The Antibiogram of Isolated Pathogens from Tracheal Aspirate among Intubated patients 2 months – 5 years old with very Severe Community Acquired Pneumonia Admitted in Pediatric Intensive Care Unit of a Tertiary Hospital in Cebu City from 2013-2016

Objective@#To determine the antibiogram of tracheal aspirate cultures (TACS) among intubated children aged 2 months to 5 years old with very severe community acquired pneumonia (CAP). @*Methodology@#A retrospective chart review using total enumerative sampling. @*Results@#66 out of the 343 patients had positive TACS. The top 5 most common isolates were Klebsiella pneumoniae(37.8%), Pseudomonas aeruginosa (25.7%), Acinetobacter baumanii (15.1%), Enterobacter cloacae (12.1%) and Methicillin Resistant Staphylococcus aureus (MRSA) (6%). The gram-negative isolates were highly sensitive to amikacin and carbapenems. Majority of these patients (92.42%) had history of Pentavalent immunization. Majority of patients who were TACS positive had history of antibiotic use prior to admission (92.42%), mostly second-generation cepahalosporin (cefuroxime, 32.42%). High rates of resistance to ampicillin and gentamicin were noted for patients with Klebsiella pneumoniae and Enterobacter cloacae isolates. Majority of patients with Klebsiella pneumoniae, Acinetobacter baumanii and MRSA expired. @*Conclusion/Recommendation@#Majority of those patients with positive isolates had MDR organisms thus for patients with very severe CAP who already received antibiotic as outpatient, broad spectrum antibiotics should be considered as empiric therapy and TACS be done on all patients with very severe CAP.

Effect of bronchoalveolar lavage on the use of antibiotics in patients with severe pneumonia / 中华急诊医学杂志

Objective To investigate the difference between bronchoalveolar lavage fluid(BALF)and tracheal aspirate(TA)on the use of antibiotics in patients with severe pneumonia.Methods Patients with severe pneumonias admitted to the Department of General Intensive Care Unit of Second Affiliated Hospital of Zhejiang University School of Medicine,between December 2014 and March 2019 were retrospectively analyzed.The difference of effects of BLAF and TA on the use of antibiotics in patients with severe pneumonia were compared and analyzed,as well as the effects of antibiotic de-escalation on patient's mortality were evaluated.The quantitative data were analyzed by independent sample t test and the enumeration data were determined by Chi-square test or Fisher exact probability method.Results Among the 120 patients more bacteria were detected in BALF than in TA(82 vs 60,P＜0.05).More fungi were detected in BALF than in TA(20 vs 3,P＜0.05).Compared with TA,BALF results were more likely to guide the adjustment of antibiotic regimens(41 vs 16,P＜0.05),including guidance for antibiotics de-escalation(27 vs 9,P＜0.05).There was no significant difference in the 14-day mortality,28-day mortality,hospital stay and duration of mechanical ventilation between the two groups(al P＜0.05).Conclusions Compared with TA,BALF,as a pathogens detection method for severe pneumonia,has more advantages in guiding antibiotics administration,including antibiotic de-escalation,which will not increase the mortality of patients.

Effect of bronchoalveolar lavage on the use of antibiotics in patients with severe pneumonia / 中华急诊医学杂志

Objective@#To investigate the difference between bronchoalveolar lavage fluid (BALF) and tracheal aspirate (TA) on the use of antibiotics in patients with severe pneumonia.@*Methods@#Patients with severe pneumonias admitted to the Department of General Intensive Care Unit of Second Affiliated Hospital of Zhejiang University School of Medicine, between December 2014 and March 2019 were retrospectively analyzed. The difference of effects of BLAF and TA on the use of antibiotics in patients with severe pneumonia were compared and analyzed, as well as the effects of antibiotic de-escalation on patient’s mortality were evaluated. The quantitative data were analyzed by independent sample t test, and the enumeration data were determined by Chi-square test or Fisher exact probability method.@*Results@#Among the 120 patients, more bacteria were detected in BALF than in TA (82 vs 60, P<0.05). More fungi were detected in BALF than in TA (20 vs 3, P<0.05). Compared with TA, BALF results were more likely to guide the adjustment of antibiotic regimens (41 vs 16, P<0.05), including guidance for antibiotics de-escalation (27 vs 9, P<0.05). There was no significant difference in the 14-day mortality, 28-day mortality, hospital stay and duration of mechanical ventilation between the two groups (all P<0.05).@*Conclusions@#Compared with TA, BALF, as a pathogens detection method for severe pneumania, has more advantages in guiding antibiotics administration, including antibiotic de-escalation, which will not increase the mortality of patients.

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

Abstract 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 inmost 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 tomake a profile of these children and guide the use of antibiotics.

Microbial investigation of biofilms recovered from endotracheal tubes using sonication in intensive care unit pediatric patients

Abstract Objectives To compare cultured microorganisms identified on endotracheal tubes biofilms through sonication technique with traditional tracheal aspirate collected at extubation of pediatric intensive care unit patients. Methods Demographic and epidemiological data were analyzed to identify factors possibly related with the microbiological profile of the two collection methods. Associations between categorical and continuous variables were analyzed using the chi-square or Fisher's exact test, or Student's t test. p-Value <0.05 were considered significant. Results Thirty endotracheal tubes and tracheal aspirates samples from 27 subjects were analyzed. Only one patient presented the clinical diagnosis of ventilator-associated pneumonia. Overall, 50% of bacteria were Gram-negative bacilli, followed by Gram-positive bacteria in 37%, and fungi in 10%. No statistically significant difference on the distribution of Gram-positive or Gram-negative bacteria (p = 0.996), and fungi (p = 0.985) were observed between the collection methods. Pseudomonas spp. was the most frequent microorganism identified (23.8%), followed by Streptococcus spp. (18.5%), Acinetobacter spp. (15.9%), coagulase-negative staphylococci (11.2%), and Klebsiella spp. (8.6%). Concordant results between methods amounted to 83.3%. Pseudomonas aeruginosa and Acinetobacter baumannii showed carbapenem resistance in 50% and 43.7% of the isolates, respectively. In general, cultures after endotracheal tubes sonication (non-centrifuged sonication fluid and centrifuged sonication fluid) yielded bacteria with higher rates of antimicrobial resistance compared to tracheal aspirates cultures. Additionally, in 12 subjects (40%), we observed discrepancies regarding microbiologic profiles of cultures performed using the collection methods. Conclusions Our study demonstrated that sonication technique can be applied to ET biofilms to identify microorganisms attached to their surface with a great variety of species identified. However, we did not find significant differences in comparison with the traditional tracheal aspirate culture approach.

Change of Antibiotics Resistance Pattern of Microorganism Cultured in Tracheal Aspirate in Mechanical Ventilated Patients after Antibiotics Restriction Policy / 대한구급학회지

BACKGROUND: To reduce production of resistant bacteria by over-use of antibiotics, an antibiotics restriction policy became effective in several hospitals. However, there are different views on its effect. This study aims to examine antibiotic resistance of pathogenic organisms cultured in tracheal aspirates of the patients who need to maintain mechanical ventilation in medical intensive care unit before and after the antibiotics restriction policy. METHODS: Before and after 2 years from August 2003, when carried out the antibiotics restriction policy in Gyeongsang university hospital, it was retrospectively investigated the antibiotic resistance pattern of bacteria cultured in tracheal aspirates of the patient who is maintained by mechanical ventilation more than 48 hours in the medical intensive care unit. Restricted antibiotics are ceftazidime, piperacillin/tazobactam, imipenem, meropenem, vancomycin, and teicoplanin. RESULTS: Before the antibiotics restriction policy, (Sep 2001~Aug 2003) and after, (Sep 2003~Aug 2005), there were 306 and 565 patients applied in each case and the total use of antibiotics, except piperacillin/tazobactam, was reduced and that of cefotaxime and ceftriaxone was increased. There was no significant change in antibiotic resistance among Acinetobacter, Pseudomonas, and Enterobacter species. CONCLUSION: The result of this study shows that the antibiotics restriction policy does not reduce production of antibiotic resistant bacteria in tracheal aspirate in a medical intensive care unit. However, it is considered that long-term observation may be necessary.

Development of Bronchopulmonary Dysplasia and the Peripheral and Tracheal Aspirate Neutrophil Counts and Cytokine Concentrations of Tracheal Aspirate in Preterm Infants with Acute Respiratory Failure

PURPOSE: The purposes of this study were to analyze the association of peripheral and tracheal aspirate neutrophil counts and tracheal aspirate cytokines [interleukin (IL)-8, IL-6, IL-10] concentrations with the development of bronchopulmonary dysplasia (BPD) in preterm infants intubated due to acute respiratory failure, and to speculate the causal relationship between the prenatal or early postnatal inflammation of the lung and the development of BPD. METHODS: A prospective study was conducted from April 1997 to March 1998 in 27 preterm infants, who were admitted to the neonatal intensive care unit of Seoul National University Children's Hospital and intubated due to acute respiratory failure. Tracheal aspirates were collected via endotracheal tube immediately after intubation. Tracheal aspirate neutrophil counts were measured by cytospin method and, cytokine concentrations were measured by ELISA method in the supernatant after centrifugation. RESULTS: BPD was diagnosed in 59.3% (16/27) of preterm infants. Compare to the non-BPD group, the BPD group had lower gestational age (27.6+/-1.3 weeks versus 32.0+/- 1.2 weeks), lower birth weight (1,112+/-228 g versus 1,666+/-334 g), higher incidence of patent ductus arteriosus (27.3% versus 81.3%), increased number of neutrophils (80,337+/-133,993/mL versus 2,672+/-6,600/mL), and increased IL-8 concentration (1,045.4+/-1,346.5 pg/mL vs 106.9+/-151.0 pg/mL) of tracheal aspirate. After control of compounding variables, increased IL-8 concentration of tracheal aspirate was found to be an independent risk factor for BPD (odds ratio; 27.7, 95% confidence interval; 1.8-436.2). CONCLUSION: Prenatal or immediate postnatal lung inflammation is an important risk factor for the development of the BPD, and the lung injuries responsible for the development of BPD might begin at the prenatal or immediate postnatal period.