THE USE OF A RESPIRATORY SAMPLE IN ANALYSIS OF MICROCIRCULATION AND MECHANISMS OF ITS REGULATION BY LDF METHOD IN NORMAL AND IN HYPOXIA

Few data are available in the literature regarding Pneumocystis jirovecii infection in children under 3 years old. This retrospective cohort study aimed to describe medically relevant information among them. All children under 3 years old treated in the same medical units from April 2014 to August 2020 and in whom a P. jirovecii evaluation was undertaken were enrolled in the study. A positive case was defined as a child presenting at least one positive PCR for P. jirovecii in a respiratory sample. Medically relevant information such as demographical characteristics, clinical presentation, microbiological co-infections, and treatments were collected. The objectives were to describe the characteristics of these children with P. jirovecii colonization/infection to determine the key underlying diseases and risk factors, and to identify viral respiratory pathogens associated. The PCR was positive for P. jirovecii in 32 children. Cardiopulmonary pathologies (21.9%) were the most common underlying disease in them, followed by severe combined immunodeficiency (SCID) (18.8%), hyaline membrane disease (15.6%), asthma (9.4%) and acute leukaemia (6.3%). All SCID children were diagnosed with pneumocystis pneumonia. Co-infection with Pj/Rhinovirus (34.4%) was not significant. Overall mortality was 18.8%. Paediatric pneumocystis is not restricted to patients with HIV or SCID and should be considered in pneumonia in children under 3 years old.

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A qualitative assessment of the diagnosis and management of ventilator-associated pneumonia among critical care clinicians exploring opportunities for diagnostic stewardship

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.130 ◽

2021 ◽

pp. 1-7

Author(s):

Blaine Kenaa ◽

Lyndsay M. O’Hara ◽

Mary Elizabeth Richert ◽

Jessica P. Brown ◽

Carl Shanholtz ◽

...

Keyword(s):

Tertiary Care ◽

Qualitative Assessment ◽

Ventilator Associated Pneumonia ◽

Care Hospital ◽

Sample Collection ◽

Respiratory Sample ◽

Identification Of Bacteria ◽

Attending Physicians ◽

Work Up ◽

Radiographic Changes

Abstract Background: Prompt diagnosis and intervention for ventilator-associated pneumonia (VAP) is critical but can lead to overdiagnosis and overtreatment. Objectives: We investigated healthcare provider (HCP) perceptions and challenges associated with VAP diagnosis, and we sought to identify opportunities for diagnostic stewardship. Methods: We conducted a qualitative study of 30 HCPs at a tertiary-care hospital. Participants included attending physicians, residents and fellows (trainees), advanced practice providers (APPs), and pharmacists. Interviews were composed of open-ended questions in 4 sections: (1) clinical suspicion and thresholds for respiratory culture ordering, (2) preferences for respiratory sample collection, (3) culture report interpretation, and (4) VAP diagnosis and treatment. Interviews transcripts were analyzed using Nvivo 12 software, and responses were organized into themes. Results: Overall, 10 attending physicians (75%) and 16 trainees (75%) trainees and APPs believed they were overdiagnosing VAP; this response was frequent among HCPs in practice 5–10 years (91%, n = 12). Increased identification of bacteria as a result of frequent respiratory culturing, misinterpretation of culture data, and fear of missing diagnosis were recognized as drivers of overdiagnosis and overtreatment. Although most HCPs rely on clinical and radiographic changes to initiate work-up, the fear of missing a diagnosis leads to sending cultures even in the absence of those changes. Conclusions: HCPs believe that VAP overdiagnosis and overtreatment are common due to fear of missing diagnosis, overculturing, and difficulty distinguishing colonization from infection. Although we identified opportunities for diagnostic stewardship, interventions influencing the ordering of cultures and starting antimicrobials will need to account for strongly held beliefs and ICU practices.

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A cluster of Legionnaires' disease in Belgium linked to a cooling tower, August–September 2016: practical approach and challenges

Epidemiology and Infection ◽

10.1017/s0950268819001821 ◽

2019 ◽

Vol 147 ◽

Cited By ~ 1

Author(s):

N. Hammami ◽

V. Laisnez ◽

I. Wybo ◽

D. Uvijn ◽

C. Broucke ◽

...

Keyword(s):

Legionella Pneumophila ◽

Cooling Tower ◽

Geographical Information ◽

Cluster Management ◽

Respiratory Sample ◽

Health Authorities ◽

Public Health Authorities ◽

Legionnaires Disease ◽

Environmental Sample Analysis

Abstract A cluster of Legionnaires' disease (LD) with 10 confirmed, three probable and four possible cases occurred in August and September 2016 in Dendermonde, Belgium. The incidence in the district was 7 cases/100 000 population, exceeding the maximum annual incidence in the previous 5 years of 1.5/100 000. Epidemiological, environmental and geographical investigations identified a cooling tower (CT) as the most likely source. The case risk around the tower decreased with increasing distance and was highest within 5 km. Legionella pneumophila serogroup 1, ST48, was identified in a human respiratory sample but could not be matched with the environmental results. Public health authorities imposed measures to control the contamination of the CT and organised follow-up sampling. We identified obstacles encountered during the cluster investigation and formulated recommendations for improved LD cluster management, including faster coordination of teams through the outbreak control team, improved communication about clinical and environmental sample analysis, more detailed documentation of potential exposures obtained through the case questionnaire and earlier use of a geographical information tool to compare potential sources and for hypothesis generation.

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Fusarium volatile, a new potential pathogen from a human respiratory sample

Fungal Systematics and Evolution ◽

10.3114/fuse.2019.04.09 ◽

2019 ◽

Author(s):

A.M.S. Al-Hatmi ◽

M. Sandoval-Denis ◽

C. Nabet ◽

S.A. Ahmed ◽

M. Demar ◽

...

Keyword(s):

Respiratory Sample ◽

Potential Pathogen

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First Time Isolation of Mycobacterium hassiacum From a Respiratory Sample

Clinical Medicine Insights Circulatory Respiratory and Pulmonary Medicine ◽

10.1177/1179548417747529 ◽

2018 ◽

Vol 12 ◽

pp. 117954841774752 ◽

Cited By ~ 3

Author(s):

Stefanie Deinhardt-Emmer ◽

Steffen Höring ◽

Christian Mura ◽

Doris Hillemann ◽

Beate Hermann ◽

...

Keyword(s):

Susceptibility Testing ◽

Respiratory Pathogen ◽

Chronic Obstructive ◽

Antibiotic Susceptibility Testing ◽

Respiratory Specimen ◽

Obstructive Pulmonary Disease ◽

Respiratory Sample ◽

Therapeutic Recommendation ◽

First Time

We describe the first isolation of Mycobacterium hassiacum, a rapid-growing, partial acid-resistant mycobacterium, in a respiratory specimen from a patient with exacerbated chronic obstructive pulmonary disease. To provide therapeutic recommendation for future cases, antibiotic susceptibility testing of 3 clinical isolates was performed by broth microdilution. All strains tested showed susceptibility to clarithromycin, imipenem, ciprofloxacin, and doxycycline. The role of M hassiacum as a respiratory pathogen remains unclear and needs to be evaluated by future reports.

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PIV-32 Utility of different respiratory sample types to diagnose respiratory viral infections by real time PCR.

Journal of Clinical Virology ◽

10.1016/s1386-6532(09)70128-3 ◽

2009 ◽

Vol 46 ◽

pp. S25

Author(s):

H.S. Al-Kindi ◽

M. Raza ◽

G. Kudesia

Keyword(s):

Real Time ◽

Real Time Pcr ◽

Viral Infections ◽

Respiratory Sample ◽

Respiratory Viral Infections

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Clinical relevance of pulmonary non-tuberculous mycobacterial isolates in three reference centres in Belgium: a multicentre retrospective analysis

BMC Infectious Diseases ◽

10.1186/s12879-019-4683-y ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Yannick Vande Weygaerde ◽

Nina Cardinaels ◽

Peter Bomans ◽

Taeyang Chin ◽

Jerina Boelens ◽

...

Keyword(s):

Clinical Relevance ◽

Treatment Decision ◽

Chest Ct ◽

Smoking History ◽

Pathogenic Potential ◽

Prospective Data ◽

Respiratory Sample ◽

Treatment Decision Making ◽

Radiological Patterns ◽

Record Review

Abstract Background/objectives Assessing the clinical relevance of non-tuberculous mycobacteria (NTM) isolated from respiratory samples can be challenging. The epidemiology and pathogenicity of NTM species vary geographically. We aimed to outline the clinical relevance and associated radiological patterns of NTM species isolated in Belgium. Methods We performed a retrospective multicentre analysis of all patients identified from the laboratory database with > 1 respiratory sample growing NTM from January 2010 through December 2017. We collected clinical, radiological and microbiological data through medical record review and assessed clinical relevance according to ATS/IDSA criteria for NTM pulmonary disease (NTM-PD). Results Of the 384 unique patients, 60% were male, 56% had a smoking history and 61% had pre-existing lung disease. Mycobacterium avium complex (MAC), M. gordonae and M. xenopi were the most frequently isolated species: 53, 15 and 8% respectively. 43% of patients met ATS/IDSA criteria, of whom 28% presented with fibrocavitary disease. Weight loss, fever, nodular bronchiectatic and fibrocavitary lesions on chest CT, and a positive acid-fast bacilli (AFB) stain were significantly associated with NTM-PD. The species with the highest pathogenic potential were M. abscessus (11/12), M. malmoense (6/7) and M. intracellulare (41/64). Conclusion In our study, MAC was the most commonly isolated NTM species, but M. abscessus and M. malmoense showed the highest probability of being clinically relevant. Clinical relevance varied not only by species but also by radiological findings on chest CT and AFB staining. Clinicians should consider these elements in their treatment decision making. Prospective data including clinical outcome are needed to provide more robust evidence.

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First isolation of Conidiobolus sp. in a respiratory sample of a patient in Europe

Clinical Microbiology and Infection ◽

10.1016/j.cmi.2017.06.015 ◽

2017 ◽

Vol 23 (11) ◽

pp. 834 ◽

Cited By ~ 3

Author(s):

I. Falces-Romero ◽

A. Alastruey-Izquierdo ◽

J. García-Rodríguez

Keyword(s):

Respiratory Sample

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569. Characterization of COVID-19 Vaccine Breakthrough Infections in Metropolitan Detroit

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.767 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S386-S386

Author(s):

Nicholas sturla ◽

Rita Kassab ◽

Rafa Khansa ◽

Thomas Chevalier ◽

David Allard ◽

...

Keyword(s):

Healthcare Workers ◽

Vaccine Uptake ◽

Effective Vaccine ◽

Breakthrough Infection ◽

Respiratory Sample ◽

Asymptomatic Patients ◽

The Status ◽

Henry Ford ◽

Heart Failure Exacerbation

Abstract Background Although COVID-19 vaccines are very effective, vaccine breakthrough infections have been reported, albeit rarely. When they do occur, people generally have milder COVID-19 illness compared to unvaccinated people. A total of 10,262 (0.01%) SARS-CoV-2 vaccine breakthrough infections had been reported as of April 30, 2021. The objective of this study was to evaluate the effectiveness of COVID-19 vaccines and characterize breakthrough infections in our patient population. Methods This was a retrospective review of all consecutive COVID-19 vaccine breakthrough infections at Henry Ford Health System (HFHS) in metropolitan Detroit, Michigan, from December 17, 2020 to June 7, 2021. Centers for Disease Control (CDC)'s breakthrough infection definition (detection of SARS-CoV-2 RNA or antigen in a respiratory sample ≥14 days after completion all recommended doses of COVID-19 vaccine) was used to identify cases. Vaccination status was extracted from the electronic medical records using Epic™ SlicerDicer. Results A total of 228,674 patients, including healthcare workers (HCW), were fully vaccinated in our healthcare system. We evaluate 299 patients for breakthrough infection but only 179 (0.08%) patients met the definition; 108 (60%) were female with median age of 59, 60 (33%) were HCW, and 11 (6%) were immunocompromised. The majority (92%) were asymptomatic (62 or 35%) or had mild/moderate illness (102 or 57%); 14 (8%) had severe or critical illness. The status of one patient was unknown. Of those who were symptomatic, 24 (13%) required hospitalization, and 3 (2%) required intensive unit care. One patient admitted for heart failure exacerbation died unexpectedly prior to being discharged. Nine had previous COVID-19 within 4 months but only one was symptomatic; this likely represented residual shedding in the asymptomatic patients. Conclusion COVID-19 vaccine was very effective among our patients and breakthrough infections were rare. Moreover, the vaccine reduced disease severity and mortality. Efforts should aim to increase vaccine uptake. Disclosures All Authors: No reported disclosures

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Clinical relevance of pulmonary non-tuberculous mycobacterial isolates in three reference centres in Belgium: a multicentre retrospective analysis.

10.21203/rs.2.13986/v2 ◽

2019 ◽

Author(s):

Yannick Vande Weygaerde ◽

Nina Cardinaels ◽

Peter Bomans ◽

Taeyang Chin ◽

Jerina Boelens ◽

...

Keyword(s):

Clinical Relevance ◽

Treatment Decision ◽

Chest Ct ◽

Smoking History ◽

Pathogenic Potential ◽

Prospective Data ◽

Respiratory Sample ◽

Treatment Decision Making ◽

Radiological Patterns ◽

Record Review

Abstract Background/objectives: Assessing the clinical relevance of non-tuberculous mycobacteria (NTM) isolated from respiratory samples can be challenging. The epidemiology and pathogenicity of NTM species vary geographically. We aimed to outline the clinical relevance and associated radiological patterns of NTM species isolated in Belgium. Methods: We performed a retrospective multicentre analysis of all patients identified from the laboratory database with >1 respiratory sample growing NTM from January 2010 through December 2017. We collected clinical, radiological and microbiological data through medical record review and assessed clinical relevance according to ATS/IDSA criteria for NTM pulmonary disease (NTM-PD). Results: Of the 384 unique patients, 60% were male, 56% had a smoking history and 61% had pre-existing lung disease. Mycobacterium avium complex (MAC), M. gordonae and M. xenopi were the most frequently isolated species: 53%, 15% and 8% respectively. 43% of patients met ATS/IDSA criteria, of whom 28% presented with fibrocavitary disease. Weight loss, fever, nodular bronchiectatic and fibrocavitary lesions on chest CT, and a positive acid-fast bacilli (AFB) stain were significantly associated with NTM-PD. The species with the highest pathogenic potential were M. abscessus (11/12), M. malmoense (6/7) and M. intracellulare (41/64). Conclusion: In our study, MAC was the most commonly isolated NTM species, but M. abscessus and M. malmoense showed the highest probability of being clinically relevant. Clinical relevance varied not only by species but also by radiological findings on chest CT and AFB staining. Clinicians should consider these elements in their treatment decision making. Prospective data including clinical outcome are needed to provide more robust evidence.

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