Terapêutica antibiótica na traqueobronquite associada à ventilação mecânica: uma revisão da literatura / Antibiotic therapy in ventilator-associated tracheobronchitis: a literature review

RESUMO O conceito de traqueobronquite associada à ventilação mecânica é controverso, e sua definição não é unanimemente aceita, sobrepondo-se, muitas vezes, à da pneumonia associada à ventilação mecânica. A traqueobronquite associada à ventilação mecânica tem incidência semelhante à da pneumonia associada à ventilação mecânica, com elevada prevalência de agentes multirresistentes isolados, condicionando um aumento do tempo de ventilação mecânica e de internação, ainda que sem impacto na mortalidade. A realização de culturas quantitativas pode permitir melhor definição diagnóstica da traqueobronquite associada à ventilação mecânica, possivelmente evitando o sobrediagnóstico desta entidade. Uma das maiores dificuldades na diferenciação entre traqueobronquite associada à ventilação mecânica e pneumonia associada à ventilação mecânica reside na exclusão de um infiltrado pulmonar por meio da radiografia do tórax; também podem ser necessárias a tomografia computadorizada torácica, a ultrassonografia torácica ou ainda a colheita de amostras invasivas. A instituição de terapêutica antibiótica sistêmica não demonstrou melhorar o impacto clínico da traqueobronquite associada à ventilação mecânica, nomeadamente na redução do tempo de ventilação mecânica, de internação ou mortalidade, apesar da eventual menor progressão para pneumonia associada à ventilação mecânica, ainda que existam dúvidas relativas à metodologia utilizada. Deste modo, considerando a elevada prevalência da traqueobronquite associada à ventilação mecânica, o tratamento desta entidade, por rotina, resultaria em elevada prescrição antibiótica sem benefícios claros. No entanto, sugerimos a instituição de terapêutica antibiótica em doentes com traqueobronquite associada à ventilação mecânica e choque séptico e/ou agravamento da oxigenação, devendo ser realizados simultaneamente outros exames auxiliares de diagnóstico para exclusão da pneumonia associada à ventilação mecânica. Após esta revisão da literatura, entendemos que uma melhor diferenciação entre traqueobronquite associada à ventilação mecânica e pneumonia associada à ventilação mecânica pode diminuir, de forma significativa, a utilização de antibióticos em doentes críticos ventilados.

ABSTRACT The concept of ventilator-associated tracheobronchitis is controversial; its definition is not unanimously accepted and often overlaps with ventilator-associated pneumonia. Ventilator-associated tracheobronchitis has an incidence similar to that of ventilator-associated pneumonia, with a high prevalence of isolated multiresistant agents, resulting in an increase in the time of mechanical ventilation and hospitalization but without an impact on mortality. The performance of quantitative cultures may allow better diagnostic definition of tracheobronchitis associated with mechanical ventilation, possibly avoiding the overdiagnosis of this condition. One of the major difficulties in differentiating between ventilator-associated tracheobronchitis and ventilator-associated pneumonia is the exclusion of a pulmonary infiltrate by chest radiography; thoracic computed tomography, thoracic ultrasonography, or invasive specimen collection may also be required. The institution of systemic antibiotic therapy does not improve the clinical impact of ventilator-associated tracheobronchitis, particularly in reducing time of mechanical ventilation, hospitalization or mortality, despite the possible reduced progression to ventilator-associated pneumonia. However, there are doubts regarding the methodology used. Thus, considering the high prevalence of tracheobronchitis associated with mechanical ventilation, routine treatment of this condition would result in high antibiotic usage without clear benefits. However, we suggest the institution of antibiotic therapy in patients with tracheobronchitis associated with mechanical ventilation and septic shock and/or worsening of oxygenation, and other auxiliary diagnostic tests should be simultaneously performed to exclude ventilator-associated pneumonia. This review provides a better understanding of the differentiation between tracheobronchitis associated with mechanical ventilation and pneumonia associated with mechanical ventilation, which can significantly decrease the use of antibiotics in critically ventilated patients.

Death due to Aspergillus Tracheobronchitis: An Autopsy Case / 대한법의학회지

Aspergillus infection is the most common cause of death due to fungi in immunocompromised hosts. Aspergillus tracheobronchitis is an uncommon but severe form of invasive pulmonary aspergillosis, which is limited entirely or mainly to the tracheobronchial tree and can often be life-threatening. We report a case of a 54-year-old man who died from Aspergillus tracheobronchitis without an underlying disease. Autopsy revealed an extensive yellowish plaque adhering to the trachea and bronchial wall. The microscopic examination of the trachea and bronchus revealed septate branching hyphae of Aspergillus.

Identification and renaming of one strain used for tracheitis vaccine production / 中华微生物学和免疫学杂志

Objective To identify and rename one strain stored in National Center for Medicine Culture Collections ( CMCC) and used for tracheitis vaccine production. Methods The test strain CMCC (B)29108 and the type strain DSM30007T were cultured on NA medium. Characteristics in morphology, physiology, biochemistry and fatty acid profile were compared between the two strains. Phylogenetic analysis was based on 16S rRNA and rpoB gene sequences, together with the DNA-DNA hybridization assay. Results A Comparative analysis of a partial sequence of the 16S rRNA gene sequence revealed that the CMCC( B) 29108 strain was closed to the Acinetobacter species and showed the highest similarity with the type strain Acinetobacter baumannii DSM30007T. Moreover, the CMCC(B)29108 strain was highly similar to type strain DSM30007T in morphology, physiology, biochemistry and fatty acid profile. On the phylogenetic tree based on 16S rRNA and rpoB gene of all Acinetobacter members, the CMCC(B)29108 strain steadily clustered into one independent branch only with the DSM30007 T strain with a DNA-DNA hybridization value of 100%. Conclusion The CMCC(B)29108 strain that is one of the strains used for the production of tracheitis vac-cine should be assigned to the species of Acinetobacter baumannii based on its phenotypic, phylogenetic and chemotaxonomic characteristics.

Effect of compound glycyrrhizin on airway inflammation in asthmatic rats / 中国医师杂志

Objective To investigate the effect and mechanism of compound glycyrrhizin on airway inflammation in asthmatic rats. Methods Forty wistar rats were randomly divided into health group (group Ⅰ), asthma group(group Ⅱ), treating group (group Ⅲ) and treating control group (group Ⅳ) (n=10 in each group). Group Ⅱ, group Ⅲ and group Ⅳ received intraperitoneal injection of ovalbumin (OVA) and aluminum hydroxide gel for sensitization and OVA aerosol by ultrasonic nebulization for challenge, in addition, group Ⅲ re-ceived intraperioneal injection of 200 μg of compound glycyrrhizin 1 hour before OVA aerosol challenging every time, and group Ⅳ were in-jected with normal saline instead of compound glycyrrhizin. Group Ⅰ were injected and nebulizated with normal saline instead of OVA and alu-minlum hydroxide. All rats were sacrificed at the 6th hour after the last challenging, venous blood and bronchoalveolar lavage fluid(BALF) were collected, the IgE in venous blood were determined and the concentration of IL-4, IL-5, IL-13 and IFN-γ in BALF were detected, the cells in BALF were counted and detached. Results The concentration of IgE, IL-4, IL-5, IL-13 and the count of neutrophilic granulocytcs, lymphocytes, cosinophils in group Ⅱ were significantly higher than those in group Ⅰ and group Ⅲ(P<0.01), and the concentration of IFN-γ in group Ⅰ and group Ⅳ were significantly lower than those in group Ⅰ and group Ⅲ(P <0.01). There was no significant difference be-tween group Ⅱ and group Ⅳ(P >0. 05). The concentration of IgE, IL-4, IL-5, IL-13 and the count of neutrophilic granulocytes, lympho-cytes, cosinophils in group Ⅲ were higher than those in group Ⅰ, and the concentration of IFN-γ and the count of mononucleat macroplile cells in group Ⅲ were lower than those in group Ⅰ, but there were no significant difference(P>0.05). Conclusion Compound giycyrrhiz-in alleviated the airway inflammation and reduced the airway hyperresponsiveness in asthmatic rats, which mechanism may be related to regu-lating the balance of Th1/Th2 cytokines, suppressing the immune ability of Th2 and promoting the immune ability of Th1.

Modulation of Lentinan on Airway Inflammation and Helper T Lymphocyte Cell 1/Helper T Lymphocyte Cell 2 Imbalance in Rats′ Model of Asthma / 实用儿科临床杂志

Objective To study helper T lymphocyte cell(Th)1/Th2 imbalance in rats′ model of asthma and the modulation of lentinan(LNT) on the airway inflammation and Th1/Th2 imbalance.Methods Thirty male SD rats were randomly divided into control,asthma and LNT groups.In the experiment,the rat model of asthma was established by the ovalbumin(OVA) challenge methods.Eosinophils(Eos) number and differentiated cell number in bronchoalveolar lavage fluid(BALF) were counted by different count fluids.The levels of IL-4 and IFN-? in BALF were measured by sandwich enzyme linked immunosorbent assay(ELISA).Results 1.The Eos count in BALF and the ratio of eosinophils to the total cell number(Eos%) of asthma group were significantly higher than those of the control group(t=21.94,12.81 Pa

Role of interleukin-9 in the pathogenesis of chronic obstructive pulmonary disease / 北京大学学报(医学版)

Objective:To study the role of interleukin 9 in the airway inflammation from patients with COPD. Methods: Induced sputum was obtained from 30 COPD patients with stable disease(group A) ,31 asthmatics patients with stable disease(group B) and 15 healthy individuals(group C). IL 9,IL 5 and IL 8 in sputum supernatants were measured by sandwich enzyme linked immunosorbent assay(ELISA) and IL 9 positive expression and quantitative analysis were conducted by Streptavidin peroxidase method and image analysis technology. Results:The levels of IL 9 in group A and B were all significantly higher than those in groups C. IL 9 positive expression mainly located in the cytoplasm of macrophages. The positive rates of IL 9 in group A and B were all significantly higher than that of group C(? 2=20.821, 19.908, P

A Case of Invasive Tracheobronchial Aspergillosis Inducing a Respiratory Failure in Immunocompromised Patient / 대한이비인후과학회지

Aspergillus infection localized to the tracheobronchial tree is an unusual form of invasive aspergillosis in which patients are usually immunocompromised. The infected airway may produce mucosal exudates and become obstructed partially or completely with fungal plugs and pseudomembranes. Microscopically, the superficial portion of the airway wall is acutely inflammed and invaded by fungal hyphae. We recently experienced a case of invasive aspergillus tracheobronchitis that occurred in a 43 year-old woman with acute lymphoblastic leukemia, for which she had received a 2nd consolidation chemotherapy. We report this case with a review of literatures.

A Case of Bacterial Tracheitis Associated with Endotracheal Intubation and Corticosteroid / 결핵

Bacterial tracheitis is a very rare complication in adults after endotracheal intubation. We report a case of bacterial tracheitis associated with endotracheal intubation and corticosteroids. The patient was discharged with a permanent tracheostomy, and a resection and an end-to-end anastomosis of the trachea is planned.

Effect of nebulized ketamine on the airway inflammation in a rat model of asthma / 中华麻醉学杂志

Objective To investigate the effect of nebulized ketamine inhalation on the airway inflammation in a rat model of asthma and to elucidate the possible mechanism. Methods Forty male SD rats weighing 160-200 g were randomly assigned to one of five group with eight animals in each group: Ⅰ control group (N);Ⅱ asthama group(A)and Ⅲ, Ⅳ,Ⅴ ketamine pretreatment groups ( K1, K2, K3 ). In group Ⅱ-Ⅴ asthma was induced in two steps; (1) the animals received subcutaneous injection of ovalbumia (OA) 1 mg and aluminum hydroxide 160 mg in 1 ml of normal saline (NS) and intraperitoneal devitalized Bordetella pertussis 6 ?109 in 1 ml NS;(2) 2 weeks later asthma was elicited by nebulized 1% OA in NS for 20 min.In group K1,K2 and K3 the sensitized animals were exposed to nebulized ketamine 12.5 mg?ml-1(K1) ,25 mg?ml-1(K2) or 50mg?ml-1(K3) for 20 min,25 min before challenge with nebulized OA.Blood samples were taken and lymphocytes were isolated and cytosol and membrane PKC fractions extracted by centrifugation and PKC acdvities were determined. The right lung was removed for microscopic examination. Results There were acute inflammatoty changes in the airway in group A and there was no significance in the inflammatory cell infiltration in and local damage to the airway between group A and K1. Compared with group A there was significantly less inflammation in the bronchial subnucosa and alveolor septum and no damage was observed in group K2 and K3. The total (PKCT ), cytosol (PKCC) and membrane ( PKCM ) PKC activity and percentage of membrane PKC [( PKCM/PKCT ( % ) ] were significantly higher in group A,K1 and K3 than those in group N ( P

Relationship Between Chronic Tracheitis and Meteorological Condition and Forecasting Model Established / 环境与健康杂志

Objective To set up forecasting models of week and ten days for chronic tracheitis.Methods The data of chronic tracheitis incidence and same time meteorological factors in 1998-2000 in Yinchuan,China were collected and analyzed using SAS6.0 statistical software.Results The incidence of chronic tracheitis was closely related with air temperature,air pressure and the other meteorological factors which showed that chronic tracheitis was caused integrated meteorological factors.Based on the correlation analysis,forecasting models of week and ten days for chronic tracheitis using multi-regression method was established.Conclusion Chronic tracheitis may be caused by integrated meteorological factors and the incidence of chronic tracheitis has a positive correlation with air temperature and a negative correlation with air pressure.