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Objective:To investigate the value of bronchoalveolar lavage fluid (BALF) genechip analysis for the identification of pathogens in children with refractory pneumonia.Methods:A retrospective study of 500 children clinically diagnosed with refractory pneumonia in the Department of Respiratory and Critical Care Medicine, Kunming Children′s Hospital, Kunming Medical University between January 2020 to January 2022 was made.During hospitalization, bronchoscopic examination and bronchoalveolar lavage were performed.BALF was collected and analyzed using genechip technology to detect potential pathogens.At the same time, bacterial culture tests of sputum and BALF samples from the patients were performed. χ2 test was used to compare the positive rates of pathogens detected by different detection methods. Results:Of the 500 children patients, 482 cases (96.4%) were positive of BALF genechip analysis for pathogen identification.There were 71 cases (14.7%) infected with a single pathogen, and 411 cases (85.3%) with 2 or more pathogens.The top 3 bacteria were Streptococcus pneumoniae [117 cases (8.3%)], Haemophilus influenzae [63 cases (4.5%)], and Bordetella pertussis [32 cases (2.3%)]. The patients were mostly infected with respiratory syncytial virus [269 cases (19.1%)], followed by parainfluenza virus [217 cases (15.4%)], and adenovirus [132 cases (9.3%)]. Among the 500 patients, 116 cases (23.2%) were positive of BALF genechip analysis for bacteria identification, 47 cases (9.4%) had a positive BALF culture, 43 cases (8.6%) had a positive sputum culture.The bacterial detection rate of BALF genechip analysis was statistically significantly higher than that of BALF culture and sputum culture tests ( χ2=34.90, 39.85; all P<0.001). Conclusions:Most patients with refractory pneumonia have mixed infections.The genechip technology can rapidly and efficiently identify the pathogens, thus providing clinical guidance for anti-infection treatment.
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OBJECTIVES@#To investigate the clinical application of metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF) in the etiological diagnosis and treatment of refractory pneumonia (RTP) in children.@*METHODS@#A retrospective analysis was performed on 160 children with RTP who were admitted to the Department of Pediatric Internal Medicine, Maternal and Child Health Hospital of Inner Mongolia Autonomous Region, from January 2020 to March 2023. According to whether mNGS was performed, they were divided into two groups: mNGS (n=80) and traditional testing (n=80). All children received the tests of inflammatory markers and pathogen tests after admission. Traditional pathogenicity tests included microbial culture (sputum specimen collected by suction tube), nucleic acid detection of respiratory pathogens, and serological test (mycoplasma, tuberculosis, and fungi). For the mNGS group, BALF specimens were collected after bronchoscopy and were sent to the laboratory for mNGS and microbial culture. The two groups were analyzed and compared in terms of the detection of pathogens and treatment.@*RESULTS@#Compared with the traditional testing group, the mNGS group had a significantly higher detection rate of pathogens (92% vs 58%, P<0.05), with more types of pathogens and a higher diagnostic rate of mixed infections. Compared with the traditional testing group, the mNGS group had a significantly higher treatment response rate and a significantly lower incidence rate of complications during hospitalization (P<0.05). Treatment was adjusted for 68 children in the mNGS group according to the results of mNGS, with a treatment response rate of 96% (65/68) after adjustment.@*CONCLUSIONS@#Compared with traditional pathogen tests, BALF mNGS can significantly improve the detection rate of pathogens and find some rare pathogens. In clinical practice, when encountering bottlenecks during the diagnosis and treatment of children with RTP, it is advisable to promptly perform the mNGS to identify the pathogens.
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Humans , Child , Bronchoalveolar Lavage Fluid , Retrospective Studies , Pneumonia/therapy , High-Throughput Nucleotide Sequencing , Bronchoscopy , Sensitivity and SpecificityABSTRACT
Objective To evaluate the efficacy and safety of the application of bronchoscopic interventional intervention in children with severe refractory pneumonia.Methods The study was based on case analysis of subjects diagnosed with severe refractory pneumonia and hence receiving bronchoscopic interventional therapy.The standards of clinical efficacy were set against clinical symptoms,microscopic manifestations and chest CT.Thirty-three children in Guiyang Children's Hospital were selected as subjects during a time span from January 2015 to March 2017.Results Mucous hyperemia,swelling and secretion were observed in all the 33 subjects,among whom 100.0％ (33/33 cases) were observed with tmucosal atrophy and longitudinal plica,63.6％ (21/33 cases) with mucosalerosion,36.4％ (12/33 cases) with proliferation of granulation tissue,27.2％ (9/33 cases) with plastic secretion plug,18.2％ (6/33 cases) with spiny change of fish bone,18.2％ (6/33 cases) with tracheobronchia stenosis,15.2％ (5/35 cases) with tracheobronchial malacia,15.2％ (5/35 cases) with tracheobronchial atresia and 9.1％ (3/33 cases) with subglottic stenosis.All the 33 cases received different bronchoscopic pulmonary interventional therapy strategies accordingly.Nine subjects with plastic bronchitis secretion plug were treated with bronchoalveolar lavage and repeated clamping by tracheal foing;5 subjects with occult foreign body were treated with argon plasma coagulation,basket-shaped foreign body forceps,cryotherapy or laser cutting;1 case with subglottic stenosis,5 cases with tracheobronchial malacia and 6 cases with tracheobronchial stenosis were treated with balloon dilatation;2 cases with subglottic stenosis and 5 cases with tracheobronchial atresia received the combined therapy.As a result,27 cases out of the 33 subjects were evaluated as complete resgonse and the rest were evaluated as partial response.In some cases,transient complications were observed during or after operation,which were well-handled and displeased.No serious complications were observed.Conclusion Based on a comprehensive understanding of the indications,contraindications and operation points of different bronchoscopic intervention modes,the strictly application of bronchoscopic interventional therapy accordingly in children with severe refractory pneumonia was proved to be effective and highly safe.
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Objective:To study the effect of bronchoscope lavage on the inflammatory mediators and pulmonary function of patients with refractory pneumonia.Methods:100 cases of patients with refractory pneumonia who were treated in our hospital from January 2010 to December 2015 were selected and randomly divided into two groups,the control group was treated with routine clinical treatment,and the observation group was treated with bronchoscope lavage.The curative effect and the changes of inflammatory mediators and pulmonary function of the two groups after treatment were compared.Results:After treatment,the effective rate of observation group was 90.00％(45/50),which was significantly higher than that of the control group (76.00％,38/50) (P＜0.05);the levels of endotoxin,IL-6,TNF-2 and LPO in the bronchoalveolar lavage fluid of both groups were significantly decreased (P＜0.05),which were decreased more significantly in the observation group (P＜0.05),the pulmonary function of both groups were significantly improved(P＜0.05),which improved more significantly in the observation group(P＜0.05).Conclusions:Bronchoscope lavage had good therapeutic effect on the patients with refractory pneumonia,it could effectively reduce the level of inflammatory mediators and improve the lung function.
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Objective To evaluate pathogens and antimicrobial resistance of pathogens causing refractory pneumonia in children.Methods Children with refractory pneumonia who admitted to a hospital between May 2008 and December 2014 were performed bronchoscopy,and bronchoalveolar lavage fluid (BALF)were performed bacterial culture and antimicrobial resistance testing.Results 1 693 patients were recruited in the study,273 bacterial isolates were isolated from BALF speci-mens of 226 children,gram-positive bacteria accounted for 38.10% (104/273 ),the main gram-positive bacteria were Streptococcus pneumoniae (n=71)and Staphylococcus aureus (n=23);gram-negative bacteria accounted for 58.24%(159/273),including 44 isolates of Haemophilus parainfluenzae ,28 Klebsiella pneumoniae ,19 Escherichia coli ,and 17 Pseud-omonas aeruginosa ;10 isolates of fungi were also detected,8 of which were Candida albicans .The sensitivity of Streptococ-cus pneumoniae to quinolones,ceftriaxone and cefotaxime were high.Methicillin-resistant Staphylococcus aureus (MRSA) positive rate was 26.32%.ESBLs-producing rate of Haemophilus parainfluenzae and Klebsiella pneumoniae was 32.72% and 62.96% respectively.Conclusion The major pathogens causing refractory pneumonia were Streptococcus pneumoniae and Haemophilus parainfluenzae ,empirical treatment should be conducted accordingly,antimicrobial resist-ance should be considered if therapeutic effect is poor,and targeted therapy should be performed according to cultured re-sults and antimicrobial susceptibility testing result.
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Objective To evaluate the value of bacteria culture and antimicrobial susceptibility test of bronchoalveolar lavage fluid(BALF) in diagnosis and treatment of refractory pneumonia in children.Methods Three hundred and sixty-eight patients who failed to a 2 weeks,routine antibiotic therapy,hospitalized in Department of Respiration,Tianjin Children's Hospital from Aug.2010 to Dec.2011,were diagnosed as refractory pneumonia.They were examined with fiberoptic bronchoscopy,BALF was collected,and bacteria culture and antimicrobial susceptibility test in BALF were performed.Results One hundred and ninety-five stains of bacteria were identified from BALF of 181 cases.There were 10 (5.1％) gram-positive stains (7 Streptococcus pneumonia and 3 Staphylococcus aureus),48 stains (24.6％) were gram-negative bacterial,and the predominant were Pseudomonas aeruginosa (23 stains,11.8 ％),followed by Serratia marcescens and Stenotrophomonas maltophilia (6 stains respectively,3.1％).There were 1 Staphylococcus aureus with positive beta-lactamases and 1 Pseudomonas fluorescens with positive AmpC enzyme.There were 1 fungi (0.5％)and 136 parasitic bacteria stains(69.7％).Gram-positive stains were universally resistant to Erythromycin,Penicillin,Cefuroxime,and susceptible to Chloramphenicol,Levofloxacin,Vancomycin.Gram-negative stains were universally resistant to Ampicillin,Cefazolin,Cefuroxime,Cefotaxime,and susceptible to Amikacin,Cefepime,Cefoperazone sulbactam,Meropenem,Imipenem,Levofloxacin,Ceftazidime,Piperacillin.There were mixed infection in most children and the predominant pathogen was Mycoplasma pneumoniae.Conclusions Bacteria culture of BALF is relatively reliable and instructively recommended for the treatment of refractory pneumonia in children,meanwhile,it can help choose the antibiotics reasonably.