Poster Discussion Room C1e - 08:30-10:30

M ONDAY, S EPTEMBER 4 TH 2006

186. Community-acquired pneumonia:

risk factors and treatment

P2082
Intrapleural heparin or heparin combined with human recombinant DNAase
is not effective in the treatment of empyema in a rabbit model
Oner Dikensoy 1,2 , Moon Jun Na 1 , Huai Liao 1 , Zhiwen Zhu 1 , Wonder Drake 3 ,
Edwin O. Donnelly 4 , Richard W. Light 1 . 1 Allergy and Pulmonary and Critical
Care, Vanderbilt University, Nashville, TN, United States; 2 Pulmonary, Gaziantep
University, Gaziantep, Turkey; 3 Infectious Diseases, Vanderbilt University,
Nashville, TN, United States; 4 Radiodiagnostic, Vanderbilt University, Nashville,
TN, United States

Purpose: To investigate the effectiveness of intrapleural heparin or heparin com-

bined with human recombinant DNAase (rhDNAase) in the treatment of empyema.
Methods: Empyema was induced with the intrapleural injection of 109 Pasteurella
multicoda organisms in infusion agar via a chest tube. There were three treatment
groups each with six rabbits. Groups were randomly given 1000 IU heparin, or
1000 IU heparin plus 1mg rhDNAase, or saline via chest tube every 12 hours for
a total of 6 treatments. The volume of each treatment was 3 ml. The animals were
sacrificed at day 10 and the amount of empyema and pleural thickening was scored
macroscopically on a scale of 0 to 6. All rabbits received 100,000 U procaine
penicillin IM every 24 hours until sacrifice.

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 Poster Discussion
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Results: The total volume of pleural effusion aspirated was significantly higher
in the heparin group (25.8± 10.7 mL) compared to either saline (8±8.9) or
heparin plus human recombinant DNAase (6.8±6.1) groups (p=0.003). The mean
empyema and pleural thickening scores did not differ significantly between the
groups (p=0.8, p=0.5, respectively). A weak correlation was found between to-
tal volume of aspirated pleural fluid and pleural parameters of white blood cell
counts and lactate dehydrogenase levels (r=0.546 and p=0.02, r=0.631 and p=0.02,
respectively).
Conclusion: The intrapleural administration of heparin alone or in combination
with rhDNAase is no more effective than saline in the treatment of empyema
in rabbits. Intrapleural heparin significantly increased the volume of pleural fluid
drainage compared to combination and saline group.
P2083
Clinical cure rates and infection types in the MOxifloxacin Treatment IV
(MOTIV) study in hospitalized patients with community-acquired
pneumonia (CAP)
Robert C. Read 1 , Antoni Torres 2 , Hartmut Lode 3 , Jean Carlet 4 , John H. Winter 5 ,
Javier Garau 6 , Thomas Welte 7 , Marie-Aude Le Berre 8 , Jane E. Ambler 9 ,
Shurjeel H. Choudhri 10 , Pierre Arvis 11 . 1 Academic Unit of Infection & Immunity,
University of Sheffield Medical School, Sheffield, United Kingdom; 2 Servei de
Pneumologia i Allèrgia Respiratòria, Hospital Clínic de Barcelona, Barcelona,
Spain; 3 Department of Chest and Infectious Diseases, City Hospital
Berlin-H-Heckeshorn, Berlin, Germany; 4 Intensive Care Unit and Infectious
Diseases Department, Fondation-Hopital Saint-Joseph, Paris, France;
5
Department of Medicine, Ninewells Hospital and Medical School, Dundee,
United Kingdom; 6 Department of Medicine, Hospital Mutua de Terrassa,
Barcelona, Spain; 7 Pneumonology Department, Medizinische Hochschule
Hannover, Hannover, Germany; 8 Biometry, Bayer HealthCare, Puteaux, France;
9
Global Clinical Development - Anti-Infectives, Bayer HealthCare
Pharmaceuticals, West Haven, CT, United States; 10 Global Clinical Development
- Anti-Infectives, Bayer HealthCare Pharmaceuticals, West Haven, CT, United
States; 11 Medical Affairs, Bayer HealthCare, Puteaux, France
Objective: To assess clinical cure at test of cure and bacterial eradication in
MOTIV study subgroups. Hospitalized patients with CAP (PSI classes, III, IV or
V) received 400 mg IV/PO moxifloxacin (MXF) q.d. or high dose ceftriaxone
(CTX) 2 g q.d. and levofloxacin (LFX) 500 mg b.i.d. for 7–14 days.
Patients and methods: 738 were randomized (MXF: 371, CTX/LFX: 367); per-
protocol (PP) population: 569 (MXF: 291, CTX/LFX: 278) – 336 (59.1%) in
PSI Classes IV–V. Organisms were identified by culture, urine antigen testing (S.
pneumoniae, L. pneumophila) or serology (L. pneumophila, C. pneumoniae, M.
pneumoniae).
Results: 250 (43.9%) PP patients had baseline causative organisms (165 [49.1%]
in PSI Classes IV–V); common CAP pathogens: 192 (33.7%), atypical pathogens:
86 (15.1%), mixed infections: 28 (4.9%). Clinical success rates in PP subgroups:
microbiologically-documented infection – MXF: 114/127 (89.8%), CTX/LFX:
110/123 (89.4%); atypical organisms – MXF: 39/41 (95.1%), CTX/LFX: 41/45
(91.1%); S. pneumoniae – MXF: 69/77 (89.6%), CTX/LFX: 74/85 (87.1%); bac-
teremia – MXF: 15/20 (75.0%); CTX/LFX: 18/24 (75.0%). Bacteriological success
rates (eradication + presumed eradication) in the MBV population were MXF:
45/54 (83.3%) and CTX/LFX: 46/54 (85.2%).
Conclusion: In hospitalized patients with CAP, sequential monotherapy with
IV/PO MXF 400 mg q.d. achieved clinical and bacteriological success rates
similar to high-dose combination therapy with ceftriaxone plus levofloxacin.
P2084
In-vitro deposition study of a levofloxacin (LEV) solution into a novel human
nasal cast model by the PARI VibrENT™
Uwe Schuschnig, Elisabeth Klopfer, Martin Luber, Titus Selzer, Manfred Keller.
PARI GmbH, Aerosol Research Institute, Munich, Germany
Predict drug deposition in nasal cavities for topical sinusitis treatment with antibi-
otics.
Nebulization efficiency was investigated using a cast model equipped with two
cavities (sinuses) in frontal, maxillary and sphenoid position. Cavities as well as
ducts (ostia) are exchangeable, allowing variation of the sinus volume and ostium
diameter. Configuration in current in-vitro study can be seen from figure 2.
349s
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Aerozolization of 3 ml LEV solution (15 mg) was conducted for 4 minutes into
the left and right nostril, each. After the experiment the cast was dismantled and
drug extracted with solvent from paranasal cavities including ostia, nasal cavity,
from nebuliser and filter. LEV content of these solutions was assayed by HPLC.
Results: About 3% of the LEV dose initially placed into the nebulizer was found
in all sinus cavities. Deposition in the single sinuses ranged from 24 μg (frontal)
up to 145 μg (maxillary). About 70% of the initial drug charge remained in the
nebulizer while 6% were found in the nasal cavity and 22% on the exit filter.
Conclusions: VibrENT delivers drug to the site of infection reducing potential
systemic side effects.
P2085
Timing of antibiotic administration and outcomes for patients with
community-acquired pneumonia (CAP). NAC-CV study
Ada Luz Andreu Rodríguez, Rafael Blanquer Olivas, Estrella
Fernández Fabrellas, Francisco Sanz, José Blanquer Olivas, Frederic Tatay.
Pneumology, NAC-CV Group, Valencia, Spain
Introduction: Guidelines have recommended antibiotic treatment within 8, 6, 4
even 2 hours of arrival at the hospital.
Objective: To analyse timing of antibiotic administration (TAA) in patients of
NAC-CV Study and its influence on mortality and length of stay.
Method: NAC-CV is a prospective 12-moths multicenter study in 13 public hospi-
tals, and 1314 patients were included.In this work, outpatients, patients with length
of stay minor than 24 hours (10 patients, 3 of them died) and previously treated
were excluded. A descriptive analysis of timing-adjusted mortality and length of
stay was performed.
Results. Seven hundred and forty five patients were included (32,6% women),
with mean age 66,31(16,7), and classified by PSI (8,6%, 13,2%,22,4%,41,7% and
14,1% from I to V group), and 55 patients (7,4%) admitted in Intensive Care Units.
Mean length of stay was 10,7 (8,5) days. Twenty six patients died (3,5%). Mean
TAA was 304 (239,6) minutes and median 240 (10-1440), with P25 and P75 3 and
6 hours. Accumulated mortality was 3/310 (2.3%) if TAA≤2 h, 13/399 (3.3%) if
≤4 h, 20/578 (3.5%) if ≤ 6h and 25/660 (3.8%) if ≤8 h of arrival at the hospital,
without difference for timing or age group. A significant difference was found
for length of stay in eldest patients who were treated within 6 hours, particularly
within 4 hours.
Conclusions. 1. A half of our patients have been treated within 4 hours and
2/3 of them within 6 hours of arrival at the hospital. 2. Significant difference
in timing-adjusted mortality was not found in any age group. 3. Length of stay
decreased in eldest patients who were treated early.
P2086
Antibiotic prescribing in acute respiratory infections – are we following
guidelines?
B. Esdaile, R. Reddy, A. Sykes, B. Mann. Department of Respiratory Medicine,
West Middlesex University Hospital, Middlesex, United Kingdom
Introduction: Specific guidelines exist (BTS guidelines Thorax 2001; 56: (suppl
IV) and Woodhead F et al., Eur Respir J 2005; 26:1138-1180) for the antibiotic
management of Community Acquired Pneumonia (CAP), Lower Respiratory Tract
Infections (LRTI) and acute exacerbations of Chronic Obstructive Pulmonary
Disease (COPD). Inappropriate prescribing may contribute to the increasing inci-
dence of Clostridium difficile associated disease (CDAD) and Methicillin Resistant
Staphylococcus Aureus (MRSA). The aim of our study was to use these guidelines
to assess whether intravenous antibiotics were being inappropriately prescribed.
Design & Methods: A retrospective study of 50 consecutive admissions, coded as
respiratory infections, during a six-week period from October 2004 and December
2004. Patient records were analysed and classified into three main categories:
CAP, LRTI and COPD. Antibiotic administration was assessed for each patient
and compared to the British and European Thoracic Society Guidelines.
Results: 53% (8/15) of patients admitted with LRTI without chest radiograph
changes received intravenous cephalosporins inappropriately. In those patients
admitted with a CAP with a CURB-65 score of 0-1, 89% (8/9) were treated
inappropriately with intravenous cephalosporins. 56% (5/9) of those admitted with
infective exacerbations of COPD with 2 or more Anthonisen criteria without
radiographic changes were treated with intravenous cephalosporins.
Conclusions: Intravenous antibiotics (cephalosporins) are being inappropriately
 Poster Discussion Room C1e - 08:30-10:30
M ONDAY, S EPTEMBER 4 TH 2006

prescribed for the treatment of respiratory tract infections. It is important to further manifestation of COPD was recorded in 54 (64%) patients, that is, severe condition
educate junior doctors as inappropriate prescribing has major infection control in 28%, mid-severe in 49.3% and minor obstructive disorders were noted in 22.7%
issues. of cases. At the end of pneumonia treatment, 45 (53%) patients quitted smoking,
i.e. 40 males and 5 females. Twenty-one smokers (25%) reduced smoking to 5-10
cigarettes per day. A year after the completed treatment, there were 78 smokers
P2087 and 6 non-smokers among subjects, meaning that 7.5% of patients quitted smoking
Antibacterial activity of telithromycin and comparators against pathogens after the disease, while in spite of physician’s advice, 63% of them started smoking
isolated from patients with community-acquired pneumonia (CAP) in again and 21.5% never quitted smoking.
PROTEKT years 1–5 (1999–2004) Conclusion: Contracting the acute respiratory diseases (pneumonia) in smokers
David Felmingham 1 , Alkiviadis Vatopoulos 2 . 1 Surveillance Department, G.R. should guide us to more intensive and prolonged work on final quitting smoking.
Micro Ltd, London, United Kingdom; 2 Department of Microbiology, National
School of Public Health, Athens, Greece
P2090
CAP has a worldwide annual incidence of 5–11 per 1000 adults and is a significant Prescription of antibiotics for the treatment of community acquired
healthcare burden. Increasing rates of resistance among bacteria implicated in the pneumonia in a district general hospital in the UK
pathogenesis of CAP may impose limitations on the treatment options for this David Owen, Tamara Shiner, Christopher Hilton, Ramachandran Sivakumar,
respiratory tract infection. This analysis aimed to determine the susceptibility of Richard Dent. Department of Medicine, Queen Elizabeth II Hospital,
Streptococcus pneumoniae (SP) and Haemophilus influenzae (HI) isolates col- Hertfordshire, United Kingdom
lected from patients with CAP to a range of antibacterials, including telithromycin
(TEL), over the first 5 years of the PROTEKT surveillance study. Minimum Background: British Thoracic Society (BTS) guidelines recommend the CURB
inhibitory concentrations and susceptibility rates were determined according to 65 score (new Confusion < 9/10, Urea >7, Respiratory rate > 30, Blood pressure
CLSI methodology and breakpoints. Antibacterial susceptibilities of these isolates < 90 systolic or 60 diastolic, age > 65) to assess the severity and treatment of
for PROTEKT Years 1–5 combined were: community acquired pneumonia.
Accordingly, oral antibiotics should always be prescribed when the CURB 65
S. pneumoniae (n=7722) H. influenzae (n=4071) score is 0-1 and intravenous antibiotics when the score is 3 or above.
Methods
Antibacterial S MIC90 S MIC90 We retrospectively reviewed 244 consecutive admissions for suspected pneumonia
(%) (mg/L) (%) (mg/L) during 2005 at the QE II Hospital, Hertforshire. Only the case notes of those
Penicillin 63.6 4 – – subsequently diagnosed with pneumonia were included. We calculated the CURB
Ampicillin – – 81.6 ≥32 65 score in all patients with a diagnosis of pneumonia. Subsequent prescription of
Amoxicillin–clavulanate 93.4 2 99.0 1 oral or intravenous antibiotics was noted.
Cefuroxime 71.4 8 97.4 2 Results: Of the 244 admissions with suspected pneumonia 106 were actually
Erythromycin 65.6 ≥128 –a 8 diagnosed and treated as pneumonia. In only 2 cases was the CURB 65 score
Clarithromycin 65.7 ≥64 84.9 16 recorded. 16 patients fulfilled the criteria for intravenous antibiotics (ie a CURB
Azithromycin 65.6 ≥128 99.6 2 65 score of 3 or above), and all of these were treated appropriately. However, of
Telithromycin 99.8 0.12 99.6 2 the 52 patients who fit the criteria for non-severe pneumonia (CURB 65 score
MIC, minimum inhibitory concentration; S, susceptible. a No CLSI breakpoints of 0 or 1) 28 (54%) were given intravenous antibiotics contrary to current BTS
guidelines.
In total, 38.9% (3005/7722) of SP isolates exhibited multiple resistance phenotypes Conclusion: Inappropriate and unnecessary use of intravenous antibiotics is ex-
(MRP) and 15.4% (626/4071) of HI isolates were [Beta]-lactamase positive (BL+). pensive and promotes antibiotic resistance, as well as hospital acquired infections
Overall, 99.6% (2992/3005) of SP isolates exhibiting MRP and 99.4% (622/626) including Clostridium difficile and Methicillin Resistant Staphylococcus aureus
of BL+ HI isolates were fully susceptible to TEL. (MRSA). Despite BTS guidelines, intravenous antibiotics are being inappropriately
In vitro, TEL is active against common CAP pathogens including SP exhibiting prescribed which may contribute to the morbidity and mortality of inpatients in
MRP and BL+ HI. UK hospitals.

P2088
Cost-efficacy analysis of cefixime switch therapy in the treatment of
community acquired pneumonia
Yubiao Guo, Canmao Xie, Mian Zeng, Jianqian Huang, Yifeng Luo. Department
of Pulmonary & Critical Care Medicine, The First Affiliated Hospital of Sun
Yat-sen University, Guangzhou, Guangdong Province, China
Objective: To compare and evaluate the efficacy, pharmaco-economics of ceftriax-
one/cefixime switch therapy and ceftrioaxone alone in the treatment of community
acquired pneumonia.
Methods: 60 Chinese patients with community acquired pneumonia were ran-
domize assigned into two treatment groups: one group (control group, n=30)
received ceftriaxone 2g intravenous injection twice daily for 7days;The other
group (switch group, n=30) received ceftriaxone 2g injection twice daily for 3
days and then switched to oral cefixime 200mg twice daily for 4 days. The efficacy
and pharmacoeconomics of two groups were compared by using the minimal
pharmacoeconomic cost-effect analysis.
Results: The total effective rate of cefixime switch group and control group was
81.8% and 75% respectively, there was no significant difference between two
groups (P>0.05).The drug-sensitivity rate of sputum-isolated bacteria and bacteria
eradication rate were 81.5% and 74.1% in control group, while in switch group they
were 78.2% and 70% respectively, there were no significant difference between two
group (P>0.05). However, the mean total therapy cost and the antibiotic-related
cost in switch group were less than those in control group (P<0.05).
Conclusion: Cefixime switch therapy is an effective and economical approach for
community acquired pneumonia.
P2089
Pneumonia as the reason for quitting smoking
Malina Percinkovski, Mirjana Danilovic, Svetlana Krstic, Spasoje Popevic.
Institute for Lung Diseases and Tuberculosis, Clinical Center of Serbia,
Belgrade, Serbia & Montenegro
The objective of the study was to establish the effect of the acute diseases of respi-
ratory tract to quitting smoking. The out-patients - smokers treated for pneumonia,
at the beginning and end of treatment as well as one year following the treatment
were analyzed. Out of 84 patients, 69 (82%) were males and 15 (18%) were
females. Bilateral pneumonia was manifested in 9 (10.7%) patients. Concurrent
P2091
Promising prophylactic means and methods for prevention of
community-acquired pneumonia and respiratory infections among
servicemen in Russia
Konstantin D. Jogolev 1 , Sergey D. Zhogolev 2 , Pavel I. Ogarkov 2 , Nikolay
N. Bespalov 3 , Boris S. Sukhanov 2 . 1 Immunology Department, Military Medical
Academy, St Petersburg, Russia; 2 Epidemiology Department, Military Medical
Academy, St Petersburg, Russia; 3 Medical Equipment Department, Mordovsky
State University, Saransk, Russia
Efficiency of some means and methods used to prevent respiratory infections was
studied in summer period of 2005 in a military training center of the North-Western
region of Russia. The investigation included three groups of recruits (May call
up) aged 18-20 (70 persons in each group) resided in similar living and service
conditions.
The first group was given ascorbic acid (0.3 g) and Dibazol (0.04 g t.i.d.) for first
10 days after the center arrival. The second group was located in the sleeping
accommodation equipped with a special ceiling radiator “Effluvion-1.3” based on
A.L.Chizhevsky method. This device being an air ionizator emits negative oxygen
aeroions through the distribution electrode network mounted on the ceiling. The
aeroions have a beneficial effect on the human body. The third group served as a
control.
Five-month follow-up showed that respiratory infection incidence in the first group
was 2.2 times lower than in the control group whereas angina incidence was 3.3
times lower and acute sinusitis incidence – 4.9 times lower. In the second group
where servicemen breathed with ionized air at nights incidence of respiratory
infectious was 1.8 times lower (angina incidence – 2.4 times lower and acute
sinusitis – 4.8 times lower) than in the control group.
Thus, both means proved to be efficient for prophylaxis of respiratory infections,
angina and acute sinusitis.
P2092
Value of bacteraemia as an unfavourable prognostic factor for
community-acquired pneumonia
F. Sanz, J. Blanquer, L. Briones, R. Blanquer, E. Chiner, C. Aguar. NAC-CV
Group, Valencia, Spain
Aims: The aim of this work is to identify etiologic agents and risk factors for

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 Poster Discussion
M ONDAY, S EPTEMBER 4 TH 2006
bacteraemia in community-acquired pneumonia (B-CAP) and their influence on
clinical outcome.
Methods: An epidemiologic, prospective, multicenter study was performed in
which 1,314 CAP cases were analyzed. Two blood cultures, urinary antigen de-
tection, and serology for atypical bacterias and viruses were performed in order to
obtain an etiological diagnosis.
Results: Among 1,037 (78.9%) blood cultures, 77 (7.4%) bacteraemic pneumonias
were identified: Streptococcus pneumoniae: 46 cases (59.7%), Streptococcus spp:
14 cases (18.2%), coagulase-positive staphylococci: 6 cases (7.8%), Escherichia
coli: 6 cases (7.8%), P. aeruginosa: 3 cases (3.9%), other: in 6 blood cultures
(7.8%). Alcoholism was the risk factor associated with B-CAP (OR 2.54; 95% CI
1.43-4.52; p=0.002), whereas concordant prior antibiotic therapy was a protective
factor for B-CAP (OR 0.31; 95%CI 0.13-0.73; p=0.007). Bacteraemia was associ-
ated with a higher hospital stay, more clinical severity (PSI) and a worse outcome
than non bacteraemic pneumonia, but ICU admission was the only significant
factor associated with bacteraemia (OR 3,97; 95% CI 1,71-9,25; p=0,001). The
mortality rate was higher in B-CAP than in non-bacteraemic pneumonias (14.5%
vs 5.1%; p=0.001).
Conclusions: 1. Streptococcus pneumoniae was the main etiologic agent of bac-
teraemic pneumonia.
2. Early antibiotic treatment acts as a protective factor for bacteraemia when it is
concordant.
3. In our experience, alcoholism is the only risk factor for bacteraemia.
4. Bacteraemic pneumonias are associated with a worse outcome, with higher ICU
admission and mortality than non-bacteraemic pneumonias.
P2093
Recognising poor prognosis community-acquired pneumonia in young adults
with simple clinical measurements
Oxana V. Fessenko. Pulmonology, State Postgraduate Medical Institute, Moscow,
Russia
Introduction: Although severe community-acquired pneumonia (CAP) and death
occur most frequently in the elderly and those with chronic underlying diseases,
young patient also die. Death from pneumonia in this group of patients might be
considered to be most likely to be preventable. Nowadays there isn’t any robust
criteria to estimate risk of mortality from CAP in young patients. Previous studies
show that all developed scoring systems (ATS, BTS, APACHE, PSI, etc) allow to
estimate pneumonia severity in adult patients but their predictive value is limited
for population of young people. It can be explained that all of these systems use
patient’s age as one of principal risk factor.
Aim: To identify risk factors of mortality from severe CAP in young people.
Methods: We reviewed data from 267 non-immunocompromissed young patients
(all male) with CAP admitted to ICU. Mean age was 22±4. 39 patients died.
StatSoft Software (version 5.0, 1997) was used for calculations.
Results: We analyzed 23 factors (temperature, blood pressure, respiratory rate,
multilobar extension, blood count, etc) measured at patient’s admission. Multivari-
ate logistic regression revealed that decreased WBC count (≤6000 cells/ml) (OR
9,6, 95% CI 4,4–20,9), dyspnea at rest (OR 7, 95% CI 3,4–14,8) and low level
of consciousness (OR 6,6, 95% CI 3,1–14,2) are three independent predictors of
mortality. Mortality risk for CAP is 91% in young patients with these 3 symptoms
presence.
Conclusion: Although our model requires further validation it may be useful as
simple and fast method for identifying young patient with poor prognosis CAP.
P2094
Validating CURB-65 score among inpatients with community acquired
pneumonia in Pakistan
Faisal F. Zuberi, Ahmed S. Haque, Javaid A. Khan, Muhammad Islam.
Pulmonology & Critical Care, Aga Khan University, Karachi, Sindh, Pakistan
Background: British Thoracic Society recommends CURB-65 score; Confusion,
Blood Urea Nitrogen (BUN) ≥20mg/dl, Respiratory Rate (RR) ≥30/min, Blood
pressure (systolic<90/diastolic ≤60mmHg) and Age≥ 65yrs to categorize pa-
tients with community acquired pneumonia (CAP) into six strata (range 0-5) of
increasing risk of mortality.
Objective: To validate CURB-65 score based risk of mortality in our population.
Methods: Records of all adult inpatients over 1 year with CAP at a 500-bed
teaching hospital were analyzed. They were grouped into Low (CURB-65score:0-
1), Intermediate (CURB-65score:2) and High (CURB-65score:3-5) mortality risk
groups with outcome as discharged alive or expired in hospital.
Results: 268 patients were studied (mean age 61 yrs, 55.2% male). Total observed
mortality was 34 (12.7%). BUN (OR 7.4; 95% CI 2.8-19.7) was the strongest,
Confusion (OR 3.7; 95% CI 1.7-8.3) intermediate and RR (OR 2.4; 95% CI 1.1-5.0)
the weakest variable predicting mortality on univariate analysis. Low BP and Age
were not statistically significant. Only BUN and Confusion were independently
associated with risk of mortality on multivariate analysis. The observed mortality
in our population was 6(4.5%) in the Low mortality group, 13(17.1%) in the
Intermediate and 15(25.0%) in the High group. This was higher than CURB-65
predicted risk of 1.5%, 9.2% and 22% respectively.
Conclusion: CURB-65 score for CAP underestimated the risk of mortality in
particular for the Low and Intermediate risk groups in our population. Amongst
CURB-65 variables only BUN and Confusion were independently associated with
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risk of mortality. Further research is needed to identify risk factors in CAP
predicting severity and mortality for our population.
P2095
Risk factors for community-acquired pneumonia in hospitalized adult
patients, a case- control study
Safaa M. Wafy, Aliae A. Mohamed. Chest Department, Assiut University
Hospital, Assiut, Egypt
Although CAP remains a major cause of hospitalization in developed countries,
few studies on risk factors have been performed.
The purpose was to identify risk factors for pneumonia diagnosed in our commu-
nity, using a case control study. All 104 CAP patients admitted to chest department
in Assiut University Hospital- Egypt, during 18 months were compared with 300
controls adults.
Results: males were 71.2% with age mean ± SD 44.77± 17.37, and females were
28.8 with age mean ± SD 45.77± 11.59. CAP was common among males 37.4%
versus 14.6%for females. It significantly affected patients aged more than 50 years
(30.1% versus 22.8%). The incidence of CAP was higher in workers, farmers and
employers (56.4%, 35.4% and32.3% respectively) and among smokers (46.1%) ver-
sus (19.9%) none smokers. Significant risk factors in univariate analysis included
renal, heart disease, hepatic, smoking, systemic diseases, diabetes and steroid ther-
apy. Multiple logistic regression analysis showed statistically significant influence
of heart failure (OR = 2.57; CI: 1.1-5.99; p = 0.029) and chronic renal failure (OR
= 3.35; CI: 1.06-10.54; p = 0.039) on high risk.Another independent risk factors
were smoking (OR=3.56; 95% CI: 1.65-8.42, p=<0.001), chronic bronchitis (9.24,
1.48 - 57.74, p = 0.000) and asthma (3.20, 1.98-7.15.p=<0.001). Hepatic (6.02,
1.08-33.3, p=<0.001), systemic diseases (11.57, 6.68-20.04, p=<0.001) corticos-
teroid therapy (OR 3.52, 95% CI 1.99 – 6.24, p =<0.001) and diabetes (OR 2.40,
95% CI 1.12 – 5.14, p =<0.001) were validated as additional independent risk
factors. These data suggest that cigarette smoking is the main avoidable risk factor
for community-acquired pneumonia in adults.
P2096
The post-tuberculosis lung changes as risk factor of the community-acquired
pneumonia delayed course
Tamara V. Rubanik 1 , Natalia L. Shaporova 2 , Vasily I. Trofimov 2 . 1 Pulmonology
Department, City Clinico-Diagnostic Center, Saint-Petersburg, Russia; 2 Hospital
Therapy, Pavlov’s State Medical University, Saint-Petersburg, Russia
To investigate the role of post-tuberculosis lung changes (PTLC) as risk factor
of the community-acquired pneumonia (CAP) delayed course we examined 60
patients with CAP delayed course and PTLC as main group and 102 ones with
CAP delayed course and without PTLC as the control, with average age 53,5 ±
1,1 years. There were 68,3% of small and 31,7% of large PTLC forms in the main
group. The ptlc presence significantly influenced the CAP severity (p<0,001). The
haemoptysis as the clinical symptom of CAP took place more frequent in the
patients with PTLC (p<0,05).And smoking patients demonstrated haemoptysis 3
times more often to be compared with none smoking ones. The prolongation of the
cough as the clinical symptom of CAP was significantly longer in the main group
(43,8 ± 1,0 and 34,4 ± 0,8, p<0,001). We still observed cough after the reversion
of XR-changes in the patients with PTLC, while in the control group cough
disappeared before the infiltration. The average prolongation of CAP in patients of
main group was approximately equal 42,3 ± 0,9 days, in control - 35,9 ± 0,6 days,
so the prolongation of CAP was significantly longer in the patients with PTLC
(p<0,001). The antibiotic treatment courses quantity was higher in the patients
with PTLC (p<0,05). The bronchoscopy investigation revealed the PTLC in all
the patients of main and in 38% patients of control group. We can conclude that
the endoscopy signs of PTLC are more frequent then the roentgenological ones.
So our investigation showed that PTLC are the important risk factor of delayed
CAP course, which influence the clinical features, prolongation and treatment
peculiarities of disease.
P2097
Incidence of pneumonia in patients after stroke
Zoran S. Arsovski 1 , Dejan V. Dokic 1 , Anita A. Arsovska 2 , Ante M. Popovski 2 .
1
Scientific Department, Clinic of Pulmonology, Skopje, Macedonia; 2 ICU, Clinic
of Neurology, Skopje, Macedonia
The purpose of this study was to evaluate the incidence of pneumonia in patients
after stroke. We have made a retrospective analysis of 400 patients (211 male,
189 female) with stroke, confirmed with computer tomography (CT) of the brain,
average age 63, which developed pneumonia in ICU. The incidence of pneumonia
was analyzed in two different groups of patients, who were classified according
to CT findings after stroke. First group-352 patients (88%) with involvement of
a.carotis interna system. The second group-48 patients (12%) with involvement
of the vertebrobasilar system. Criteria for diagnosis of pneumonia were: new
pneumonic infiltration seen on a chest X-ray, physical chest findings and one or
more of the following symptoms: temperature higher then 37,5 C, dyspnea and
cough. Pneumonia was found in 45 patients (12,78%) in the first group and 22
patients (45,83%) in the second group. Aspiration pneumonia was mainly cause
of pneumonia, 82% were developed due to post stroke swallowing disorders. 18%
 Poster Discussion Room C1e - 08:30-10:30
M ONDAY, S EPTEMBER 4 TH 2006

of patients developed nosocomial pneumonia. Pefloxacinum (Abactal) 400 mg bid
for 10 days was the therapy of choice in 68,75% of the cases. We can conclude that
patients with stroke which affected the vertebrobasilar system should be subjected
to developed pneumonia (p<0,05) owing to frequent aspiration.
Early recognition of the swallowing disorders could reduce the incidence of
pneumonia in patients with stroke.
P2098
Predictive factors of in-hospital mortality of patients with
community-acquired pneumonia
Sandra Saleiro, Vitor Braz, António Oliveira e Silva, Sofia Pereira, Margarida
Freitas Silva. Pneumology, Hospital São João, Porto, Portugal; Internal
Medicine, Hospital São João, Porto, Portugal
Community-acquired pneumonia (CAP) is a frequent cause of hospital admission
and mortality worldwide.To evaluate predictive factors of in-hospital mortality
in patients admitted with CAP, a retrospective study of patients admitted to a
Medicine ward, between January and December 2003, was carried out. Data re-
lated to demographics, comorbilities, clinical and radiological presentation were
collected through medical records review. Statistical analysis was made using
Epi Info and Stata. A p value < 0.05 was considered statistically significant.
The study included 333 patients (51.4% male; mean age 72.8 ± 16.4 years).
In-hospital mortality was 17.7%. In univariate analysis, malignant disease [OR:
2.39 (1.08-5.25)], cerebrovascular disease [OR: 1.84 (1.00-3.38)], chronic hepatic
disease [OR: 3.53 (0.92-13.15)] and current treatment with oral steroids [OR: 2.99
(0.91-9.53)] were associated with in-hospital mortality, as was impaired conscious
level [OR: 2.78 (1.48-5.24)] and bilateral pulmonary involvement in chest ra-
diograph [OR: 2.86 (1.42-5.74)]. Chronic obstructive pulmonary disease (COPD)
was negatively associated with in-hospital mortality [OR: 0.22 (0.05-0.79)]. In
multivariate analysis, current treatment with oral steroids [OR: 3.35 (1.02-11.0)],
impaired conscious level [OR: 2.14 (1.04-4.42)], bilateral pulmonary involvement
[OR: 2.89 (1.41-5.89)] and COPD [OR: 0.24 (0.07-0.85)] remained as independent
variables associated with in-hospital mortality.
Conclusion: This study identified the presence of current treatment with oral
steroids, impaired conscious level and pulmonary bilateral involvement in chest
radiograph as predictive factors of in-hospital mortality of patients with CAP.
P2099
Community acquired pneumonia in elderly: clinical aspects and prognostic
factors
Ivanka Djordjevic, Tatjana Pejcic, Slavica Golubovic, Milan Radovic,
Tatjana Radjenovic-Petkovic, Dragana Dacic. Department for Nonspecific Lung
Diseases, Clinic for Lung Diseases, Nis, Serbia, Serbia & Montenegro
The aim of this study were to determine the clinical and epidemiological character-
istics of community acquired pneumonia (CAP) in elderly, to identify prognostic
factors and to established a predictive model for mortality of CAP. Patients (pts)
≥65 years old with CAP admitted in the clinic over the last year were included
in study. Multivariate analysis was used to identified prognostic factors from
variables present on admission, from which a discrimination rule was constructed
to predict mortality. Among total of 172 pts with CAP, there were 75 elderly pts.
(43,6%). Clinical pictures lasted 21 days on average and was atypical in 15 pts
(20%). The main clinical feature were cough in 54 pts (72%). Most pts 48 (66%)
had some kind of accompained or undrelying disease. Microbiological diagnosis
was made in 9 pts (12%). There were 6 (8%) deaths. The prognostic factors in
multivariate analysis on admission were bilateral radiographic infiltrates, hypera-
zotaemia, absence of fever, tachypnoea, alteration in mental status and shock. The
dicriminating rule to predict mortality comprising three or more of these factors
was 56% sensitivity with specificity of 88% and an overall accuracy of 84%.
CAP in elderly is associated with a high degree of mortality.The discriminating
rule incorporating the prognostic factors identified is powerful predictor of bad
course of CAP.
4.68; 95%CI 2.17-8.60, p<0.0001), mechanical ventilation (O.r. 6.64; 95%CI
1.64-27.37, p=0.0063), ICU admission (O.r. 3.33; 95% CI 1.43-7.75, p=0.0063),
ischemic heart disease (O.r. 7.56; 95%CI 2.58-22.10, p<0.0001), the absence of
microbiological analyses (O.r. 50.00; 95%CI 9.15-273.10), p<0.0001), the use
of narcotic analgesics (O.r. 8.67; 95%CI 2.2-34.36, p=0.0019), the average day
infusion volume more than 2000ml (O.r. 6.00; 95%CI 1.47-24.46, p=0.017), tem-
perature by admission less than 37.7 C without antipyretics (O.r.4.65; 95%CI
2.96-21.87, p=0.003).
Conclusion: while there are some common predictors of in-hospital mortality,
mortality is affected by the use of narcotic analgesics, high infusion volume, the
absence of microbiological analyses and temperature less than 37.7 C.
P2101
Atypical bacterial and viral ethiology of community-acquired pneumonia in
Chile: a preliminary report
Mauricio H. Ruiz, Maria A. Martinez, Vivian R. Luchsinger, Enna M. Zunino,
Lucia R. Aguad, Pamela L. Arce, Mauricio A. Lopez, Luis F. Avendano.
Enfermedades Respiratorias, Hospital Clinico Universidad Chile, Santiago,
Chile; Microbiologia ICBM, Universidad de Chile, Santiago, Chile; Virologia
ICBM, Universidad de Chile, Santiago, Chile; Infeccioso, Hospital Lucio
Cordova, Santiago, Chile; Infeccioso, Hospital Lucio Cordova, Santiago, Chile;
Medicina, Hospital Clinico Universidad Chile, Santiago, Chile; Medicina,
Hospital Clinico Universidad Chile, Santiago, Chile; Virologia ICBM,
Universidad de Chile, Santiago, Chile
Community-acquired pneumonia (CAP) is a worldwide leading cause of mortality.
S. pneumoniae seems to be the principal pathogen; the etiology remains usually
unclear.
Objectives. To determine the etiology of CAP in ambulatory and hospital settings
in Chile and clinical features associated to viral and atypical bacteria etiology.
Methods: Persons ≥ 18 years old with radiographic confirmed CAP were enrolled
in 2005 in Santiago. Clinical features were registered. Laboratory study included:
viral culture and immunofluorescent antigen detection for RSV, adenovirus, in-
fluenza and parainfluenza viruses; urinaryS. pneumoniae antigen detection; sputum
culture for conventional bacteria and Legionella; polymerase chain reaction for
RSV, metapneumovirus, Mycoplasma pneumoniae, Chlamydia pneumoniae and
Legionella pneumophila; paired sera test for antibodies to RSV, M pneumoniae,
C. pneumoniae.
Results: The average age of the137 cases studied (66 female) was 57 ± 20 years.
15% were outpatient, 58% hospitalized and 23% had severe CAP. Pathogens were
identified in 53% of cases: S. pneumoniae in 20%, atypical bacteria (M. pneu-
moniae or Ch. Pneumoniae) in 28%, viruses in 12%, mixed infections in 11%.
Co-infecction were significantly associated to ambulatory cases (p<0,01). No rela-
tionship was found between clinical severity and etiology. Atypical bacterias were
detected more frequently in spring and summer (p<0,01), while viral and mixed
infections were common in winter and fall (p<0,01 and <0,05 respectively).
Conclusion: Viral and atypical bacteria are agents frequently associated to CAP,
with seasonal distribution and without severity relationship. Supported by FONDE-
CYT 1050734.

P2100
Factors influencing in-hospital mortality in community-acquired pneumonia
(CAP)
Natalia B. Lazareva, Lubov S. Dolgenkova, Anton A. Igonin, Vladimir
V. Arkhipov, Alla N. Tsoi. Clinical Pharmacology, Pulmonology, Sechenov
Moscow Medical Academy, Moscow, Russia

Aim: to determinate the factors that predict in-hospital mortality among patients
require hospitalization for the treatment of CAP.
Methods: a retrospective observational study of the patients who were admitted
to Moscow city clinical hospital in 2005.
Results: a total of 150 patients were enrolled in the study, 16 of whom died
(10.66%). The mortality among the patients with severe CAP (according to BTS,
2002) was 48%. The median age was 63 (17-85) years. The population was 59%
male. The non-survived patients had 30(15-57) points by SAPS II vs. 25 (6-57),
p<0.05. The initial temperature (36.7±0.89 vs.38.3±0.89, p=0.0037) and maxi-
mal temperature (37.6±1.19 vs.38.7±0.77, p=0.0014) were lower in the group of
the non-survived patients in comparison with the survived patient. The following
factors were associated with increased mortality: two-sided infiltration (Odds ratio

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