Respiratory health outcomes 1 year after admission with severe lower respiratory tract infection

Severe lower respiratory infection (LRI) is believed to be one precursor of protracted bacterial bronchitis, chronic moist cough (CMC), and chronic suppurative lung disease. The aim of this study was to determine and to describe the presence of respiratory morbidity in young children 1 year after being hospitalized with a severe LRI. Children aged less than 2 years admitted from August 1, 2007 to December 23, 2007 already enrolled in a prospective epidemiology study (n = 394) were included in this second study only if they had a diagnosis of severe bronchiolitis or of pneumonia with no co‐morbidities (n = 237). Funding allowed 164 to be identified chronologically, 131 were able to be contacted, and 94 agreed to be assessed by a paediatrician 1 year post index admission. Demographic information, medical history and a respiratory questionnaire was recorded, examination, pulse oximetry, and chest X‐ray (CXR) were performed. The predetermined primary endpoints were; (i) history of CMC for at least 3 months, (ii) the presence of moist cough and/or crackles on examination in clinic, and (iii) an abnormal CXR when seen at a time of stability. Each CXR was read by two pediatric radiologists blind to the individuals' current health. Results showed 30% had a history of CMC, 32% had a moist cough and/or crackles on examination in clinic, and in 62% of those with a CXR it was abnormal. Of the 81 children with a readable follow‐up X‐ray, 11% had all three abnormal outcomes, and 74% had one or more abnormal outcomes. Three children had developed bronchiectasis on HRCT. The majority of children with a hospital admission at <2 years of age for severe bronchiolitis or pneumonia continued to have respiratory morbidity 1 year later when seen at a time of stability, with a small number already having sustained significant lung disease. Pediatr Pulmonol. 2013; 48:772–779. © 2012 Wiley Periodicals, Inc.     

Antibiotic resistance among gram-negative bacteria of lower respiratory tract secretions in hospitalized patients

Data on antibiotic resistance pattern of gram-negative bacterial isolates of lower respiratory tract secretions of hospitalized patients were fed into WHONET computer and analyzed for the year 1999. Out of 860 samples, 269 (31.2%) were culture positive. Gram-negative bacteria (GNB) accounted for 238 (88.4%) positive samples. Non-fermenting gram-negative bacteria (NFGNB) were found in 34% samples, the other common ones being Klebsiella spp (29.8%) and Pseudomonas spp (17.2%). GNB isolates from tracheal aspirates and sputum were 132 (55.4%) and 106 (44.5%) respectively. Adults (32.7%) and elderly patients (24.3%) recorded higher isolation of GNB as compared to pediatric patients (1.6%). The highest mean resistance among predominant GNB in both tracheal aspirate (96.6%) and sputum (86.9%) was noted to ampicillin while the lowest mean resistance in tracheal aspirate (28%) and sputum (14.3%) was to amikacin. NFGNB of tracheal aspirates and sputum showed highest resistance of 50% and 32% to amikacin, respectively. Pseudomonas spp showed the highest variation in the resistance pattern between tracheal aspirates and sputum samples. Overall mean resistance was highest among tracheal aspirate isolates compared to sputum isolates.     

Etiology of acute severe lower respiratory tract infection in hospital-based patients.

Acute respiratory infections are common childhood illnesses. Most are mild and self-limiting. Five percent are lower respiratory tract diseases and are potentially serious. A prospective study was conducted to ascertain the etiology of community-acquired severe lower respiratory tract infections (LRTI) in hospital based patients. Mycoplasma was the most frequently identified agent (33%). This was followed by viruses (28%) and bacteria (15%). Twenty-four percent of children had no identified causative agent.     

Etiological analysis and establishment of a discriminant model for lower respiratory tract infections in hospitalized patients

正Objective To analyze the pathogens of lower respiratory tract infection(LRTI)including bacterial,viral and mixed infection,and to establish a discriminant model based on clinical features in order to predict the pathogens.Methods A total of 243 hospitalized patients with lower respiratory tract infections were enrolled in Fujian     

Population pharmacokinetics of vancomycin from severe patients with lower respiratory tract infection

正Objective To develop a population pharmacokinetic(PPK)model of vancomycin in Chinese inpatients with severe lower respiratory tract infection.Methods We gathered serum concentrations of vancomycin from inpatients who received vancomycin during Nov 2011 to Nov2012.Vancomycin serum concentrations was measured by high performance liquid chromatography.Vancomycin     

Respiratory picornavirus infections in Korean children with lower respiratory tract infections

Recently, human rhinoviruses (RVs) and enteroviruses have been suggested as important etiological agents in young children with lower respiratory tract infections (LRTIs). We investigated the role of respiratory picornaviruses in hospitalized children with LRTI. A total of 233 nasopharyngeal samples were collected from hospitalized children with LRTIs from July 2004 to January 2006. All specimens were tested for the presence of human respiratory syncytial virus (hRSV), influenza virus A, influenza B, parainfluenzavirus, and adenovirus using direct immunofluorescent assay, and for human metapneumovirus (HMPV) by RT-PCR. Detection of RV was performed in nasopharyngeal samples by a RT-PCR assay that incorporated a BglI restriction enzyme digestion of the picornavirus RT-PCR amplicon, and detection of enterovirus was accomplished by hemi-nested RT-PCR using specific primers. Viral agents were detected in 70.4% (164/233) of the study population. The most frequently detected viruses were RV (64/233, 27.4%), hRSV (48/233, 20.6%), and enterovirus (43/233, 18.4%). Picornaviruses were detected as the sole viral agents in 27.0% (63/233) of children, whereas mixed viral infection was detected in 12.0%. These results suggest that picronavirus infection is an important etiological cause of LRTIs in Korean children.     

Parainfluenza virus infection among adults hospitalized for lower respiratory tract infection.

To better define the contribution of human parainfluenza viruses (HPIVs) to lower respiratory tract infection in adults, we tested acute- and convalescent-phase serum specimens from hospitalized adults participating in a population-based prospective study of lower respiratory tract infection during 1991-1992. We tested all available specimens from the epidemic seasons for each virus and approximately 300 randomly selected specimens from the corresponding off-seasons for antibodies to HPIV-1, HPIV-2, or HPIV-3. During the respective epidemic season, HPIV-1 infection was detected in 18 (2.5%) of 721 and HPIV-3 infection in 22 (3.1%) of 705 patients with lower respiratory tract infection. Only 2 (0.2%) of 1,057 patients tested positive for HPIV-2 infection. No HPIV-1 infections and only 2 (0.7% of 281 patients tested) HPIV-3 infections were detected during the off-seasons. HPIV-1 and HPIV-3 were among the four most frequently identified infections associated with lower respiratory tract infection during their respective outbreak seasons.     

Impact of oseltamivir treatment on influenza-related lower respiratory tract complications and hospitalizations

BACKGROUND: Influenza causes lower respiratory tract complications (LRTCs), particularly bronchitis and pneumonia, in both otherwise healthy adults and those with underlying conditions. The aim of this study was to assess the effect of oseltamivir treatment on the incidence of LRTCs leading to antibiotic treatment and hospitalizations following influenza illness. METHODS: We analyzed prospectively collected data on LRTCs and antibiotic use from 3564 subjects (age range, 13-97 years) with influenzalike illness enrolled in 10 placebo-controlled, double-blind trials of oseltamivir treatment. RESULTS: In adults and adolescents with a proven influenza illness, oseltamivir treatment reduced overall antibiotic use for any reason by 26.7% (14.0% vs 19.1% with placebo; P<.001) and the incidence of influenza-related LRTCs resulting in antibiotic therapy by 55% (4.6% vs 10.3% with placebo; P<.001). In those subjects considered at increased risk of complications, 74 (18.5%) of 401 placebo recipients developed an LRTC leading to antibiotic use compared with 45 (12.2%) of 368 oseltamivir recipients (34.0% reduction; P =.02). Hospitalization for any cause occurred in 18 (1.7%) of 1063 placebo recipients compared with 9 (0.7%) of 1350 oseltamivir-treated patients (59% reduction; P =.02). In contrast, among subjects with an influenzalike illness but without a confirmed influenza infection, the incidence of LRTCs (6.7% vs 5.3%), overall antibiotic use (19.7% vs 19.3%), or hospitalizations (1.7% vs 1.9%) was similar between placebo and oseltamivir recipients, respectively. CONCLUSION: Oseltamivir treatment of influenza illness reduces LRTCs, antibiotic use, and hospitalization in both healthy and "at-risk" adults.     

Serum tumor necrosis factor-alpha concentrations in children hospitalized for acute lower respiratory tract infection

Tumor necrosis factor-alpha (TNF alpha) concentrations were measured by radioimmunoassay in sera of 118 children (median age, 1.7 years; range, 2 months-15 years) hospitalized for acute lower respiratory tract infection (ALRI). Both viral and bacterial ALRI were associated with elevated concentrations of TNF alpha. Concentrations greater than 40 ng/l were seen in children with bacterial or mixed ALRI in 64% and with viral ALRI in 50% of cases. Elevated concentrations were associated with longer duration of fever before admission (P less than .05) and with a higher serum C-reactive protein concentration (P less than .05). There were no significant differences in TNF alpha concentrations between gram-positive and gram-negative infections, nor was there an association with clinical severity of ALRI. TNF alpha concentrations decreased in most patients to normal within 5 days of hospitalization, irrespective of the etiology of the infection.     

Lower respiratory tract infection in hospitalized children

OBJECTIVE: The aim of the present study was to investigate the aetiology and antibiotic-resistance patterns of community-acquired lower respiratory tract infection (LRTI) in 1999 and compare it with data from 1995 and 1988. METHODOLOGY: A prospective observational study of LRTI in hospitalized children at KK Women's & Children's Hospital, Singapore, was undertaken. RESULTS: A positive isolate was found in 58% of patients (671/1158), comprising viruses (n = 477, 41.2%), non-type B Haemophilus influenzae (n = 101, 8.7%), Streptococcus pneumoniae (n = 66, 5.7%), Mycoplasma pneumoniae (n = 92, 8%), Moraxella catarrhalis (n = 19, 1.6%) and other bacteria (n = 19, 1.6%). Mixed virus-bacteria (n = 104, 9%) infections were comprised mostly of virus-H. influenzae combinations. In 1999, S. pneumoniae resistance rates were penicillin 44.6% (17%, 1995), amoxycillin 3% (18%, 1995; MIC 0.5-2 microg/mL reclassified as susceptible in 1999), erythromycin 55% (30%, 1995), trimethoprim-sulfamethoxazole (TMP/SMX) 60% (23%, 1995). H. influenzaeresistance rates were amoxycillin 26.7% (38%, 1995), erythromycin 99% (37%, 1995), TMP/SMX 98% (37%, 1995). There were 15 cases of empyema of which seven were proven S. pneumoniae and there was one pneumococcal death (0.08%). CONCLUSIONS: Pneumococcal pneumonia needs to be treated aggressively due to its high morbidity. Amoxycillin still remains useful for treating pneumococcus despite an increasing resistance to penicillin, erythromycin and TMP/SMX. Judicious use of antibiotics is needed to curb the increasing rate of antibiotic-resistance.     

345株下呼吸道感染革兰阴性杆菌的分布及耐药

目的了解院内下呼吸道感染革兰阴性杆菌的状态，供临床用药借鉴。方法院内下呼吸道感染患者痰菌分离，经培养鉴定共取得３４５株革兰阴性杆菌。抗生素敏感性测定采用ＫＢ纸片法，最低抑菌浓度（ＭＩＣ）采用琼脂二倍稀释法。β内酰胺酶的测定采用Ｎｉｔｒｏｃｅｐｈｉｎ纸片法，超广谱β内酰胺酶（ＥＳＢＬｓ）测定采用Ｅｔｅｓｔ法。结果（１）克雷伯菌属及铜绿假单胞菌在３４５株细菌中分别占３９７％、１７４％。（２）头孢噻肟耐药率由４２９％（６年前）降至８２％。（３）ＥＳＢＬｓ检测结果为阴性。结论（１）克雷伯菌属及铜绿假单胞菌构成院内下呼吸道感染主要致病菌。（２）尚未发现ＥＳＢＬｓ的存在，但今后应加强监测     

Acute lower respiratory tract infections in patients with rheumatoid arthritis

OBJECTIVE: To determine whether drugs used in the treatment of rheumatoid arthritis (RA) contribute to the increased risk of respiratory infection or influence its outcome. METHODS: We identified all episodes of lower respiratory tract infection (LRTI) in our RA population over a 12 month period. A detailed drug history was recorded in each case, together with the clinical outcome. Premorbid illnesses and admission data were collected and analyzed to assess the influence of oral steroids and disease modifying antirheumatic drugs (DMARD) on outcome. RESULTS: The overall annual incidence of LRTI in patients with RA was 2.3% with a mortality rate of 22.5%. Demographic factors predicting LRTI included older age and male sex. Oral steroids and not taking DMARD were also associated with an increased risk of hospital admission with LRTI. Being male and having RA for over 10 years trended to the prediction of death as a result of infection. Taking DMARD was not associated with any adverse outcome. CONCLUSION: Respiratory infection is common in patients with RA and carries a high mortality. Oral steroids predispose to infection, while DMARD do not. Increasing age and male sex also predispose to respiratory tract infection.     

Exhaled carbon monoxide in patients with lower respiratory tract infection

The concentration of carbon monoxide (CO) in exhaled air is increased in patients with asthma, bronchiectasis and upper respiratory tract viral infections. However there is no information about the level of CO in patients with lower respiratory tract infection. We studied a group of 35 patients (22 males) aged 45 +/- 3 (SEM) years with cough productive of purulent phlegm and pyrexia in a general practice setting. All were non-smokers or ex-smokers and none had a previous history of respiratory problems or diabetes. We measured CO level in exhaled air before and after a course of antibiotics. Therapy was deemed successful when patient no longer complained of cough productive of purulent phlegm. Twenty-eight of 35 patients had elevated CO level at their initial visit. Twenty-two out of 35 patients reported clinical improvement after antibiotic treatment and this was associated with a fall in exhaled CO level from 5.2 +/- 0.5 ppm to 2.3 +/- 0.3 ppm (P < 0.0001). We suggest that simple CO measurements in exhaled air can detect the inflammatory process within the airways caused by infection and that a repeat measurement can be used to assess the nature of inflammation.