Cefotaxime Versus Ceftriaxone: A Comprehensive Comparative Review.

Neutrophils are the predominant inflammatory cells recruited to the respiratory tract as part of the innate immune response to viral infections. Recent reports indicate the existence of distinct functional neutrophil subsets in the circulatory compartment of adults, following severe inflammatory conditions. Here, we evaluated the occurrence of neutrophil subsets in blood and broncho-alveolar lavage fluid during severe viral respiratory infection in infants based on CD16/CD62L expression. We show that during the course of severe respiratory infection infants may develop four heterogeneous neutrophil subsets in blood (mature, immature, progenitor, and suppressive neutrophils), each with distinct activation states. However, while isolated viral respiratory infection was characterized by a relative absence of suppressive neutrophils in both blood and lungs, only patients with bacterial co-infection were shown to produce suppressive neutrophils. These data suggest the occurrence of distinct and unique neutrophil subset responses during severe viral and (secondary) bacterial respiratory infection in infants.

Human bocavirus (HBOV) has been reported as a worldwide distributed respiratory pathogen. It has also been associated with encephalitis recently by detection of the virus in cerebrospinal fluid (CSF) of patients presented with encephalitis. This retrospective study aimed to present clinical features of HBOV infections in children with respiratory symptoms and describe unexplained encephalopathy in a subgroup of these patients. Results of 1,143 pediatric nasal samples from mid‐December 2013 to July 2014 were reviewed for detection of HBOV. A multiplex real time polymerase chain reaction assay was used for viral detection. Medical records of the patients were retrospectively analyzed. HBOV was detected in 30 patients (2.6%). Median age was 14 months (5–80). Clinical diagnoses were upper respiratory tract infection (n = 10), bronchopneumonia (n = 9), acute bronchiolitis (n = 5), pneumonia (n = 4), acute bronchitis (n = 1), and asthma execarbation (n = 1). Hospitalization was required in 16 (53.3%) patients and 10 (62.5%) of them admitted to pediatric intensive care unit (PICU). Noninvasive mechanical ventilation modalities was applied to four patients and mechanical ventilation to four patients. Intractable seizures developed in four patients while mechanically ventilated on the 2nd–3rd days of PICU admission. No specific reason for encephalopathy was found after a thorough investigation. No mortality was observed, but two patients were discharged with neurological sequela. HBOV may lead to respiratory infections in a wide spectrum of severity. This report indicates its potential to cause severe respiratory infections requiring PICU admission and highlights possible clinical association of HBOV and encephalopathy, which developed during severe respiratory infection. J. Med. Virol. 87:1831–1838, 2015. © 2015 Wiley Periodicals, Inc.

연구배경: 원내 폐렴의 적절한 항균제 치료를 위해서는 원발 병소에서의 원인균 규명과 항균제에 대한 내성 유무 확인이 필수적이다. 본 연구는 원내 폐렴이 의심되는 경우 기관지내시경을 통한 정량적 기관지폐포 세척술(bronchoalveolar lavage, BAL) 배양검사를 시행하여 빈번하게 분리되는 균주와 이들의 항균제 내성 현황을 알아보고자 하였다. 방법: 2004년 1월부터 2006년 6월까지 한림의대 한강성심병원 화상 중환자실과 비화상 중환자실에서 폐 침윤의 원인규명 위해 BAL 검사를 시행하였다. 104 CFU/mL 이상의 균주가 분리되면 양성으로 판정하였다. 결과: BAL 검사 결과 화상중환자실 27예(77.1%), 비화상중환자실 22예(59.4%)에서 배양 양성이었다. 분리되는 주요 균주는 S. aureus, Acinetobacter species 및 P. aeruginosa였다. 화상중환자실에서 분리된 S. aureus의 경우 전부 MRSA(100%)였으며, 비화상중환자실에서는 71.4%가 MRSA로 보고되었다. P. aeruginosa의 경우 화상중환자실 및 비화상중환자실에서 amikacin 54.6% vs. 50.0%, ciprofloaxacin 100% vs. 50%, cefepime 90.9% vs. 50%, imipenem 72.7% vs. 50%, ceftazidime 45.5% vs. 25% 및 piperacillin/tazobactam 90.9% vs. 50%의 내성률을, Acinetobacter species의 경우는 amikacin 90.9% vs. 100%, ciprofloxacin 100% vs. 87.5%, cefepime 90.9% vs. 100%, imipenem 100% vs. 62.5%, ceftazidime 90.9% vs. 100% 및 piperacillin/tazobactam 81.8% vs. 62.5%의 내성률을 보여주었다. 결론: 화상중환자실과 비화상중환자실에서 원내 폐렴이 의심되는 환자의 원인균 분포와 약제 내성 현황을 알 수 있었으며 향후 항균제 치료 전략에 도움을 줄 것으로 사료된다.

ObjectiveHyponatremia in COVID-19 is often due to the syndrome of inadequate antidiuresis (SIAD), possibly mediated by interleukin-6 (IL-6)-induced non-osmotic arginine vasopressin (AVP) secretion. We hypothesized an inverse association between IL-6 and plasma sodium concentration, stronger in COVID-19 compared to other respiratory infections.DesignSecondary analysis of a prospective cohort study including patients with COVID-19 suspicion admitted to the Emergency Department, University Hospital of Basel, Switzerland, between March and July 2020.MethodsWe included patients with PCR-confirmed COVID-19 and patients with similar symptoms, further subclassified into bacterial and other viral respiratory infections. The primary objective was to investigate the association between plasma sodium and IL-6 levels.ResultsA total of 500 patients were included, 184 (37%) with COVID-19, 92 (18%) with bacterial respiratory infections, and 224 (45%) with other viral respiratory infections. In all groups, median (IQR) IL-6 levels were significantly higher in hyponatremic compared to normonatremic patients (COVID-19: 43.4 (28.4, 59.8) vs 9.2 (2.8, 32.7) pg/mL, P < 0.001; bacterial: 122.1 (63.0, 282.0) vs 67.1 (24.9, 252.0) pg/mL, P < 0.05; viral: 14.1 (6.9, 84.7) vs 4.3 (2.1, 14.4) pg/mL, P < 0.05). IL-6 levels were negatively correlated with plasma sodium levels in COVID-19, whereas the correlation in bacterial and other viral infections was weaker (COVID-19: R = −0.48, P < 0.001; bacterial: R = −0.25, P = 0.05, viral: R = −0.27, P < 0.001).ConclusionsIL-6 levels were inversely correlated with plasma sodium levels, with a stronger correlation in COVID-19 compared to bacterial and other viral infections. IL-6 might stimulate AVP secretion and lead to higher rates of hyponatremia due to the SIAD in these patients.

BackgroundAdults with IgG subclass deficiency (IgGSD) with subnormal IgG2 are inadequately characterized.MethodsWe retrospectively analyzed observations in unrelated adults with IgGSD evaluated in a single hematology clinic (1991–2019) and selected those with subnormal serum IgG2 (<117 mg/dL (<1.2 g/L)) without corticosteroid therapy to describe: age; prevalence of women; upper/lower respiratory infection; autoimmune condition(s); atopy; other allergy; frequent or severe respiratory tract infection in first-degree relatives; IgG, IgG subclasses, IgA, and IgM; blood lymphocyte subpopulations; human leukocyte antigen (HLA)-A and -B types and haplotypes; and 23-valent pneumococcal polysaccharide vaccination (PPSV23) responses. We determined the prevalence of subnormal IgG2 among unrelated adults with IgGSD without corticosteroid therapy and compared general characteristics of those with and without subnormal IgG2.ResultsThere were 18 patients (94.4% women) with subnormal IgG2. Mean age was 52 ± 11 y. Upper/lower respiratory infection occurred in 94.4%/74.8%, respectively. Autoimmune condition(s), atopy, other allergy, and frequent or severe respiratory infection in first-degree relatives occurred in 44.4%, 44.4%, 61.1%, and 22.2%, respectively. Median IgG2 was 105 mg/dL (83, 116). Subnormal IgG, IgG1, IgG3, IgG4, IgA, and IgM was observed in 66.7%, 50.0%, 100.0%, 5.6%, 33.3%, and 0%, respectively. Lymphocyte subpopulations were normal in most patients. HLA frequencies were similar in patients and controls. Three of 4 patients had no protective S. pneumoniae serotype-specific IgG levels before or after PPSV23. These 18 patients represent 7.6% of 236 adults with IgGSD. Prevalence of subnormal IgG, subnormal IgG3, and subnormal IgA was significantly greater in 18 adults with subnormal IgG2 than 218 adults without subnormal IgG2. Prevalence of subnormal IgM was significantly lower in patients with subnormal IgG2.ConclusionsCharacteristics of adults with IgGSD with subnormal IgG2 include female predominance, other immunologic abnormalities, subnormal IgG3 and/or IgG1, lack of HLA-A and -B association, and suboptimal PPSV23 response.

Epidemiology, etiology, and diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia in Asian countries

The aim was to assess the performance of a blood assay combining measurements of MxA (myxovirus resistance protein A) and CRP (C-reactive protein) to differentiate viral from bacterial respiratory infections. In a prospective study, MxA and CRP were measured in the blood by the AFIAS panel in adults admitted with respiratory infection. Patients were split into discovery and validation cohorts. Final diagnosis was adjudicated by a panel of experts. Microbiology-confirmed cases comprised the discovery cohort, and infections adjudicated as highly probable viral or bacterial comprised the validation cohort. A total of 537 patients were analyzed: 136 patients were adjudicated with definitive viral infections and 131 patients with definitive bacterial infections. Using logistic regression analysis, an equation was developed to calculate the probability for bacterial infection using the absolute value of MxA and CRP. Calculated probability≥0.5 and/or MxA to CRP ratio less than 2 applied as the diagnostic rule for bacterial infections. This rule provided 91.6% sensitivity and 90.4% negative predictive value for the diagnosis of bacterial infections. This diagnostic sensitivity was confirmed in the validation cohort. A MxA/CRP ratio less than 0.15 was associated with unfavorable outcome. The calculation of the probability for bacterial infection using MxA and CRP may efficiently discriminate between viral and bacterial respiratory infections.

Rehospitalization of children born prematurely (referred to as preterm children) caused by severe respiratory infections is common. Most studies have focused on respiratory syncytial virus infection. We designed a study to determine the virological and clinical characteristics of severe respiratory infections of children born early (<32 weeks) and moderate preterm (32 to 36 weeks), and compared them with full term (FT; ≥37 weeks) children who were subsequently admitted with respiratory illness. A 7-year observational prospective study was conducted on preterm and FT children, less than 14 years old hospitalized with respiratory infection. The presence of 16 respiratory viruses in nasopharyngeal aspirates was sought. Clinical and virological characteristics of subjects were compared among term and preterm children. We studied 411 respiratory hospital admissions of 262 preterm children who were compared with 2057 respiratory hospital admissions of term children. In 78.6% of preterm episodes, at least 1 respiratory virus was identified. The most frequent viruses were respiratory syncytial virus (29%), rhinovirus (25%) and human bocavirus (13%). Human metapneumovirus and parainfluenza virus were significantly more frequent in preterm than in term children (P < 0.001 and P = 0.017, respectively). Early preterm (EPT) infants admitted with bronchiolitis presented more hypoxia (P = 0.08), longer hospital stay (P = 0.05), more infiltrate on chest radiograph (P = 0.02) and more antibiotic treatment (P = 0.02) than moderate preterm (MPT) infants. Moreover, MPT needed more intensive care unit admission than FT infants (P < 0.001). Regarding wheezing episodes, EPT patients showed significantly more infiltrate/atelectasis (P < 0.001), longer oxygen therapy (P = 0.039) and longer hospital stay (P = 0.07) than MPT children, although similar percentage of intensive care unit admission was seen in both groups. MPT-wheezy children needed longer hospital stay than FT (P = 0.05). Previous bronchiolitis and EPT were independent factors associated with multiple wheezing admissions. Our results demonstrate that besides respiratory syncytial virus, other viruses mainly rhinovirus and human bocavirus are important pathogens in severe respiratory infections in preterm children. Human metapneumovirus and parainfluenza virus seem also to play a significant role in this group of children. There is increased medical resource utilization, not only among EPT but also in MPT hospitalized children with respiratory infections as many of them require more medical support than FT children.

Introduction: Patients suffering from Coronavirus disease-2019 (COVID-19) are prone to develop respiratory bacterial infections irrespective of their need for mechanical ventilatory support. Hypothesis/Gap Statement: Information about the incidence of concomitant respiratory bacterial infections in COVID- 19 patients from India is limited.&#160;Aim: This study denotes the incidence of concomitant respiratory bacterial pathogens and their drug resistance in these patients. Methodology: A prospective study was performed by including the patients who were admitted to our tertiary care center from March 2021 to May 2021 to evaluate secondary bacterial respiratory co-infections in patients with Real-time polymerase chain reaction (RT-PCR) confirmed cases of COVID-19 disease caused by SARS CoV-2 virus.&#160;Results: Sixty-nine culture-positive respiratory samples from patients suffering from COVID-19 were incorporated into this study. The most commonly isolated bacterial microorganism was Klebsiella pneumoniae (23, 33.33%) and Acinetobacter baumannii (15, 21.73%), followed by Pseudomonas aeruginosa (13, 18.84%). Among the microorganisms isolated, 41 (59.4%) were multidrug-resistant (MDR), and 9 (13%) were extensively drug-resistant (XDR). Among the Gram-negative bacteria isolated, Klebsiella pneumoniae showed high drug resistance. Fifty carbapenem-resistant microorganisms were isolated from the patients included in our study. Concerning the hospital stay of the patients enrolled, there was an increased length of intensive care unit (ICU) stay, which was 22.25 ± 15.42 days among patients needing mechanical ventilation in comparison to 5.39 ± 9.57 days of intensive care unit stay in patients on ambient air or low/high flow oxygen. Conclusion: COVID-19 patients need increased length of hospitalization and have a high incidence of secondary respiratory bacterial infections and high anti-microbial drug resistance.

Severe respiratory viral infections are accompanied by an unbalanced immune response due to suppression of endogenous interferon (IFN) synthesis, which leads to hyperproduction of proinflammatory cytokines. This results in inadequate inflammation in the lungs, accompanied by acute respiratory distress syndrome, respiratory failure, and dysfunction of other organs. Cytokine imbalance that underlies the immunopathogenesis of severe acute respiratory viral infections including COVID-19 offers the potential for two principal approaches to cytokine therapy, which are determined by the stage of the infectious process and the severity of clinical symptoms. Cytokine therapy with intranasal recombinant type I and III IFN represent a viable therapeutic strategy in prevention of virus infection or at early stages of the disease, particularly in endogenous IFN deficit at the onset. For example, during the COVID-19 pandemic, intranasal products based on recombinant IFNα2b demonstrated high antiviral activity and good tolerability, and are included in the national guidelines for control of coronavirus infection in Russia and other countries. This therapeutic approach aims at normalizing endogenous IFN expression, which may be inhibited by certain respiratory viruses, such as SARS-CoV-2. In cases of cytokine storm and severe respiratory infections, an anticytokine therapy may effectively inhibit the overproduction of proinflammatory cytokines. Both cytokine immunotherapies are based on using either synthetic analogs of endogenous cytokines or monoclonal antibodies that inhibit the cytokine up-regulation above physiological levels.

Introduction: Respiratory tract infection (RTI) is the major cause of Intensive Care Unit (ICU)-associated sepsis in Europe. To better inform healthcare improvement programmes, surveillance for VAP in Wales has been mandatory since 2008, coordinated by Public Health Wales and utilising HELICS criteria (1). Welsh VAP rates have been consistently low (2.3 per 1000 ventilator days) compared with Scottish (6.5 per 1000 ventilator days) and wider European data (12.2 per 1000 ventilator days). While possibly reflecting success of VAP-prevention measures, investigation into the reliability of the surveillance data appeared warranted. Our aims were to: prospectively capture episodes of ICU-acquired RTI occurring within Welsh ICUs using an alternative data collection tool, explore whether these episodes met HELICS criteria, identify reasons for episodes not meeting HELICS criteria, and compare numbers of VAP cases identified prospectively with numbers from the established surveillance system. Methods: Over a two-week study period, local investigators identified via WICSARG screened all invasively ventilated patients for new onset ICU-acquired RTI. When episodes occurred more than 48 hours after ICU admission, investigators evaluated whether they met HELICS criteria and estimated likelihood of infection according to a modified Clinical Pulmonary Infection Score (mCPIS). Established VAP surveillance processes continued in parallel. Results: Thirteen of 15 Welsh ICUs participated. Data was captured for 182 invasively ventilated patients on 1343 ventilator days. Antibiotics were commenced in 73 patients for new onset infection; respiratory tract was second most frequent source (17, 23.3%) after abdominal (23, 31.5%). Out of the 17 episodes of ICU-acquired RTI, 7 met HELICS criteria giving a VAP rate of 5.2 per 1000 ventilator days. In 36% episodes, HELICS criteria could not be fulfilled because chest radiography was not performed. Using a threshold mCPIS of 6 to diagnose ICU-acquired RTI, there were 3 further cases where RTI seemed likely, but HELICS criteria were not met. Interestingly, 2 VAPs fulfilled the HELICS criteria with a relatively low mCPIS of 4. Data was obtained for 1668 ventilator days in the same time period from the 13 ICUs using the established VAP surveillance mechanism. 5 episodes met HELICS criteria, giving a VAP rate of 3.0 per 1000 ventilator days. However, 5 other HELICS-defined episodes identified using the prospective data collection tool were not captured. Conclusions: Estimates of VAP incidence based on current surveillance mechanisms probably underestimate the true incidence of VAP in Wales. Use of HELICS criteria for VAP surveillance may exclude episodes likely to represent VAP, largely because chest radiography is not routine when antibiotics are commenced for suspected RTI in ICU. The use of mCPIS score could help to add reliability to the already collected data, however based on our results this score alone could not be used at a traditional cut-off of 6 points. We plan to re-audit our practice using the recently published CDC criteria to compare it’s effectiveness to the HELICS definition in capturing ICU acquired RTIs.

Early targeted antibiotic therapy is crucial for improving the prognosis of immunocompromised patients with severe respiratory infections (SRIs) in the intensive care unit (ICU). Metagenomic next-generation sequencing (mNGS) has shown significant value in pathogen detection, but research on lower respiratory tract microorganisms remains limited. This study enrolled 234 patients with SRIs in the ICU, and individuals were categorized into immunocompromised and immunocompetent groups. We compared the diagnostic performance of mNGS using bronchoalveolar lavage fluid (BALF) with conventional microbiological tests (CMTs) and analyzed the value of mNGS in immunocompromised patients with SRIs in the ICU. Among all patients, the pathogenic microorganism detection rate of mNGS was higher than that of CMTs (94.02% vs 66.67%, P < 0.05), both in the immunocompromised group (95.0% vs 58.75%, P < 0.05) and the immunocompetent group (93.51% vs 71.43%, P < 0.05). mNGS detected more pathogens than CMTs did (167 vs 51), identifying 116 organisms that were missed by CMTs. The proportion of antibiotic regimen adjustments based on mNGS results was significantly higher compared to CMTs in both the immunocompromised (70.00% vs 17.50%, P < 0.05) and immunocompetent groups (48.70% vs 15.58%, P < 0.05). In the immunocompromised group, patients who had their antibiotic treatment adjusted on mNGS results had improved prognosis, with significantly lower ICU mortality (8.93% vs 50%, P < 0.05) and 28-day mortality rates (30.36% vs 68.75%, P < 0.05) than CMTs. In the immunocompetent group, no statistically significant differences were observed in ICU mortality or 28-day mortality (20.00% vs 33.33%, P > 0.05; 42.67% vs 45.83%, P > 0.05). mNGS shows significant value in detecting pathogens in immunocompromised patients with SRIs in ICU. For immunocompromised patients who respond poorly to empirical treatment, mNGS can provide an etiological basis, helping adjust antibiotic regimens more precisely and thereby improving patient prognosis.

Clinical application of nano-silver spray in patients with bacterial respiratory tract infections under CT examination

IntroductionRespiratory infection is a common cause of severe sepsis.1 Current therapeutic guidelines emphasise the importance of early initiation of antibiotic therapy, but make no recommendations on dose. Recent studies have...

Objective To evaluate the effect and safety of thymosin combined with biapenem in the treatment of severe lower respiratory tract infection of gram negative bacilli.Methods 54 patients with severe lower respiratory tract infection of gram negative bacilli were randomly divided into study group (group A) and control group (group B),group A was treated with thymosin and biapenem,group B biapenem.All patients were treated for 7 ～ 14 days in a course.The clinical effect,treatment time of biapenem,the bacterial clearance rate and adverse drug reaction betweeen two groups were compared.Results The clinical effective rate of group A and B were 84.6％ and 82.1％,respectively,there was no statistical difference (P ＞ 0.05).Treatment time of biapenem in group A and B was (8.2 ±3.4) days and (13.2 ± 3.6) days,respectively,there was statistical difference (P ＜ 0.05).The bacterial clearance rate of group A and B were 86.7％ and 80.7％,respectively,there was no statistical difference between two groups (P ＞ 0.05).Conclusion The treatment time of thymosin combined with biapenem treatment of gram-negative bacilli severe respiratory tract infection was shorter than that of biapenem alone treatment,and it was safe,effective,and worthy of ciinical application. Key words: Respiratory tract infections; Gram-negative bacteria; Thymus extracts; Biapenem; Treatment outcome