Resistance Profile From Staphylococcus Aureus And Pseudomonas Aeruginosa Obtained From Tracheostomized Children

Background The tracheostomized patients exhibit high risks of bacterial infections, because the tracheal tube acts as a gateway to these microorganisms. The objective was to characterize microbiologically the tracheal secretion of tracheostomized children, to evaluate the biofilm formation, and to study the phenotypic and molecular profile of antimicrobial resistance of Staphylococcus aureus and Pseudomonas aeruginosa isolated. Methods The study collected 88 tracheal secretion samples. The material processed by phenotypic tests were performed for bacterial identification. For identification of the biofilm, the Congo red agar test and the plaque microtiter test were used, and the qPCR method was used to resistance verification. Results Were obtained 27 samples of S. aureus and 71 of P. aeruginosa . All S. aureus samples were positive for biofilm formation on Congo red agar test. In antibiogram test, S. aureus showed resistance to seven drugs. Regarding the identification of resistance genes, were amplificated bla Z in 42.8% from S. aureus and mec A in 28.6% of them. Pseudomonas aeruginosa presented resistance to eight drugs. The most frequent chromosomal genes were bla OXA with 66.7% and bla KPC with 58.3%. To plasmidial DNA, was highlighted bla NDM with 58.3% positive. Conclusion The S. aureus and P. aeruginosa characterization of colonization from lower respiratory tract associated with the use of the device in tracheotomy patients, and the physiology and antimicrobial resistance profile, will help health professionals to choose the most appropriate treatment to be administered in children with tracheotomy, increasing the chances of airway restoration and decannulation.

Resistance profile from Staphylococcus aureus and Pseudomonas aeruginosa Obtained from tracheostomized children

Background The tracheostomized patients exhibit high risks of bacterial infections, because the tracheal tube acts as a gateway to these microorganisms. The objective was to characterize microbiologically the tracheal secretion of tracheostomized children, to evaluate the biofilm formation, and to study the phenotypic and molecular profile of antimicrobial resistance of Staphylococcus aureus and Pseudomonas aeruginosa isolated. Methods The study collected 88 tracheal secretion samples. The material processed by phenotypic tests were performed for bacterial identification. For identification of the biofilm, the Congo red agar test and the plaque microtiter test were used, and the qPCR method was used to resistance verification. Results Were obtained 27 samples of S. aureus and 71 of P. aeruginosa . All S. aureus samples were positive for biofilm formation on Congo red agar test. In antibiogram test, S. aureus showed resistance to seven drugs. Regarding the identification of resistance genes, were amplificated bla Z in 42.8% from S. aureus and mec A in 28.6% of them. Pseudomonas aeruginosa presented resistance to eight drugs. The most frequent chromosomal genes were bla OXA with 66.7% and bla KPC with 58.3%. To plasmidial DNA, was highlighted bla NDM with 58.3% positive. ConclusionThe S. aureus and P. aeruginosa characterization of colonization from lower respiratory tract associated with the use of the device in tracheotomy patients, and the physiology and antimicrobial resistance profile, will help health professionals to choose the most appropriate treatment to be administered in children with tracheotomy, increasing the chances of airway restoration and decannulation.

Pediatric tracheostomy: epidemiology and characterization of tracheal secretion - a literature review

SUMMARY INTRODUCTION Despite the benefits, tracheostomized children are susceptible to respiratory infections, since the tube is located in a strategic region where there is colonization by several bacteria and biofilm formation. Biofilm is formed when the bacteria adhere strongly to the surfaces of the tubes, providing protection against various types of aggression, such as antibiotic treatment. OBJECTIVE To carry out a literature review of the last ten years on tracheostomized pediatric patients, in order to characterize the bacteria isolated in children’s tracheal secretions, and verify which ones are the most frequent. METHODS Two authors searched the Lilacs, SciELO, Medline Plus, and PubMed databases. The MeSH terms used were: ‘tracheostomy’ and ‘tracheotomy’ associated with ‘infections’, ‘children’, ‘child’, and ‘bacterial’ as qualifiers. RESULTS Of the 512 studies on the subject, 19 were selected for review. The total number of children evaluated in the studies was 4,472, with a mean age of 7.5 years. As for the bacteria found in the secretions of tracheostomized children, 12 species of bacteria were more frequent, P. aeruginosa was the predominant bacterium, followed by S. aureus (63.1%), Klebsiella pneumoniae (57.8%), Streptococcus pneumoniae (47.3%), and Stenotrophomonas maltophilia (47.3%). CONCLUSION One of the main complications treated in tracheostomized patients were infections, since the respiratory system is colonized by several bacteria that can cause serious infections, which are associated with the formation of biofilms. The predominant bacterium in most of the studies was P. aeruginosa, and the second species commonly reported was S. aureus.

PositivePneumocystis jiroveciiSputum PCR Results with Negative Bronchoscopic PCR Results in Suspected Pneumocystis Pneumonia

Introduction. The diagnostic standard forPneumocystis jiroveciipneumonia (PCP) is direct microscopic identification; however, in recent years, polymerase chain reaction (PCR) from bronchoalveolar lavage (BAL) samples to detectPneumocystisnucleic acids has proven to be more sensitive and specific. Sputum samples have been presumed inferior to bronchoscopic samples secondary to variability and adequacy of sample collection. We observed several cases of positive sputum PCP-PCR results with negative PCP-PCR BAL results. The aim of the current study was to further characterize the clinical setting and outcomes in patients with positive sputum PCP-PCR samples and negative BAL PCP-PCR samples.Methods. We identified all patients who underwentP. jirovecii-PCR testing at Mayo Clinic between 2011 and 2016. Patients with a positive sputum and negative BAL sample collected within a 14-day time frame were identified and underwent further chart review for demographics, immunocompromised state, and clinical outcome.Results. From 2011 to 2016, 4431 respiratory samples from 3021 unique patients were tested for the presence ofP. jiroveciiby PCR. Fifty-five samples (1.2% of all samples collected) belonging to 24 unique patients (0.79% of patients tested) were identified as having a positive and negative sample collected within 14 days. Of these 24 patients, 10 (46%) patients had a positive sputum or tracheal secretion sample with negative BAL or bronchial washings. Out of these 10 patients, 8 were immunocompromised and 9 underwent treatment for PCP with 6 patients improving.Conclusion. Our results suggest that discordantP. jirovecii-PCR testing results from sputum and bronchoscopic specimens are an infrequent occurrence. Patients with positiveP. jirovecii-PCR sputum/tracheal secretion samples and negative bronchoscopic samples appear to be clinically infected and respond to PCP treatment. SputumP. jirovecii-PCR testing may be a viable alternative to invasive testing.

Microbiology of Tracheal Secretions: What to Expect with Children and Adolescents with Tracheostomies

Introduction People with tracheostomies exhibit a higher risk of colonization of the lower respiratory tract, acute tracheitis and pneumonia. Despite this, the culture of tracheal secretions is not a routine in most hospitals, and sometimes empiric therapy is based on personal experience, which is not an ideal situation. Objective To recognize the pathogens present in the tracheal secretions collected from people up to 18 years old with tracheostomies. Methods Prospective evaluation of patients under the age of 18 of a tertiary care hospital. A standardized questionnaire was completed, and tracheal secretion aspirates were sent for microbiological cultures and antibiograms. Results Twenty patients under 18 years of age were evaluated, 65% of whom were male. The microbiological culture was positive in 90% of the patients, and the most common microorganisms found were Pseudomonas aeruginosa (55.5%) and Staphylococcus aureus (27.7%). Discussion Tracheostomized children and adolescents have respiratory tracts colonized by pathogens, the most common of which is Pseudomonas aeruginosa. These patients must undergo tracheal secretion cultures, whether they present symptoms or not, to determine if there is a correlation between the colonization and the infections. This finding could guide the adequate treatment, avoiding the inappropriate use of antibiotics and indicating the better therapy in cases of laryngeal reconstruction. Conclusion In this sample, the culture of tracheal secretions was mainly positive, and the most common agent was P. aeruginosa. We suggest the routine access to Brazilian children and adolescents tracheal secretion cultures, which could help to make a profile of these children and guide the use of antibiotics.

A Novel Porcine Model of Ventilator-associated Pneumonia Caused by Oropharyngeal Challenge with Pseudomonas aeruginosa

Background: Animal models of ventilator-associated pneumonia (VAP) in primates, sheep, and pigs differ in the underlying pulmonary injury, etiology, bacterial inoculation methods, and time to onset. The most common ovine and porcine models do not reproduce the primary pathogenic mechanism of the disease, through the aspiration of oropharyngeal pathogens, or the most prevalent human etiology. Herein the authors characterize a novel porcine model of VAP due to aspiration of oropharyngeal secretions colonized by Pseudomonas aeruginosa. Methods: Ten healthy pigs were intubated, positioned in anti-Trendelenburg, and mechanically ventilated for 72 h. Three animals did not receive bacterial challenge, whereas in seven animals, a P. aeruginosa suspension was instilled into the oropharynx. Tracheal aspirates were cultured and respiratory mechanics were recorded. On autopsy, lobar samples were obtained to corroborate VAP through microbiological and histological studies. Results: In animals not challenged, diverse bacterial colonization of the airways was found and monolobar VAP rarely developed. In animals with P. aeruginosa challenge, colonization of tracheal secretion increased up to 6.39 ± 0.34 log colony-forming unit (cfu)/ml (P < 0.001). VAP was confirmed in six of seven pigs, in 78% of the cases developed in the dependent lung segments (right medium and lower lobes, P = 0.032). The static respiratory system elastance worsened to 41.5 ± 5.8 cm H2O/l (P = 0.001). Conclusions: The authors devised a VAP model caused by aspiration of oropharyngeal P. aeruginosa, a frequent causative pathogen of human VAP. The model also overcomes the practical and legislative limitations associated with the use of primates. The authors’ model could be employed to study pathophysiologic mechanisms, as well as novel diagnostic/preventive strategies.

A Pilot Study of Pepsin in Tracheal and Oral Secretions

BackgroundBecause reflux of gastric juice into the oropharynx must precede its aspiration into the lungs, it is reasonable to hypothesize that the detection of pepsin (the major gastric enzyme in gastric juice) in oral secretions may provide a relatively noninvasive method of predicting risk for aspiration.ObjectiveTo describe the incidence of pepsin in oral and tracheal secretions collected concurrently from a sample of 50 gastric-fed patients undergoing mechanical ventilation.MethodsAn exploratory descriptive design with a convenience sample from 4 medical and surgical intensive care units. An oral secretion and a tracheal secretion were collected concurrently from each patient (yielding a sample of 50 oral and 50 tracheal secretions). The tracheal secretions were obtained via the inline suction system with an attached sputum trap; oral secretions were obtained via a Yankauer suction tip with an attached sputum trap. All specimens were assayed for pepsin by the Western blot method.ResultsOral secretions from 10 patients (20%) and tracheal secretions from 2 patients (4%) were pepsin-positive. Both patients with pepsin-positive tracheal secretions also had pepsin-positive oral secretions. Pepsin was not found in the tracheal secretions from the remaining 8 patients with pepsin-positive oral secretions.ConclusionsAlthough reflux of gastric juice into the oropharynx must precede its aspiration into the lungs, individual reflux events do not necessarily lead to aspiration. Thus, it is reasonable that we found pepsin 5 times more often in oral secretions than in tracheal secretions.