[Application of metagenomic next-generation sequencing of bronchoalveolar lavage fluid in the diagnosis and treatment of refractory pneumonia in children]. / æ”¯æ°”ç®¡è‚ºæ³¡çŒæ´—æ¶²å®åŸºå› ç»„äºŒä»£æµ‹åºåœ¨å„¿ç«¥éš¾æ²»æ€§è‚ºç‚Žè¯Šæ²»ä¸­çš„åº”ç”¨.

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.

Refractory Escherichia Coli Pneumonia: A Case Report.

Escherichia (E.) coli pneumonia is a rare infection commonly presenting with a cavitary lesion. We report a case of a 44-year-old Hispanic male with comorbidities who was admitted to our facility with multiple falls for two days, shortness of breath, continuous diarrhea, and urinary urgency. Lab results showed leukocytosis with neutrophil predominance, anemia, and respiratory alkalosis. The patient was also noted to have uncontrolled diabetes mellitus with an A1c of 17.6%. Prior to admission to the medical intensive care unit (MICU), the patient was administered vancomycin and cefepime. The patient was then started on fluconazole while admitted to the MICU. In addition, a chest X-ray was conducted, showing patchy airspace opacities in the right upper lobe. A chest and abdominal CT also showed multiple cavitary lesions, pulmonary nodules, and nodular liver contour. Bronchoscopy with bronchoalveolar lavage conferred trimethoprim/sulfamethoxazole-resistant E. coli without fungal or acid-fast bacilli growth and was subsequently started on ampicillin/sulbactam. Infectious disease was consulted and advised to begin ertapenem. The patient developed increased respiratory demands and was subsequently started on mechanical ventilation with vasopressors. The patient was successfully weaned off and downgraded to the telemetry floor. The patient was successfully discharged in stable condition. This case highlights a severe and uncommon complication of E. coli infection causing pneumonia with cavitary lesions.

The value of bronchoalveolar lavage fluid genechip analysis for the identification of pathogens in children with refractory pneumonia / 中华实用儿科临床杂志

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.

Application of metagenomic next-generation sequencing of bronchoalveolar lavage fluid in the diagnosis and treatment of refractory pneumonia in children / 中国当代儿科杂志

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.

Effect of bronchofiberscopic lavage with budesonide suspension on refractory mycoplasma pneumoniae pneumonia.

Objectives: To investigate the clinical efficacy of budesonide suspension through bronchofiberscopic lavage in the treatment of refractory mycoplasma pneumoniae pneumonia.(RMPP). Methods: A total of 108 children with refractory mycoplasma pneumoniae pneumonia from June 2018 to October 2020 were randomly divided into two groups: the study group and the control group, with 54 cases in each group. Children in the control group were treated with anti-infective, antitussive, antipyretic routine symptomatic treatment and nebulization of budesonide suspension, while children in the study group were treated with bronchofiberscopic lavage with Budesonide suspension along with standard treatment as in control group. The clinical efficacy, changes in blood gas analysis indexes, levels of inflammatory mediators, time for improvement of clinical symptoms and the incidence of adverse reactions were compared between the two groups. Results: The efficacy of treatment in the study group was 85.19%, which was higher than 66.67% in the control group (P<0.05). The antipyretic time, antitussive time, lung rales disappearance time and length of hospital stay in the study group were shorter than those in the control group (P<0.05). Moreover, the levels of arterial oxygen partial pressure (PaO2) in the study group were higher than those in the control group, while the levels of partial pressure of carbon dioxide (PaCO2) and arterial oxygen saturation (SaO2) in the study group were lower than those in the control group (P<0.05). The levels of inflammatory mediators interleukin-6 (IL-6), interleukin-4 (IL-4), and interferon-γ (IFN-γ) in the study group were lower than those in the control group (P<0.05), and no significant difference was found in the comparison of the incidence of adverse reactions between the two groups (P>0.05). Conclusions: Budesonide suspension combined with bronchofiberscopic lavage with Budesonide suspension is a safe treatment regimen that can significantly improve the clinical outcome in children with RMPP. With such a combined treatment regimen, the clinical symptoms of children can be ameliorated, the ventilation function can be enhanced, and the level of inflammatory mediators will be reduced.

Meta-analysis and systematic review of electronic bronchoscopy in refractory pneumonia.

BACKGROUND: A systematic review and meta-analysis were performed to explore the adoption value of electronic bronchoscopy (EBS) in the diagnosis and treatment of refractory pneumonia and to provide a theoretical basis for the clinical bronchoscopy treatment of patients. METHODS: Randomized controlled trials of treatment-resistant pneumonia searched on PubMed, Embase, and other websites before December 31, 2020 were collected. Literature was selected by inclusion and exclusion criteria. Bias risk was assessed using Cochrane intervention system Review manual 5.0.2 and Review Manager 5.3. RESULTS: A total of 6 articles meeting the requirements were included, comprising 796 participants. The results of meta-analysis showed that the clinical efficacy [odds ratio (OR) =3.8; 95% confidence interval (CI): 1.11-12.99; Z=2.13; P =0.03] and white blood cell counts [mean difference (MD) =0.55; 95% CI: -0.57 to 1.67; Z=0.96; P=0.34] of patients both increased. The mortality rate (OR =0.7; 95% CI: 0.3-1.63; Z=0.82; P=0.41), the incidence of infection (OR =0.84; 95% CI: 0.5-1.39; Z=0.69; P=0.49), ICU hospitalization days (OR =0.59; 95% CI: 0.36-0.98; Z=2.04; P=0.04), days of antibiotic use (OR =0.39; 95% CI: 0.18-0.84; Z=2.41; P=0.02), body temperature (MD =-0.2; 95% CI: -0.24 to 0.16; Z=9.5; P<0.0001), and the PaO2:FIO2 ratio (MD =-9.96; 95% CI: -13.31 to -6.61; Z=5.83; P<0.0001) of patients in the experimental group were lower than those of the control group. Differences in white blood cell count, mortality rate, and incidence of infection of patients in the experimental group were not statistically significant compared with those in the control group. DISCUSSION: EBS adopted in the diagnosis and treatment of refractory pneumonia can reduce the occurrence of postoperative adverse reactions, reduce the infection rate, and effectively improve the clinical symptoms. It is therefore suitable for the treatment of this disease.

Effect of bronchoalveolar lavage on the clinical efficacy, inflammatory factors, and immune function in the treatment of refractory pneumonia in children.

BACKGROUND: Refractory pneumonia is a special type of pneumonia in children. This study aimed to analyze the effect of bronchoalveolar lavage (BAL) on the clinical efficacy, inflammatory factors, and immune function in the treatment of pediatric refractory pneumonia. METHODS: A total of 196 children with refractory pneumonia admitted to our hospital from January 2017 to January 2020 were enrolled and allocated to a study group (n=99) and a control group (n=97). The study group was treated with BAL treatment plus conventional treatment, and the control group was treated with conventional treatment. The clinical efficacy, time of fever regression, time of cough relief, and length of hospital stay were compared between groups. Changes in inflammatory factors, immune function, pulmonary ventilation function, and complications were analyzed. The levels of inflammatory factors in BAL fluid were compared. RESULTS: The times of fever remission, cough relief, and hospital stay of the study group was shorter than those of the control group, and the total clinical effective rate of the study group was higher. At any time after treatment, the levels of interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-alpha (TNF-α) in the study group were lower than the control group. After 3-day of treatment, IL-6, CRP and TNF-α in BAL fluid in the study group were significantly decreased compared with before treatment. Immunoglobulin A (IgA) and immunoglobulin G (IgG) levels in the study group were higher than those in the control group at any time after treatment, and immunoglobulin M (IgM) levels were lower than in the control group. The levels of oxygenation index (OI), lung dynamic compliance (Cdyn), and work of breathing (WOB) in the study group were higher than those in the control group at any time after treatment. CONCLUSIONS: BAL treatment can effectively relieve the inflammatory response, improve immune function and lung ventilation function in children with refractory pneumonia. The clinical effect is remarkable and worthy of promotion.

Highly homogeneous microbial communities dominated by Mycoplasma pneumoniae instead of increased resistance to macrolide antibiotics is the characteristic of lower respiratory tract microbiome of children with refractory Mycoplasma pneumoniae pneumonia.

BACKGROUND: Although researchers have found that the microbiota changed during the lower respiratory tract (LRT) infection, little was known about the association between LRT microbiome and refractory M. pneumoniae pneumonia (RMPP). METHODS: From June 28th, 2019 to March 23rd, 2020, we enrolled fifty-two children diagnosed with RMPP or non-refractory M. pneumoniae pneumonia (NRMPP), and characterized the structure and function of microbiota in the bronchoalveolar lavage fluid (BALF) by metagenomic next generation sequencing (mNGS). RESULTS: Based on Bray-Curtis distance between samples, samples in RMPP group were highly homogeneous, and Shannon index in the RMPP group was much lower than NRMPP group while Simpson index, which presents the degree of dominance, was higher in RMPP group. The dominant taxon with relative abundance greater than 50% was merely Mycoplasma among RMPP and NRMPP patients, but the proportions of other taxonomic distribution were different. M. pneumoniae was the dominant species and occupied almost all niches in the vast majority of RMPP patients, whereas the other genera were dramatically lower. The NRMPP group was more enriched in antibiotic resistance genes (ARGs) than the RMPP group, and also exhibited a greater relative abundance of macrolide antibiotics resistance gene (macB) and fluoroquinolone antibiotic resistance genes (patA-B) in M. pneumoniae genome. In RMPP patients, higher relative abundance of Streptococcus pneumoniae had a strong correlation with increased hospitalization days while higher relative abundance of Streptococcus pneumoniae had a negative correlation with hospitalization days among NRMPP patients. CONCLUSIONS: The microbiota of LRT in children with RMPP was much more homogeneous and simpler than that of the NRMPP group and with lower relative abundance of macrolide antibiotics resistance gene in M. pneumoniae genome. M. pneumoniae was absolutely dominant in the vast majority of RMPP patients. Prolonged hospitalization days was associated with relative abundance of M. pneumoniae in NRMPP patients while it was related with other pathogens' relative abundance (e.g., Streptococcus pneumoniae) in RMPP patients.

Clinical Role of Serum Interleukin-17A in the Prediction of Refractory Mycoplasma pneumoniae Pneumonia in Children.

BACKGROUND: Mycoplasma pneumoniae pneumonia (MPP) is a common community-acquired pneumonia (CAP) in children, which may become refractory MPP (RMPP) to treatment. OBJECTIVE: The purpose of this study was to evaluate the clinical utility of measuring serum interleukin (IL)-17A to predict RMPP. PATIENTS AND METHODS: A retrospective clinical study at a single pediatric center included a review of the medical records of all children hospitalized for CAP between November 2015 and October 2019. The diagnosis of MPP was based on clinical presentation, chest radiography, and measurement of serum anti-Mycoplasma immunoglobulin IgM antibody titer using the microparticle agglutination method or sputum samples for Mycoplasma pneumoniae by PCR. Serum levels of IL-18 and IL-17A were determined by ELISA. RESULTS: Of the 625 children diagnosed with CAP, there were 154 children with MPP and without underlying diseases who were divided into a non-refractory MPP (NRMPP) group (n = 109) and a RMPP group (n = 45). The RMPP group had a higher incidence of tachypnea, cyanosis, hypoxia, segmental or lobar pneumonia, pleural effusion, and a longer period of hospitalization compared with NRMPP group (all P-values < 0.05). A serum IL-17A level above 10.8 pg/mL was a predictor for RMPP: area under the curve (AUC) 0.822; standard error (SE) 0.039; 95% confidence interval (CI) 0.746-0.897; diagnostic sensitivity and specificity of 77.8% and 77.1%, respectively. An LDH level above 436.5 IU/L and an IL-18 level above 464.5 pg/mL were the second most useful markers for RMPP: AUC 0.775, 0.775; SE 0.038, 0.039; 95% CI 0.700-0.850, 0.698-0.852; sensitivity 77.8%, 82.2%; specificity 62.4%, 59.6%; respectively. CONCLUSION: This preliminary study of MPP in a pediatric population has shown that measurement of serum IL-17A may be a useful marker for the predictor of RMPP.

Comparison of high-dose and low-dose corticosteroid therapy for refractory Mycoplasma pneumoniae pneumonia in children.

BACKGROUND: Mycoplasma pneumoniae pneumonia (MPP) is generally a self-limiting disease, but it may become refractory. It is thought that refractory MPP is linked to the excessive immunologic responses of the host. Consequently, the use of adjunctive systemic corticosteroids may have beneficial effects. In this study, we compared the effects of high- and low-dose corticosteroid therapy in a pediatric population with refractory MPP. METHODS: We retrospectively collected data from 91 pediatric MPP patients treated with adjunctive systemic corticosteroids between April 2014 and October 2016. The patients were divided into the following two groups: high-dose corticosteroid group (2 mg/kg/day or more of prednisolone equivalents; n = 38) and low-dose corticosteroid group (<2 mg/kg/day; n = 53). Additionally, we compared the number of febrile days post-corticosteroid administration. We used 25 paired patients in a propensity score matching analysis to correct for confounding factors both by age and by days (from onset till corticosteroid therapy initiation). RESULTS: We observed that in the high-dose corticosteroid group defervescence following corticosteroid therapy initiation was achieved significantly earlier and length of hospitalization was significantly shorter (0.8 ± 1.0 vs. 1.5 ± 1.4 days and 8.2 ± 2.4 vs. 10.7 ± 2.7 days, respectively). In the propensity score matching, we observed that significant differences in the length of fever following corticosteroid therapy initiation and hospitalization were still present. Further, neither of the groups developed corticosteroid-related adverse events. CONCLUSION: Our results suggest that patients with refractory MPP treated with high-dose corticosteroid could achieve defervescence earlier and have a shorter hospitalization.

Efficay and safety analysis of bronchoscopic interventional therapy in 33 children with severe refractory pneumonia / 中华实用儿科临床杂志

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.

Effect of Bronchoalveolar Lavage on the Inflammatory Mediators and Pulmonary Function of Patients with Refractory Pneumonia / 现代生物医学进展

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.

Chronic granulomatous disease presenting as refractory pneumonia in late adulthood.

We present a case of refractory pneumonia in an adult patient with underlying chronic granulomatous disease (CGD). Her lobectomy tissue grew B urkholderia cepacia and histopathology revealed diffuse severe pneumonic consolidation with suppurative/necrotizing granulomata. An initial attempt to find an underlying immune deficiency was unsuccessful. Following recurrent invasive infections, repeat immunological assessment revealed reduced neutrophil function, demonstrating skewed carrier status (lyonization) for X-linked CGD (only 3% normal cells). A pathogenic mutation in the CYBB gene was found on sequencing. CYBB gene encodes the gp91phox, a catalytic subunit of nicotinamide adenine dinucleotide phosphate-oxidase that produces reactive oxygen species in phagocytes. Lyonization increases with age, explaining the delayed clinical CGD. CGD is a rare neutrophil disorder that usually presents in early life with recurrent infections due to bacteria and fungi primarily involving lungs and skin. It is secondary to a defective NADPH oxidase system needed to kill intracellular organisms and activate the formation of neutrophil extracellular traps.

Setting a standard for the initiation of steroid therapy in refractory or severe Mycoplasma pneumoniae pneumonia in adolescents and adults.

Serum interleukin (IL)-18 level was thought to be a useful as a predictor of refractory or severe Mycoplasma pneumoniae pneumonia, and steroid administration is reported to be effective in this situation. The serum levels of IL-18 correlated significantly with those of lactate dehydrogenase (LDH). The purpose of this study was to set a standard for the initiation of steroid therapy in M. pneumoniae pneumonia using a simple serum marker. We analyzed 41 adolescent and adult patients with refractory or severe M. pneumoniae pneumonia who received steroid therapy, and compared them with 108 patients with M. pneumoniae pneumonia who responded to treatment promptly (control group). Serum LDH levels were significantly higher in the refractory and severe group than in the control group at the initiation of steroid therapy (723 vs 210 IU/L, respectively; p < 0.0001). From receiver operating characteristic curve analysis, we calculated serum LDH cut-off levels of 364 IU/L at initiation of steroid therapy and 302 IU/L at 1-3 days before the initiation of steroid therapy. The administration of steroids to patients in the refractory and severe group resulted in the rapid improvement of symptoms and a decrease in serum LDH levels in all patients. Serum LDH level can be used as a useful parameter to determine the initiation of steroid therapy in refractory or severe M. pneumoniae pneumonia. A serum LDH level of 302-364 IU/L seems to be an appropriate criterion for the initiation of steroid therapy.

Analysis on bacterial culture of bronchoalveolar lavage fluid from 1 693 children with refractory pneumonia / 中国感染控制杂志

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.

Value of bacteria culture and antimicrobial susceptibility test of bronchoalveolar lavage fluid in diagnosis and treatment of refractory pneumonia in children / 中华实用儿科临床杂志

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.