scholarly journals Prognosis of lower respiratory tract infected patients with virus detected in bronchial alveolar lavage fluid: a retrospective observational study

2020 ◽  
Author(s):  
Yuan Zhang ◽  
Qiuping Huang ◽  
Zhigang Zhou ◽  
Yun Xie ◽  
Xianchen Li ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Clinical Information ◽  
Lavage Fluid ◽  
Hospital Length Of Stay ◽  
Transfusion Rate ◽  
Severity Scores ◽  
Bronchial Alveolar Lavage Fluid ◽  
Bronchial Alveolar Lavage

Abstract Background and Objectives The influence of virus detected in BALF is still debating. This study aimed to compare the prognosis of lower respiratory tract infected patients with virus detected in bronchial alveolar lavage fluid (BALF) and patients with virus undetected by using metagenomic next-generation sequencing technology.Methods This was a retrospective cohort study. 53 patients with lower respiratory tract infection were enrolled. BALF samples were collected from each patient and sent to perform mNGS pathogenic test in the study. According to the results of mNGS test, patients were divided into virus-detected group and virus-undetected group. In the meanwhile, patients’ clinical information, medical history, disease severity scores, parameters of organ function at the day of ICU admission, prognosis, hospital length of stay, ICU length of stay and needs for medical support were also collected.Results 39.6 percent (21/53) of the BALF samples were virus nucleic acid positive. Mortality rate, tracheotomy rate, mechanical ventilation supporting time, blood transfusion rate were significantly higher in virus-detected group than that in virus-undetected group. Virus-detected was closely related to hospital and ICU survival time.Conclusions Patients with virus detected in BALF were prone to a poorer prognosis. The detection of virus was a high-risk factor of death for LRTI patients. Virus-detected patients required more medical resources.

scholarly journals Functional profiling of COVID-19 respiratory tract microbiomes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Niina Haiminen ◽  
Filippo Utro ◽  
Ed Seabolt ◽  
Laxmi Parida
Keyword(s):  
Respiratory Tract ◽  
Carbohydrate Metabolism ◽  
Lower Respiratory Tract ◽  
Viral Infections ◽  
Lavage Fluid ◽  
Degradation Pathway ◽  
Community Acquired Pneumonia ◽  
The Body ◽  
Sequencing Data ◽  
Functional Profiling

AbstractIn response to the ongoing global pandemic, characterizing the molecular-level host interactions of the new coronavirus SARS-CoV-2 responsible for COVID-19 has been at the center of unprecedented scientific focus. However, when the virus enters the body it also interacts with the micro-organisms already inhabiting the host. Understanding the virus-host-microbiome interactions can yield additional insights into the biological processes perturbed by viral invasion. Alterations in the gut microbiome species and metabolites have been noted during respiratory viral infections, possibly impacting the lungs via gut-lung microbiome crosstalk. To better characterize microbial functions in the lower respiratory tract during COVID-19 infection, we carry out a functional analysis of previously published metatranscriptome sequencing data of bronchoalveolar lavage fluid from eight COVID-19 cases, twenty-five community-acquired pneumonia patients, and twenty healthy controls. The functional profiles resulting from comparing the sequences against annotated microbial protein domains clearly separate the cohorts. By examining the associated metabolic pathways, distinguishing functional signatures in COVID-19 respiratory tract microbiomes are identified, including decreased potential for lipid metabolism and glycan biosynthesis and metabolism pathways, and increased potential for carbohydrate metabolism pathways. The results include overlap between previous studies on COVID-19 microbiomes, including decrease in the glycosaminoglycan degradation pathway and increase in carbohydrate metabolism. The results also suggest novel connections to consider, possibly specific to the lower respiratory tract microbiome, calling for further research on microbial functions and host-microbiome interactions during SARS-CoV-2 infection.

scholarly journals Diagnostic Stewardship in Lower Respiratory Tract Infections Using Procalcitonin

2021 ◽  
Vol 1 (S1) ◽  
pp. s31-s32
Author(s):  
Amanda Gusovsky ◽  
David Burgess ◽  
Donna Burgess ◽  
Emily Slade ◽  
Chris Delcher ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Infectious Diseases ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Length Of Hospital Stay ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Lower Respiratory Tract Infections ◽  
Tract Infections

Background: A team of infectious diseases physicians, infectious diseases pharmacists, clinical laboratorians, and researchers collaborated to assess the management of lower respiratory tract infections (LRTIs). In 1 sample from our institution, 96.1% of pneumonia cases were prescribed antibiotics, compared to 85.0% in a comparison group. A collaborative effort led to the development of a protocol for procalcitonin (PCT)-guided antibiotic prescribing that was approved by several hospital committees, including the Antimicrobial Stewardship Committee and the Healthcare Pharmacy & Therapeutics Committee in December 2020. The aim of this analysis was to develop baseline information on PCT ordering and antibiotic prescribing patterns in LRTIs. Methods: We evaluated all adult inpatients (March–September 2019 and 2020) with a primary diagnosis of LRTI who received at least 1 antibiotic. Two cohorts were established to observe any potential differences in the 2 most recent years prior to adoption of the PCT protocol. Data (eg, demographics, specific diagnosis, length of stay, antimicrobial therapy and duration, PCT labs, etc) were obtained from the UK Center for Clinical and Translational Science, and the study was approved by the local IRB. The primary outcome of interest was antibiotic duration; secondary outcomes of interest were PCT orders, discharge antibiotic prescription, and inpatient length of stay. Results: In total, 432 patients (277 in 2019 and 155 in 2020) were included in this analysis. The average patient age was 61.2 years (SD, ±13.7); 47.7% were female; and 86.1% were white. Most patients were primarily diagnosed with pneumonia (58.8%), followed by COPD with complication (40.5%). In-hospital mortality was 3.5%. The minority of patients had any orders for PCT (29.2%); among them, most had only 1 PCT level measured (84.1%). The median length of hospital stay was 4 days (IQR, 2–6), and the median duration of antibiotic therapy was 4 days (IQR, 3–6). Conclusions: The utilization of PCT in LRTIs occurs in the minority of patient cases at our institution and mostly as a single measurement. The development and implementation of a PCT-guided therapy could help optimize antibiotic usage in patients with LRTIs.Funding: NoDisclosures: None

A One Health Approach to Simple Liquid Sample Handling for Respiratory Based -Omics Analysis; Tracheal Wash and Bronchoalveolar Lavage Fluid

2021 ◽  
Author(s):  
Anna E. Karagianni ◽  
Samantha L. Eaton ◽  
Dominic Kurian ◽  
Eugenio Cillán-Garcia ◽  
Jonathan Twynam-Perkins ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Bronchoalveolar Lavage ◽  
Airway Inflammation ◽  
Lower Respiratory Tract ◽  
Bronchoalveolar Lavage Fluid ◽  
Lavage Fluid ◽  
Lower Airway ◽  
Simple Liquid ◽  
Sample Handling ◽  
Sequential Screening

Abstract Airway inflammation is highly prevalent in horses, with the majority of non-infectious cases being defined as equine asthma. Currently, cytological analysis of airway derived samples is the principal method of assessing lower airway inflammation. Samples can be obtained by tracheal wash (TW) or by lavage of the lower respiratory tract (bronchoalveolar lavage fluid; BALF). Although BALF cytology carries significant diagnostic advantages over TW cytology, sample acquisition is invasive, making it prohibitive for routine and sequential-screening of airway health. The aim of this study was to establish a robust protocol to isolate macrophages, protein and RNA for molecular characterisation of TW samples and demonstrate the applicability of sample handling to rodent and human pediatric bronchoalveolar lavage fluid isolates. TW samples provided a good quality and yield of both RNA and protein for downstream transcriptomic/proteomic analyses. The sample handling methodologies were successfully applicable to BALF for rodent and human research. TW samples represent a rich source of airway cells, and molecular analysis to facilitate and study airway inflammation, based on both transcriptomic and proteomic analysis. This study provides a necessary methodological platform for future transcriptomic and/or proteomic studies on equine lower respiratory tract secretions and BALF samples from humans and mice.

Bacterial etiology of lower respiratory tract infection:a surveillance report from a Chinese large teaching hospital from 2015 to 2019

2020 ◽  
Author(s):  
zhen zhang ◽  
lei tian
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Bacterial Resistance ◽  
Lavage Fluid ◽  
Resistance Rate ◽  
Large Teaching Hospital ◽  
High Incidence ◽  
Positive Rate ◽  
Surveillance Report ◽  
Tract Infections

Abstract Background Sputum is the most common specimen type of lower respiratory tract in China, but its cultivation result is easily confused by the bacteria colonized in the oral cavity and pharynx. It is very difficult to evaluate the clinical significance of sputum culture results both for clinicians and microbiologists. Bronchoscope alveolus lavage fluid(BALF)is a good specimen, which can accurately reflect the situation of lower respiratory tract infections (LRIs). Methods The accumulated data of BALF culture and antimicrobial susceptibility test in our hospital from January 2015 to October 2019 were reviewed and analyzed. Results The positive rate of BALF culture in our hospital was 18.3% (3467/18935) in 2015–2019. The most common pathogens were Klebsiella pneumoniae (18.1%, 627/3467), Pseudomonas aeruginosa (16.9%, 587/3467) and Acinetobacter baumannii (14.0%, 485/3467). For the eight most common pathogens, 40–70 years old was the highest age of distribution, but for Escherichia coli and Streptococcus pneumoniae, 0–5 years old was also the higher age of distribution. The antibiotic resistance rate of K. pneumoniae to imipenem and meropenem was 30.6% and 30.8%, respectively. The sensitivity of P. aeruginosa to antibiotics other than minocycline and ticarcillin clavulanic acid was all more than 60%. However, the resistance rate of A. baumannii to antibiotics other than tegacyclin and minocycline was all more than 80%. Conclusions 40–70 years old was the high incidence age of lower respiratory tract bacterial infection. K. pneumoniae resistant to carbapenems (CR-K. pneumoniae) and A. baumannii were a great challenge to clinical treatment and bacterial resistance control.

scholarly journals Anaemia in patients undergoing major bowel surgery – Prevalence and current practice: A public and private institution experience

2020 ◽  
pp. 175045892093432 ◽  
Author(s):  
Edgar Poon ◽  
David Pache ◽  
Alana Delaforce ◽  
Lemya Abdalla ◽  
Treasure McGuire
Keyword(s):  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Transfusion Rate ◽  
Preoperative Treatment ◽  
National Guidelines ◽  
Biochemical Tests ◽  
Bowel Surgery ◽  
The Impact ◽  
Preoperative Anaemia

Aim The study aimed to compare the frequency and alignment of preoperative anaemia screening and treatment with Australian guidelines in elective bowel surgery and determine the impact on clinical outcomes. Methods We performed a retrospective observational study, with an audit of 559 adult patients who underwent major elective bowel surgery in an Australian metropolitan hospital, January 2016–December 2018. Outcome measures included rate of anaemia, guideline compliance, hospital length of stay, and transfusion rate. Results Preoperative anaemia assessment occurred in 82.6% of patients. However, only 5.2% received recommended biochemical tests at least one week before surgery. Only 25.2% of anaemic patients received preoperative treatment; they experienced a longer hospital length of stay (9.93 days versus 7.88 days, p < 0.001) and an increased rate of transfusion (OR: 3.186, p < 0.05). Conclusion The gaps between current preoperative anaemia screening, management and national guidelines may place patients at higher risk of poor surgical outcome.

‘Normal’ Vital Signs Belie Occult Hypoperfusion in Geriatric Trauma Patients

2010 ◽  
Vol 76 (1) ◽  
pp. 65-69 ◽  
Author(s):  
Jeremiah T. Martin ◽  
Fuad Alkhoury ◽  
Judith A. O'Connor ◽  
Tassos C. Kyriakides ◽  
John A. Bonadies
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Unit Length ◽  
Vital Signs ◽  
Intensive Care Unit Length ◽  
Hospital Length Of Stay ◽  
Common Finding ◽  
Trauma Patients ◽  
Severity Scores

Base deficit (BD) and lactic acid (LA) are accepted markers of hypoperfusion and predictors of outcome in the trauma patient and we aim to assess the value of these markers in the triage of the elderly with “normal” vital signs. Patients older than age 65 who presented between 1997 and 2004 but who did not have isolated head injuries were included. Three patient groups were established: normal, occult hypoperfusion (OH), and shock. Outcome measures included mortality, hospital length of stay, intensive care unit length of stay, and discharge disposition. One hundred six patients were included in the analysis and had similar Injury Severity Scores. Mean systolic blood pressure was similar in the normal and OH groups. Forty-two per cent of patients had abnormal BD or LA in the emergency room indicating OH. These patients were more likely to have a longer intensive care unit length of stay (8.6 days vs 3 days; P = 0.01) and were also more likely to be discharged to a nursing facility ( P = 0.03). The trend was toward increased mortality in the OH group. OH is a common finding in elderly trauma patients. Outcomes in these patients are different and more like those presenting in shock.

TH1/17 hybrid CD4+ cells in bronchial alveolar lavage fluid from leukemia patients with checkpoint inhibitor-induced pneumonitis.

2018 ◽  
Vol 36 (5_suppl) ◽  
pp. 204-204
Author(s):  
Sang Kim ◽  
Vickie Shannon ◽  
Ajay Sheshadri ◽  
Hagop M. Kantarjian ◽  
Guillermo Garcia-Manero ◽  
...  
Keyword(s):  
Cell Biology ◽  
Myeloid Leukemia ◽  
Immune Checkpoint Inhibitor ◽  
Checkpoint Inhibitor ◽  
Statistical Significance ◽  
Standard Of Care ◽  
Lavage Fluid ◽  
Cd4 Cells ◽  
Bronchial Alveolar Lavage Fluid ◽  
Bronchial Alveolar Lavage

204 Background: Immune checkpoint inhibitor (ICI)-based therapies are showing encouraging results for acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). 20% of AML or MDS patients receiving an ICI develop lung inflammation (herein, pneumonitis), one of fatal immune related adverse events (irAEs). The mechanisms of pneumonitis, the most important step for risk stratification and early detection, remain elusive. Methods: We analyzed bronchial alveolar lavage (BAL) fluid from 8 AML or MDS patients, who received an ICI, developed respiratory symptoms, and underwent a standard-of-care bronchoscopy. As a control, we analyzed BAL fluid from 5 AML or MDS patients who had never received an ICI or had received last ICI more than 16 weeks prior to the bronchoscopy. We also analyzed matched blood within 72 hours after the bronchoscopy. We stained CD4+ cells with lineage specific markers, including CXCR3, CXCR5, CD25, CD127, CCR4, and CCR6. Proportion of the CD4+ cell subsets within total CD4+ lymphocytes in BAL and blood were compared between the pneumonitis and controls. Results: Th1 (CXCR3hi) CD4+ cells were expanded in controls in BAL (pneumonitis versus control, 4.2 ± 2.5 % versus 17.2 ± 6.3 % within total CD4+ lymphocytes, P= 0.04) and blood (pneumonitis versus control, 0.5 ± 0.3 % versus 4.0 ± 1.3 % within total CD4+ lymphocytes, P= 0.01). In contrast, Th1/17 (CXCR3hi CCR6hi) hybrid CD4+ cells, known to be pathogenic in autoimmune diseases, were expanded in BAL from the pneumonitis group (pneumonitis versus control, 40.3 ± 8.4 % versus 13.7 ± 4.5 % within total CD4+ lymphocytes, P= 0.03). Th1/17 hybrid CD4+ cells were also PD-1hi Ki67hi, suggesting their hyperactive status. Though not reached statistical significance, regulatory T cells were decreased in BAL from pneumonitis group (pneumonitis versus control, 20.8 ± 4.9 % versus 26.2 ± 9.2 % within total CD4+ lymphocytes). Conclusions: These results suggest that Th1/17 hybrid CD4+ cells may play a central role in pneumonitis. Understanding of the Th1/17 hybrid CD4+ cell biology will provide therapeutic targets and reliable biomarkers for pneumonitis.

scholarly journals The Relationship Between Lower Respiratory Tract Microbiome and Allergic Respiratory Tract Diseases in Children

2020 ◽  
Author(s):  
Jinghua Cui ◽  
Yuanyuan Zhang ◽  
Hanqing Zhao ◽  
Zhen Chen ◽  
Quan Zhang ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Absolute Lymphocyte Count ◽  
Allergic Diseases ◽  
Lavage Fluid ◽  
Intestinal Microbiome ◽  
Upper Respiratory Tract ◽  
Healthy Human ◽  
Significant Difference ◽  
The Relationship

Abstract Background: With the development of sequencing technologies, it has been found that there are microbes similar to those in the upper respiratory tract present in the healthy human lower respiratory tract (LRT), including the lungs and bronchus. Thus, to study the LRT microbiome and evaluate the relationship between this microbiome and allergic respiratory diseases in children, we enrolled 68 children who visited the respiratory department and underwent bronchoscopy from January 2018 to December 2018 in the affiliated hospital of the Capital Institute of Pediatrics. Methods: Using the total IgE (TIgE) values, children were divided into two groups: one group had 34 patients with allergy (allergy sensitivity, AS); the second group had 34 patients with no allergy (no allergy sensitivity, NAS). Nucleic acid was extracted from samples of bronchoalveolar lavage fluid (BALF) taken during bronchoscopy treatment and the 16S rDNA gene was sequenced and analysed. Results: The results showed that Haemophilus, Moraxella, Streptococcus, Prevotella, Neisseria, and Rothia were detected in all patients. There was a statistically significant difference in the composition and distribution of microbiota between the AS and NAS groups (p < 0.01). Compared with children in the AS group, the LRT of those belonging to the NAS group were enriched with Streptococcus, Lactobacillus, and Anoxybacillus. However, the level of Bacteroidetes in the AS group was significantly higher. Analysis of the correlation of clinical indices and microbiome showed that TIgE was positively correlated with Bacteroidetes and negatively correlated with Streptococcus. In addition, absolute lymphocyte count showed a relationship with Streptococcus, and the absolute neutrophil count or percentage of neutrophils showed a relationship with Cardiobacterium.Conclusions: The respiratory tract microbiome functioned similarly to the intestinal microbiome. That is, the decrease in microbial diversity and the change in composition could lead to an increase in allergic symptoms. The colonised microbiota of the LRT in children, especially that of Bacteriodetes and Streptococcus, showed a certain correlation with early respiratory allergic diseases. Trial registration number is ISRCTN18302701, and date of registration is 06/10/2020.

Sign in / Sign up

Export Citation Format

Share Document