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Lung Dec 2019Up to 90% of children develop Pseudomonas aeruginosa (Pa)-positive respiratory cultures after tracheotomy.
BACKGROUND
Up to 90% of children develop Pseudomonas aeruginosa (Pa)-positive respiratory cultures after tracheotomy.
OBJECTIVE
To identify the factors associated with chronic Pa-positive respiratory cultures in the first 2 years after tracheotomy.
METHODS
We conducted a retrospective cohort study of 210 children ≤ 18 years old who underwent tracheotomy at a single freestanding children's hospital that had two or more years of respiratory cultures post-tracheotomy available for analysis. We conducted multivariable logistic regression to test the association between demographic and clinical factors to our primary outcome of chronic Pa infection, defined as > 75% of respiratory cultures positive for Pa in the first 2 years after tracheotomy.
RESULTS
Of the primarily male (61%), Hispanic (68%), and publicly insured (88%) cohort, 18% (n = 37) developed chronic Pa-positive respiratory cultures in the first 2 years. On multivariable logistic regression, pre-tracheotomy Pa-positive respiratory culture (aOR 11.3; 95% CI 4-1.5) and discharge on beta agonist (aOR 6.3; 95% CI 1.1-36.8) were independently associated with chronic Pa-positive respiratory cultures, while discharge on chronic mechanical ventilation was associated with decreased odds (aOR 0.3; 95% CI 0.1-0.7). On sensitivity analysis examining those without a pre-tracheotomy Pa-positive respiratory culture, discharge on MV continued to be associated with decreased odds of chronic Pa (aOR 0.1; 95% CI 0.02-0.4) and three other variables (male gender, chronic lung disease, and discharge on inhaled corticosteroids) were associated with increased odds of chronic Pa.
CONCLUSION
Because pre-tracheotomy Pa growth on respiratory culture is associated with post-tracheotomy chronic Pa-positive respiratory cultures, future research should examine pre-tracheotomy Pa eradication or suppression protocols.
Topics: Administration, Inhalation; Adrenal Cortex Hormones; Adrenergic beta-Agonists; Carrier State; Child, Preschool; Chronic Disease; Culture Techniques; Female; Humans; Infant; Logistic Models; Lung Diseases; Male; Multivariate Analysis; Preoperative Care; Preoperative Period; Pseudomonas Infections; Pseudomonas aeruginosa; Respiration, Artificial; Respiratory Tract Infections; Retrospective Studies; Risk Factors; Sex Factors; Tracheostomy
PubMed: 31673781
DOI: 10.1007/s00408-019-00285-6 -
Anales de Pediatria (Barcelona, Spain :... Aug 2005Bacterial tracheitis is a cause of severe upper respiratory airway obstruction. It has been considered a rare entity whose clinical and epidemiological features are not...
INTRODUCTION
Bacterial tracheitis is a cause of severe upper respiratory airway obstruction. It has been considered a rare entity whose clinical and epidemiological features are not well known.
PATIENTS AND METHODS
The medical records of children diagnosed with bacterial tracheitis and admitted to our pediatric intensive care unit (PICU) from June 1992 to May 2004 (12 years) were analyzed. The following variables were recorded: age, sex, personal history, need for endotracheal intubation, duration of intubation, isolated bacteria, antibiotic treatment, steroid administration, and length of stay in the PICU.
RESULTS
Twelve patients (six girls and six boys) were included in this study. Age ranged from 1 month to 13 years (median 24 months). Four children had a history of acute laryngotracheitis, one had Down syndrome and another had interauricular communication. All patients needed orotracheal intubation for 2 to 72 hours (median 48 hours). All patients received empirical antibiotic therapy: cephalosporins in 11 children (91 %) (in association with vancomycin or teicoplanin in four of them) and erythromycin in one (9 %). Corticosteroids were administered in nine patients (75 %). Bacterial pathogens were isolated from tracheal secretion culture in seven children (58 %) and the most common was Staphylococcus aureus (42 %). Three children (25 %) developed lobar pneumonia and one developed congestive cardiac insufficiency as a complication of bacterial tracheitis. In all patients, clinical outcome was satisfactory.
CONCLUSIONS
Although the absolute frequency of bacterial tracheitis is low, in our environment this entity represents a considerable cause of severe upper respiratory airway obstruction secondary to an infectious process. Therefore, it should be considered in patients who present with stridor and fever. If the correct treatment is provided, the prognosis is generally good.
Topics: Adolescent; Airway Obstruction; Bacterial Infections; Child; Child, Preschool; Female; Humans; Infant; Male; Tracheitis
PubMed: 16045877
DOI: 10.1157/13077460 -
Virology Journal Aug 2014Respiratory infections are important causes of morbidity and mortality in reptiles; however, the causative agents are only infrequently identified.
BACKGROUND
Respiratory infections are important causes of morbidity and mortality in reptiles; however, the causative agents are only infrequently identified.
FINDINGS
Pneumonia, tracheitis and esophagitis were reported in a collection of ball pythons (Python regius). Eight of 12 snakes had evidence of bacterial pneumonia. High-throughput sequencing of total extracted nucleic acids from lung, esophagus and spleen revealed a novel nidovirus. PCR indicated the presence of viral RNA in lung, trachea, esophagus, liver, and spleen. In situ hybridization confirmed the presence of intracellular, intracytoplasmic viral nucleic acids in the lungs of infected snakes. Phylogenetic analysis based on a 1,136 amino acid segment of the polyprotein suggests that this virus may represent a new species in the subfamily Torovirinae.
CONCLUSIONS
This report of a novel nidovirus in ball pythons may provide insight into the pathogenesis of respiratory disease in this species and enhances our knowledge of the diversity of nidoviruses.
Topics: Animal Diseases; Animals; Boidae; Disease Outbreaks; Female; Male; Molecular Sequence Data; Nidovirales; Nidovirales Infections; Phylogeny; RNA, Viral; Respiratory Tract Diseases; Sequence Analysis, DNA
PubMed: 25106433
DOI: 10.1186/1743-422X-11-144 -
Journal of Korean Medical Science May 2015This study was conducted to estimate the prevalence of antimicrobial prescribing for acute upper respiratory tract infections (URI) among pediatric outpatients and to...
This study was conducted to estimate the prevalence of antimicrobial prescribing for acute upper respiratory tract infections (URI) among pediatric outpatients and to identify the national patterns of its use from 2009 to 2011 in Korea. Using National Patients Sample database from 2009 to 2011, we estimated the frequency of antibiotics prescribing for URI in pediatric outpatients with diagnoses of acute nasopharyngitis (common cold), acute sinusitis, acute pharyngitis, acute tonsillitis, acute laryngitis/tracheitis, acute obstructive laryngitis/epiglottitis, and acute upper respiratory infections of multiple and unspecified sites. The proportions of each antibiotic class were calculated by year and absolute and relative differences were estimated. Also, we investigated daily amount of prescribed antibiotics per defined population according to the type of medical care institution, physician specialty, and geographic region. The overall antibiotic prescribing proportion was 58.7% and its annual proportion slightly decreased (55.4% in 2011 vs. 60.5% in 2009; adjusted odds ratio, 0.82; 95% confidence interval, 0.82-0.83). Variations by the type of medical care institution were observed. Tertiary hospitals (45.0%) were less likely to prescribe antibiotics than primary care clinics (59.4%), hospitals (59.0%), and general hospitals (61.2%); they showed different tendencies in choosing antibiotics. Variations by physician specialty and region were also observed. Prevalence of antimicrobial prescribing for pediatric URI is still considered higher than that of western countries and varies by the type of medical care institution, physician specialty, and geographic region.
Topics: Acute Disease; Anti-Bacterial Agents; Databases, Factual; Drug Prescriptions; Hospitals; Humans; Odds Ratio; Physicians; Practice Patterns, Physicians'; Republic of Korea; Respiratory Tract Infections
PubMed: 25931794
DOI: 10.3346/jkms.2015.30.5.617 -
Archives of Pathology & Laboratory... Feb 2010In March 2009, a novel swine-origin influenza A/H1N1 virus was identified. After global spread, the World Health Organization in June declared the first influenza...
CONTEXT
In March 2009, a novel swine-origin influenza A/H1N1 virus was identified. After global spread, the World Health Organization in June declared the first influenza pandemic in 41 years.
OBJECTIVE
To describe the clinicopathologic characteristics of 34 people who died following confirmed A/H1N1 infection with emphasis on the pulmonary pathology findings.
DESIGN
We reviewed medical records, autopsy reports, microbiologic studies, and microscopic slides of 34 people who died between May 15 and July 9, 2009, and were investigated either by the New York City Office of Chief Medical Examiner (32 deaths) or through the consultation service of a coauthor (2 deaths).
RESULTS
Most of the 34 decedents (62%) were between 25 and 49 years old (median, 41.5 years). Tracheitis, bronchiolitis, and diffuse alveolar damage were noted in most cases. Influenza viral antigen was observed most commonly in the epithelium of the tracheobronchial tree but also in alveolar epithelial cells and macrophages. Most cases were reverse transcription-polymerase chain reaction positive for influenza. Histologic and microbiologic autopsy evidence of bacterial pneumonia was detected in 55% of cases. Underlying medical conditions including cardiorespiratory diseases and immunosuppression were present in 91% of cases. Obesity (body mass index, >30) was noted in 72% of adult and adolescent cases.
CONCLUSIONS
The pulmonary pathologic findings in fatal disease caused by the novel pandemic influenza virus are similar to findings identified in past pandemics. Superimposed bacterial infections of the respiratory tract were common. Preexisting obesity, cardiorespiratory diseases, and other comorbidities also were prominent findings among the decedents.
Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Comorbidity; Disease Outbreaks; Female; Humans; Infant; Infant, Newborn; Influenza A Virus, H1N1 Subtype; Influenza, Human; Lung; Male; Middle Aged; Pneumonia, Bacterial; Radiography; Time Factors
PubMed: 20121613
DOI: 10.5858/134.2.235 -
Archives of Disease in Childhood Sep 1987Four children with Down's syndrome and bacterial tracheitis are described. In three the infection was due to Haemophilus influenza. In patients with Down's syndrome...
Four children with Down's syndrome and bacterial tracheitis are described. In three the infection was due to Haemophilus influenza. In patients with Down's syndrome presenting with stridor tracheitis should be considered and appropriate treatment started.
Topics: Child; Child, Preschool; Down Syndrome; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Tracheitis
PubMed: 2960275
DOI: 10.1136/adc.62.9.962 -
Journal of Pediatric Surgery Nov 1992To study the incidence and types of infection among severely traumatized children, we reviewed the medical charts of 212 children, hospitalized following traumatic... (Comparative Study)
Comparative Study
To study the incidence and types of infection among severely traumatized children, we reviewed the medical charts of 212 children, hospitalized following traumatic injury, who received antibiotics at sometime during their hospitalization. Infection occurred in 19%. Eleven children had trauma-related infections, whereas 29 (71% of those infected) had 36 nosocomial infections. Tracheitis, sepsis, and urinary tract infections were the most common nosocomial infections and were diagnosed in the second week (10 +/- 3 days) following injury. Nosocomial infections were more likely to develop in children who were more severely injured and who had a greater number of invasive procedures. Severe head injury (cerebral edema or subarachnoid hemorrhage) was more common in those with nosocomial infection (P < .0002, odds ratio 6.8, 95% confidence interval 2.2 to 21.3). Those without these injuries were much less likely to develop nosocomial infections (specificity 97% and negative predictive value 86%). Finally, the development of any nosocomial infection prolonged the hospitalization by a mean of 16 +/- 6 days when comparing children with the same degree of traumatic injury. Prevention of nosocomial infection in children with severe trauma will significantly reduce length of hospitalization.
Topics: Accidents, Traffic; Anti-Bacterial Agents; Bacterial Infections; Child; Cross Infection; Female; Hospitalization; Humans; Injury Severity Score; Male; Philadelphia; Trauma Centers; Urinary Tract Infections; Wound Infection; Wounds and Injuries
PubMed: 1479496
DOI: 10.1016/0022-3468(92)90184-9 -
Cureus Mar 2022Acute pharyngitis is a common complaint in emergency department (ED), urgent care, and primary care settings. Most cases are due to bacterial or viral infections easily...
Acute pharyngitis is a common complaint in emergency department (ED), urgent care, and primary care settings. Most cases are due to bacterial or viral infections easily treated with antibiotics or supportive care. However, serious pathologies in the pharyngitis differential include Ludwig's angina, peritonsillar abscess, retropharyngeal abscess, and bacterial tracheitis. Rarely, oncologic conditions such as leukemia may initially present as pharyngitis in an acute care setting. We present a case of pharyngitis in a 32-year-old male ED patient with a final diagnosis of acute myelogenous leukemia (AML). Knowledge of the appropriate ED evaluation of AML is key for accurate diagnosis and prompt referral to avoid unnecessary patient morbidity and mortality.
PubMed: 35464587
DOI: 10.7759/cureus.23306 -
Intensive Care Medicine Aug 2023
Topics: Humans; Pneumonia, Ventilator-Associated; Bronchitis; Tracheitis; Lung; Anti-Bacterial Agents
PubMed: 37256342
DOI: 10.1007/s00134-023-07105-9 -
Journal of Medical Case Reports Aug 2018Laryngectomees run the risk of developing severe respiratory tract infections especially during the winter and when they do not wear a stoma cover. A case of severe...
BACKGROUND
Laryngectomees run the risk of developing severe respiratory tract infections especially during the winter and when they do not wear a stoma cover. A case of severe tracheobronchitis in a laryngectomee is presented that illustrates the risks and difficulties encountered in managing this infection in a neck breather.
CASE PRESENTATION
A 76-year-old Caucasian man, a laryngectomee, presented with bacterial tracheobronchitis and conjunctivitis due to beta-lactamase-producing nontypeable Haemophilus influenzae. He was febrile (38.9 °C; 102.0 F), and had repeated episodes of hypertension. He was treated with levofloxacin 500 mg/day, ciprofloxacin eye drops, acetaminophen, and guaifenesin. Humidification of his trachea and the airway was sustained by insertions of saline into the stoma as well as breathing humidified air. The main challenge was to maintain the patency of his airway as the mucus was very dry and viscous and tended to stick to the walls of his trachea and the stoma. His condition improved within 7 days and he had a complete recovery.
CONCLUSIONS
Maintaining the patency of the airway in laryngectomees who suffer from lower respiratory tract infection is of utmost importance as the mucus can be very dry and viscous and can stick to the walls of the trachea and the stoma.
Topics: Aged; Anti-Bacterial Agents; Bronchitis; Haemophilus Infections; Haemophilus influenzae; Humans; Laryngectomy; Male; Respiratory Tract Infections; Tracheitis
PubMed: 30124173
DOI: 10.1186/s13256-018-1764-2