University Hospitals. 40 patients with ventilator associated pneumonia were concluded in the study. Clinical pulmonary infection score was used to diagnose VAP. History, clinical examination, routine laboratory investigation and chest X-ray and level of CRP and BAL and serum PTX3 were done. Data were collected from patients within 48 hours of intubation and mechanical ventilation then after follow up ≥48 hours for the occurrance of any evidence of pneumonia by using clinical pulmonary infection score more than 6 for diagnosis (newly developed lung infiltrates, fever >38.2°C, leukocytosis >12,000 mm−3 and purulent endotracheal secretions).
The result of our study showed that the patient’s demographics data and Comorbidities not significantly affect the result of level of PTX3.
PTX3 levels ≥6ng/ml in BAL fluid was associated with 96.7% sensitivity, 100% specificity, 100% positive predictive value and 90% negative predictive value for culture-positive pneumonia.
PTX3 levels ≥6ng/ml in serum was associated with 87% sensitivity, 88.8% specificity, 96.4% positive predictive value and 66.6% negative predictive value for culture-positive pneumonia.
CRP levels ≥ 12 mg/L in serum was associated with 77.4%sensitivity, 33.3% specificity, 80% positive predictive value and 30 % negative predictive value for culture-positive pneumonia.
So PTX3 level ≥6ng/ml in BAL fluid was discriminative of microbiologically confirmed pneumonia in mechanically ventilated patients.