-
European Annals of Otorhinolaryngology,... Oct 2022
Topics: Anti-Bacterial Agents; Gram-Negative Bacteria; Humans; Tracheitis
PubMed: 35078731
DOI: 10.1016/j.anorl.2021.11.010 -
Pediatric Allergy, Immunology, and... Jun 2020In recent years, administration of inhaled aminoglycosides has gained popularity in tracheostomy-dependent pediatric patients because of medication delivery to the...
In recent years, administration of inhaled aminoglycosides has gained popularity in tracheostomy-dependent pediatric patients because of medication delivery to the target site of action while minimizing systemic absorption and adverse effects. A recent report of detectable serum tobramycin concentrations in critically ill children receiving inhaled tobramycin 300 mg every 12 h prompted our investigation in tracheostomy-dependent pediatric patients receiving inhaled tobramycin 80 mg every 8 h. Serum tobramycin trough concentrations were obtained from tracheostomy-dependent pediatric patients receiving treatment with inhaled tobramycin 80 mg every 8 h for the treatment of tracheitis. Patient data, including demographic data, medical history, renal function, and serum concentrations, were collected. Twelve patients with a median age of 0.5 (0.3-6.1) years had serum tobramycin concentrations evaluated. Eleven of the 12 patients had undetectable trough concentrations (<0.6 mcg/mL). All of these patients had normal blood urea nitrogen (BUN) and serum creatinine (SCr) for age and no history of kidney disease. One patient had a detectable trough concentration of 2.1 mcg/mL. This patient was 11 months old and had polycystic kidney disease with an elevated BUN and SCr for age. Detectable serum concentration from systemic absorption of inhaled tobramycin 80 mg every 8 h is unlikely in tracheostomy-dependent pediatric patients with normal renal function. However, in tracheostomy-dependent pediatric patients with a history of renal dysfunction or elevations in BUN or SCr, inhaled tobramycin should be used with caution. Monitoring serum concentrations to guide dose modification should be considered in these patients.
PubMed: 35921575
DOI: 10.1089/ped.2020.1161 -
Clinics in Chest Medicine Sep 2011Intubated patients are at risk of bacterial colonization and ventilator-associated respiratory infection (VARI). VARI includes tracheobronchitis (VAT) or pneumonia... (Review)
Review
Intubated patients are at risk of bacterial colonization and ventilator-associated respiratory infection (VARI). VARI includes tracheobronchitis (VAT) or pneumonia (VAP). VAT and VAP caused by multidrug-resistant (MDR) pathogens are increasing in the United States and Europe. In patients with risk factors for MDR pathogens, empiric antibiotics are often initiated for 48 to 72 hours pending the availability of pathogen identification and antibiotic sensitivity data. Extensive data indicate that early, appropriate antibiotic therapy improves outcomes for patients with VAP. Recognizing and treating VARI may allow earlier appropriate therapy and improved patient outcomes.
Topics: Bronchitis; Diagnosis, Differential; Humans; Pneumonia, Bacterial; Pneumonia, Ventilator-Associated; Tracheitis
PubMed: 21867822
DOI: 10.1016/j.ccm.2011.06.001 -
American Journal of Transplantation :... Jun 2016Bacterial pneumonia and tracheobronchitis are diagnosed frequently following lung transplantation. The diseases share clinical signs of inflammation and are often...
Bacterial pneumonia and tracheobronchitis are diagnosed frequently following lung transplantation. The diseases share clinical signs of inflammation and are often difficult to differentiate based on culture results. Microbiome and host immune-response signatures that distinguish between pneumonia and tracheobronchitis are undefined. Using a retrospective study design, we selected 49 bronchoalveolar lavage fluid samples from 16 lung transplant recipients associated with pneumonia (n = 8), tracheobronchitis (n = 12) or colonization without respiratory infection (n = 29). We ensured an even distribution of Pseudomonas aeruginosa or Staphylococcus aureus culture-positive samples across the groups. Bayesian regression analysis identified non-culture-based signatures comprising 16S ribosomal RNA microbiome profiles, cytokine levels and clinical variables that characterized the three diagnoses. Relative to samples associated with colonization, those from pneumonia had significantly lower microbial diversity, decreased levels of several bacterial genera and prominent multifunctional cytokine responses. In contrast, tracheobronchitis was characterized by high microbial diversity and multifunctional cytokine responses that differed from those of pneumonia-colonization comparisons. The dissimilar microbiomes and cytokine responses underlying bacterial pneumonia and tracheobronchitis following lung transplantation suggest that the diseases result from different pathogenic processes. Microbiomes and cytokine responses had complementary features, suggesting that they are closely interconnected in the pathogenesis of both diseases.
Topics: Adult; Aged; Bayes Theorem; Bronchitis; Bronchoalveolar Lavage Fluid; Cytokines; Diagnosis, Differential; Female; Humans; Lung Transplantation; Male; Microbiota; Middle Aged; Pneumonia, Bacterial; Retrospective Studies; Tracheitis; Transplant Recipients
PubMed: 26693965
DOI: 10.1111/ajt.13676 -
Poultry Science Feb 2021Ammonia (NH) is a known harmful gas and exists in haze, forming secondary organic aerosols. Exposure to ambient ammonia correlates with the respiratory tract infection,...
Ammonia (NH) is a known harmful gas and exists in haze, forming secondary organic aerosols. Exposure to ambient ammonia correlates with the respiratory tract infection, and microbiota in the upper respiratory tract is an emerging crucial player in the homeostatic regulation of respiratory tract infection, and microbiota perturbation is usually accompanied by the inflammatory reactions; however, the effects of different levels of ammonia exposure on tracheal microbiota and inflammation are unclear. A total of 288 22-day-old male Arbor Acres broilers were chosen and divided into 4 groups with 6 replicates of 12 chickens, and respectively exposed to ammonia at 0, 15, 25, and 35 ppm for 21-d trial period. Cytokines (interleukin (IL)-1β, IL-6, and IL-10) in the trachea were measured at the 21 d of exposure to NH. Tracheal microbiota at the 21 d was analyzed by the 16S rRNA gene analysis. The results showed that an increase in ammonia levels, even in 15 ppm, significantly decreased the alpha diversity and changed the bacterial community structure. Six genera (Faecalibacterium, Ruminococcus]_torques_group, unclassified_f__Lachnospiraceae, Ruminococcaceae_UCG-014, Streptococcus, Blautia) significantly increased, whereas Lactobacillus significantly decreased under different levels of ammonia exposure. We also observed positive associations of Faecalibacterium, Blautia, g__Ruminococcaceae_UCG-014, unclassified_f__Lachnospiraceae and Ruminococcus]_torques_group abundances with tracheal IL-1β concentration. Moreover, an increase in ammonia levels, even in 15 ppm, caused respiratory tract inflammatory injury. The results indicated that 15 ppm ammonia exposure changed the composition of tracheal microbiota that caused the tracheal injury possibly through increasing the IL-1β, which might make the broiler more sensitive to the changes of environment and pathogenic micro-organisms in the poultry house, and may be also a critical value that needs high alertness. Herein, the present experiment also suggested that the standard limit of ammonia concentration in adult poultry house is 15 ppm. This research provides an insight into the relationship between the upper respiratory tract microbiota and inflammation under ammonia exposure.
Topics: Ammonia; Animals; Bacteria; Chickens; Male; Microbiota; Poultry Diseases; RNA, Ribosomal, 16S; Trachea; Tracheitis
PubMed: 33518122
DOI: 10.1016/j.psj.2020.11.026 -
Journal of the American Veterinary... May 2012A 7-year-old neutered male Saint Bernard was evaluated because of a 6-month history of coughing, gagging, change in phonation, excessive panting, and chronic...
CASE DESCRIPTION
A 7-year-old neutered male Saint Bernard was evaluated because of a 6-month history of coughing, gagging, change in phonation, excessive panting, and chronic intermittent vomiting and diarrhea.
CLINICAL FINDINGS
Physical examination revealed no remarkable findings other than panting. Total thyroxine concentration and results of a CBC, serum biochemistry analysis, urinalysis, and thoracic radiography were within reference limits. A laryngeal examination revealed edema, erythema, and ulceration of the larynx and pharynx, with normal laryngeal movement. Results of bronchoscopy and cytologic examination of bronchoalveolar lavage fluid were diagnostic only for distal tracheitis. Esophagoscopy and an esophagography revealed esophagitis consistent with gastroesophageal reflux. Gastroduodenoscopy and histologic examination of biopsy specimens revealed Helicobacter colonization and lymphocytic or plasmacytic enteritis.
TREATMENT AND OUTCOME
Following treatment for gastroesophageal reflux and suspected Helicobacter infection with combination antacid and antimicrobial treatment, the dog's respiratory signs resolved but vomiting continued. Gastroduodenoscopy revealed complete resolution of the previous laryngitis, pharyngitis, and esophagitis. Treatment for the lymphocytic or plasmacytic enteritis was initiated with prednisone (1 mg/kg [0.45 mg/lb], p.o., q 12 h) and a novel protein diet. The previous treatment was also continued. Complete resolution of clinical signs was maintained 4 months after initiation of appropriate treatment.
CLINICAL RELEVANCE
Laryngeal dysfunction induced by gastroesophageal reflux as occurred in the patient described in this report is a previously undocumented association in the veterinary literature. This association could be a potential consideration in dogs with concurrent respiratory and gastrointestinal signs. The present report may provide a basis for further studies investigating this association.
Topics: Animals; Antacids; Anti-Bacterial Agents; Dog Diseases; Dogs; Gastroesophageal Reflux; Helicobacter Infections; Laryngitis; Laryngoscopy; Male; Pharyngitis; Treatment Outcome
PubMed: 22515631
DOI: 10.2460/javma.240.9.1100 -
Open Veterinary Journal Mar 2024Respiratory diseases, including the multifactorial "swine respiratory disease complex," have a significant impact on swine production. Recently, a condition manifesting... (Review)
Review
BACKGROUND
Respiratory diseases, including the multifactorial "swine respiratory disease complex," have a significant impact on swine production. Recently, a condition manifesting primarily in the trachea, known as hemorrhagic tracheitis syndrome (HTS), has been described in pigs. HTS is characterized by severe coughing and high mortality in finishing pigs.
CASE DESCRIPTION
This report presents the first case of HTS in an adult male pig from a Portuguese farm. The animal died without any previous clinical signs. Necropsy revealed significant thickening of the trachea. Fibrinous necrotic hemorrhagic tracheitis was identified through histopathological analysis, but no bacterial infectious agents were detected during microbiological examination.
CONCLUSION
This case underscores the need for comprehensive research, including systematic necropsies and histopathological assessments, to understand the actual prevalence of the disease, elucidate the etiology, and develop effective interventions for HTS in swine productions.
Topics: Animals; Swine; Male; Portugal; Swine Diseases; Tracheitis; Fatal Outcome; Hemorrhage; Syndrome
PubMed: 38682145
DOI: 10.5455/OVJ.2024.v14.i3.21 -
Critical Care (London, England) Feb 2015Laboratory studies demonstrated that the lateral Trendelenburg position (LTP) is superior to the semirecumbent position (SRP) in the prevention of ventilator-associated...
INTRODUCTION
Laboratory studies demonstrated that the lateral Trendelenburg position (LTP) is superior to the semirecumbent position (SRP) in the prevention of ventilator-associated pulmonary infections. We assessed whether the LTP could also prevent pulmonary colonization and infections caused by an endotracheal tube (ETT) biofilm.
METHODS
Eighteen pigs were intubated with ETTs colonized by Pseudomonas aeruginosa biofilm. Pigs were positioned in LTP and randomized to be on mechanical ventilatin (MV) up to 24 hour, 48 hour, 48 hour with acute lung injury (ALI) by oleic acid and 72 hour. Bacteriologic and microscopy studies confirmed presence of biofilm within the ETT. Upon autopsy, samples from the proximal and distal airways were excised for P.aeruginosa quantification. Ventilator-associated tracheobronchitis (VAT) was confirmed by bronchial tissue culture ≥3 log colony forming units per gram (cfu/g). In pulmonary lobes with gross findings of pneumonia, ventilator-associated pneumonia (VAP) was confirmed by lung tissue culture ≥3 log cfu/g.
RESULTS
P.aeruginosa colonized the internal lumen of 16 out of 18 ETTs (88.89%), and a mature biofilm was consistently present. P.aeruginosa colonization did not differ among groups, and was found in 23.6% of samples from the proximal airways, and in 7.1% from the distal bronchi (P = 0.001). Animals of the 24 hour group never developed respiratory infections, whereas 20%, 60% and 25% of the animals in group 48 hour, 48 hour-ALI and 72 hour developed P.aeruginosa VAT, respectively (P = 0.327). Nevertheless, VAP never developed.
CONCLUSIONS
Our findings imply that during the course of invasive MV up to 72 hour, an ETT P.aeruginosa biofilm hastily colonizes the respiratory tract. Yet, the LTP compartmentalizes colonization and infection within the proximal airways and VAP never develops.
Topics: Animals; Bacterial Adhesion; Biofilms; Bronchitis; Intubation, Intratracheal; Lung; Microscopy, Confocal; Microscopy, Electron, Scanning; Models, Animal; Patient Positioning; Pneumonia, Ventilator-Associated; Swine; Tracheitis
PubMed: 25887536
DOI: 10.1186/s13054-015-0785-0 -
Monatsschrift Kinderheilkunde : Organ... 2011Dyspnoea, inspiratory stridor, wheeze, cyanosis and chest pain are common symptoms of respiratory emergencies in children and adolescents. The airways of infants and...
Dyspnoea, inspiratory stridor, wheeze, cyanosis and chest pain are common symptoms of respiratory emergencies in children and adolescents. The airways of infants and toddlers are narrow and soft and oxygen reserve is small. Muscle fatigue can quickly lead to respiratory insufficiency. Symptoms, diagnosis, differential diagnosis and therapy of foreign body inhalation, croup, epiglottitis, bacterial tracheitis, bronchiolitis and acute asthma are dealt with in detail.
PubMed: 32226151
DOI: 10.1007/s00112-011-2420-8 -
BMC Pediatrics Apr 2022There is limited data on pediatric ventilator-associated events (PedVAE) in the neonatal intensive care unit (NICU) setting, since the CDC mandated state reporting of...
BACKGROUND
There is limited data on pediatric ventilator-associated events (PedVAE) in the neonatal intensive care unit (NICU) setting, since the CDC mandated state reporting of these events in January 2019. This study sought to describe PedVAE rates and characteristics in the NICU population.
METHODS
Single-center case-control study of infants requiring mechanical ventilation in a 39-bed level IV NICU between January 1, 2018 and December 31, 2020. Baseline infant demographic, respiratory support and antibiotic use data was obtained and comparisons were performed between patients with potential PedVAEs and those without events.
RESULT
Two hundred and nine infants were mechanically ventilated. Two of the 126 patients ventilated for ≥4 days met CDC criteria for PedVAEs with a total of 3 events, and 32 (25%) received antibiotics with escalation of respiratory support, primarily for tracheitis.
CONCLUSION
NICU-specific data on PedVAE is limited. Only 2 infants in the study period met the current CDC criteria for PedVAE with a rate of 0.9 events per 1000 ventilator days. The current CDC PedVAE definition might be inadequate to identify actionable VAEs to inform prevention efforts in the NICU population, and alternate indices could better characterize these events.
Topics: Anti-Bacterial Agents; Case-Control Studies; Centers for Disease Control and Prevention, U.S.; Child; Humans; Infant; Infant, Newborn; Intensive Care Units, Neonatal; Pneumonia, Ventilator-Associated; Respiration, Artificial; United States; Ventilators, Mechanical
PubMed: 35392855
DOI: 10.1186/s12887-022-03236-y