phenylephrine-hydrochloride and Pneumonia--Bacterial

The alteration of the microbial community in the upper respiratory tract (URT) can contribute to the colonization and invasion of respiratory pathogens. However, there are no studies regarding whether the characteristics of the URT microbiota can be affected by infections in lower respiratory tract (LRT). To elucidate the microbial profiles of the URT during pneumonia, the oral, nasal, and lung microbiota was evaluated at the early phase in a murine pneumonia model by direct intratracheal inoculation of Klebsiella pneumoniae. The meta 16S rRNA sequencing of bronchoalveolar lavage fluid after K. pneumoniae inoculation presented alterations in the beta diversity of the microbes, but not in the alpha diversity. At this point, a significant increase in microbial alpha diversity was observed in the oral cavity, but not in the nasal cavity. The significant increase was observed in the family Carnobacteriaceae and family Enterococcaceae. These results suggest that characterizing the microbial community of the respiratory tract may not just involve a simple downstream relationship from the URT to the LRT. The health status of the LRT may influence the oral microbiota. Thus, evaluation of the oral microbiota may contribute towards monitoring lung health; the oral microbiota may act as a diagnostic marker of pneumonia.

Topics: Animals; Bronchoalveolar Lavage Fluid; Disease Models, Animal; Female; Klebsiella Infections; Klebsiella pneumoniae; Lung; Mice; Mice, Inbred C57BL; Microbiota; Mouth; Nose; Pneumonia, Bacterial; RNA, Ribosomal, 16S

To develop and evaluate a novel method for simultaneous identification of 12 potential bacterial pathogens in children with community-acquired pneumonia.. A multiplex PCR-based reverse line blot (mPCR/RLB) assay was developed, to identify 12 respiratory bacterial pathogens, namely Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes, Moraxella catarrhalis, Haemophilus influenzae, Haemophilus influenzae type b, Bordetella pertussis, Klebsiella pneumoniae, Legionella pneumophila, Mycobacterium tuberculosis, Chlamydia pneumoniae, Mycoplasma pneumoniae, and single (uniplex) PCRs were used for S. pneumoniae and H. influenzae only. In a preliminary evaluation, we compared the results of mPCR/RLB with those of single (uniplex) PCRs and culture of nasopharyngeal aspirates (NPAs) from 100 children under 5 years, admitted to Beijing Children's Hospital between October 2004 and May 2005, with pneumonia.. Reference strains and clinical isolates of all 12 target species were correctly identified by mPCR/RLB. Potential pathogens were isolated from one blood culture and 26% of respiratory cultures. One or more pathogens were identified in 70% of respiratory specimens--by mPCR/RLB in 63%, uPCR only in another 3%, culture only in 2%, and culture plus uPCR in 2%. The species most commonly identified were S. pneumoniae (54%) and H. influenzae (38%, including type b, 4%). Cultures were not performed for B. pertussis, M. tuberculosis, C. pneumoniae or M. pneumoniae but each was identified by mPCR/RLB in between one and four specimens. Two or more potential pathogens were identified in 35% of specimens. Ten of 14 S. pneumoniae isolates belonged to serotypes represented in the 11-valent pneumococcal conjugate vaccine.. The mPCR/RLB assay is a sensitive tool for identification of respiratory pathogens, including mixed infections and bacteria requiring special culture methods.

Topics: Bacteria; Base Sequence; Child, Preschool; China; Clinical Laboratory Techniques; Community-Acquired Infections; Female; Haemophilus influenzae; Humans; Infant; Male; Molecular Probe Techniques; Molecular Sequence Data; Nose; Nucleic Acid Hybridization; Pharynx; Pneumococcal Vaccines; Pneumonia, Bacterial; Polymerase Chain Reaction; Sensitivity and Specificity; Serotyping; Streptococcus pneumoniae

We performed a prospective observational cohort study of the epidemiology and etiology of nosocomial pneumonia in 358 medical ICU patients in two university-affiliated hospitals. Protected bronchoscopic techniques (protected specimen brush and bronchoalveolar lavage) were used for diagnosis to minimize misclassification. Risk factors for ventilator-associated pneumonia were identified using multiple logistic regression analysis. Twenty-eight cases of pneumonia occurred in 358 patients for a cumulative incidence of 7.8% and incidence rates of 12.5 cases per 1, 000 patient days and 20.5 cases per 1,000 ventilator days. Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Hemophilus species made up 65% of isolates from the lower respiratory tract, whereas only 12.5% of isolates were enteric gram-negative bacilli. Daily surveillance cultures of the nares, oropharynx, trachea, and stomach demonstrated that tracheal colonization preceded ventilator-associated pneumonia in 93.5%, whereas gastric colonization preceded tracheal colonization for only four of 31 (13%) eventual pathogens. By multiple logistic regression, independent risk factors for ventilator- associated pneumonia were admission serum albumin <= 2.2 g/dl (odds ratio [OR] 5.9; 95% confidence interval [CI] 2.0-17.6; p = 0.0013), maximum positive end-expiratory pressure >= 7.5 cm H2O (OR, 4.6; 95% CI, 1.4 to 15.1; p = 0.012), absence of antibiotic therapy (OR, 6.7; 95% CI, 1.8 to 25.3; p = 0.0054), colonization of the upper respiratory tract by respiratory gram-negative bacilli (OR, 3.4; 95% CI, 1.1 to 10.1; p = 0.028), pack-years of smoking (OR, 2.3 for 50 pack-years; 95% CI, 1. 2 to 4.2; p = 0.012), and duration of mechanical ventilation (OR, 3. 4 for 14 d; 95% CI, 1.5 to 7.8; p = 0.0044). Several of these risk factors for ventilator-associated pneumonia appear amenable to intervention.

Topics: Anti-Bacterial Agents; Bronchoalveolar Lavage; Bronchoscopes; Bronchoscopy; Cohort Studies; Confidence Intervals; Critical Care; Cross Infection; Enterobacteriaceae; Enterobacteriaceae Infections; Haemophilus Infections; Humans; Incidence; Logistic Models; Nose; Odds Ratio; Oropharynx; Pneumonia, Bacterial; Pneumonia, Pneumococcal; Pneumonia, Staphylococcal; Positive-Pressure Respiration; Prospective Studies; Pseudomonas aeruginosa; Pseudomonas Infections; Risk Factors; Serum Albumin; Smoking; Stomach; Tennessee; Time Factors; Trachea; Ventilators, Mechanical

A case of life-threatening Chlamydia TWAR pneumonia complicated by encephalitis in a young, previously healthy adult is described. The patient presented with full blown adult respiratory distress syndrome and required prolonged ventilatory support and rigorous antibiotic and supportive care. He recovered fully without any neurologic sequelae. Chlamydia pneumoniae pneumonia should be included in the differential diagnosis of the severe community acquired pneumonia, because if properly sought and adequately treated, may have an excellent outcome.

Topics: Adult; Anti-Bacterial Agents; Chlamydia Infections; Chlamydophila pneumoniae; Community-Acquired Infections; Diagnosis, Differential; Disease-Free Survival; Encephalitis; Humans; Male; Nose; Pneumonia, Bacterial; Respiration, Artificial; Respiratory Distress Syndrome; Tachycardia

Nasal swabs and lungs of 150 pigs with pneumonia were tested by culture at post mortem examination. The isolated agents were Pasteurella multocida (P.m.), P. haemolytica, Bordetella bronchiseptica, Actinobacillus pleuropneumoniae, Staphylococcus aureus, Streptococcus spp. and Escherichia coli. P.m. was most frequently found, and this agent only showed a significant correlation between lungs and nasal swabs. In 80.6% of pigs with P.m. in the lung the agent was detected in the nose, too. Drug resistance patterns of P.m. isolates from lungs and noses of the single animals were identical or similar, also in case of different capsular types. The examination of porcine nasal swabs for bacteria capable of causing pneumonia should be limited to P. multocida. Demonstration of agents in lung material is generally more certain.

Topics: Animals; Anti-Bacterial Agents; Bacteria; Drug Resistance, Microbial; Lung; Nose; Pneumonia, Bacterial; Swine; Swine Diseases