Endotracheal Aspirate Research Articles

In vitro antibacterial effect of probiotics against Carbapenamase-producing multidrug-resistant Klebsiella pneumoniae clinical isolates, Cairo, Egypt

BackgroundSearching for a non-antibiotic therapeutic option such as probiotics is gaining momentum nowadays. We aimed to evaluate the in vitro antibacterial ability of cell-free supernatant (CFS) of selected Lactobacillus strains (with probiotic properties) against clinical isolates of OXA-48-producing multidrug-resistant (MDR) Klebsiella pneumoniae separately and in combination with cefoperazone antibiotic.MethodsOver a period of 8 months, a cross-sectional experimental study involving 590 Klebsiella pneumoniae isolates was done. Our study took place at The Specialized Pediatric Teaching Hospital of Cairo University. Of the 590 Klebsiella pneumoniae isolates collected from blood cultures, pus, endotracheal aspirates, and pleural fluid, only 50 unrepeated clinical isolates of MDR Klebsiella pneumoniae-producing OXA-48-like detected by CHROMID® OXA-48 (bioMérieux, France) were selected for our study. After determining the minimal inhibitory concentration of CFS of ten Lactobacillus strains and cefoperazone each, the synergistic effect of both was tested.ResultsAmong ten tested Lactobacillus spp., a significant increase in the mean value of inhibition zone diameter with CFS of L. helveticus (14.32 mm) and L. rhamnosus (13.3 mm) was detected separately. On the contrary, an antagonistic activity against all tested isolates was detected upon combination of Lactobacilli with cefoperazone (512 μg/ml). The mean value of inhibition zone diameter of L. helveticus CFS+ cefoperazone was (11.0 mm) and for L. rhamnosus CFS+ cefoperazone was (10.88 mm) (p value <0.001).ConclusionThe antimicrobial efficiency of using CFS of Lactobacillus species separately indicates that these therapies may be a substitute treatment strategy against MDR Klebsiella pneumoniae.

A RARE MANIFESTATION OF SYSTEMIC LUPUS ERYTHEMATOSUS (SLE): DIFFUSE ALVEOLAR HEMORRHAGE

A RARE MANIFESTATION OF SYSTEMIC LUPUS ERYTHEMATOSUS (SLE): DIFFUSE ALVEOLAR HEMORRHAGE

Detection of influenza and non-influenza respiratory viruses in lower respiratory tract specimens among hospitalized adult patients and analysis of the clinical outcome.

Lower respiratory tract infection (LRTI) is one of the most fatal diseases for adults. Influenza is a well-recognized cause of severe pneumonia; however, the outcomes of LRTI caused by non-influenza respiratory viruses (NIRVs) have not been sufficiently investigated. This study aimed to describe the characteristics and outcomes of LRTI associated with respiratory viruses (RVs) in adults. A retrospective review was performed using medical records of adult patients whose lower respiratory tract (LRT) specimens (endotracheal aspirate and bronchoalveolar lavage fluid) tested positive for RVs using multiplex PCR. Underlying comorbidities, laboratory data, and clinical outcomes were analyzed. Among the 808 LRT specimens collected from 666 adult patients, RV was identified in 115 specimens (14%) from 106 patients (16%). The underlying comorbidities and laboratory data did not differ between patients with influenza- and NIRV-related LRTI. The 14-day and 30-day mortality rates were higher in the influenza group than in the NIRV group (24% versus 7%, p=0.03 and 33% versus 13%, p=0.02, respectively), whereas the 90-day mortality rate did not. In a multivariate Cox model to predict 90-day mortality, shock and acute kidney injury independently predicted a higher mortality rate (hazard ratio (HR): 4.28, 95% CI: 1.46-12.58, p=0.01 and HR: 2.80, 95% CI: 1.28-6.15, p=0.01, respectively), whereas the detection of influenza did not. Influenza and NIRVs were associated with increased mortality due to LRTI in adults. Therefore, NIRVs are among key pathogens causing LRTI and should not be neglected by clinicians.

Carbapenem-Resistant Gram-Negative Bacilli Causing Ventilator Associated Pneumonia: Study of MASTDISCS Combi Carba Plus for Detection of Carbapenemase Producing Enterobacterales.

Ventilator-associated pneumonia (VAP) caused by carbapenem-resistant gram-negative bacteria has been proven to be an escalating public health challenge in Egypt owing to its high mortality rate and raised health care costs. Detection of carbapenem-resistant gram-negative bacilli among VAP patients, genotypic identification of carbapenemase genes in the isolated strains with evaluation of their impact on patient outcome and detection of carbapenemase-producing enterobacterales by MASTDISCS combi Carba plus disc system. Broncho-alveolar lavage fluid (BALF) and endotracheal aspirate were collected aseptically from clinically suspected VAP patients. Pathogen identification and antibiotic sensitivity testing were done. Carbapenemase-encoding genes (bla KPC, bla NDM, and bla OXA-48) were tested by PCR in all carbapenem-resistant gram-negative isolates. Performance of MASTDISCS combi Carba plus in isolated Enterobacterales was assessed in relation to the PCR results. Eighty-three carbapenem-resistant gram-negative isolates were detected. The most frequent pathogens were Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa representing 34.9%, 20.5% and 18.1%, respectively. bla KPC was the predominant gene. Patients with persistent mechanical ventilation less than 15 days and Pseudomonas aeruginosa infection were significantly associated with a higher death rate. MAST-Carba plus had the highest sensitivity, specificity, positive and negative predictive values for detecting OXA-48 carbapenemases representing 81.8%, 92.5%, 75% and 94.9%, respectively. Worse outcome in VAP patients was associated with carbapenem-resistant gram-negative bacilli. MASTDISCS combi Carba plus is an efficient simple method for identification of different carbapenemases among enterobacterales.

THE BEAST IN THE BEAUTY BOX

THE BEAST IN THE BEAUTY BOX

Viral Isolates in Pediatric Ventilator-Associated Pneumonia

Introduction: Although ventilator-associated pneumonia (VAP) mostly has bacterial etiology, many cases have viral etiology. The present study aimed at determining the proportion of viral VAP and any associated factors and identifying the viral isolates in pediatric VAP. Materials and Methods: A descriptive observational study was conducted at pediatric intensive care unit of tertiary referral center including 120 VAP cases aged 1–18 years. Endotracheal aspiration samples from these patients were tested for viral etiology. Results: Most VAP cases were males (66.7%). Virus was isolated in 14.2% of cases of VAP. Human adenovirus (29%), respiratory syncytial virus (29%), and herpes simplex virus (24%) were the most common viruses identified. Viral VAP was significantly associated with age, primary disease, and total leukocyte count. Neutrophil count decreased and lymphocyte count increased significantly after viral VAP. Conclusion: Viral etiology should be considered in VAP patients, especially in patients not responding to antibiotics as proper diagnosis and timely initiation of appropriate antiviral could be lifesaving. Prevalent viruses may vary geographically; hence, hospitals should try to identify the common viruses causing VAP in their settings to guide appropriate battery of tests and antiviral drugs.

ANTIBIOTIC RESISTANCE RATES OF BACTERIA ISOLATED FROM ENDOTRACHEAL ASPIRATE SAMPLES OF INTENSIVE CARE UNIT PATIENTS

Amaç&#x0D; Nozokomiyal enfeksiyonlar hastanede yatan hastaların&#x0D; önemli mortalite ve morbidite nedenleri arasında&#x0D; yer almaktadır. Yoğun bakım ünite (YBÜ)’lerinde&#x0D; görülen enfeksiyonlar nozokomiyal enfeksiyonların&#x0D; %25’ini oluşturmakta, bunların içerisinde en sık solunum&#x0D; sistemi enfeksiyonları bildirilmektedir. Bu enfeksiyonlardan&#x0D; izole edilen etkenler ve antibiyotik direnç&#x0D; durumları hastaneler arasında farklılıklar gösterebileceği&#x0D; gibi aynı ünite içinde de zamanla değişiklikler&#x0D; görülebilmektedir. Endotrakeal aspirat (ETA) kültürleri,&#x0D; tüm dünyada solunum yolu örneklemesinde en&#x0D; yaygın kullanılan mikrobiyolojik tanı yöntemi olarak&#x0D; karşımıza çıkmaktadır. Bu çalışmada Süleyman Demirel&#x0D; Üniversitesi YBÜ’sindeki hastaların ETA örneklerinden&#x0D; izole edilen bakteriyel etkenler ve antibiyotik&#x0D; direnç oranlarının retrospektif olarak araştırılması&#x0D; amaçlanmıştır.&#x0D; Gereç ve Yöntem&#x0D; Ocak 2018- Ocak 2021 tarihleri arasında YBÜ’deki&#x0D; hastaların ETA örneklerinden izole edilen bakteriyel&#x0D; etkenler ve bu etkenlerin antibiyotik duyarlılık testleri&#x0D; (ADT) hastane veri tabanından retrospektrif olarak&#x0D; elde edildi. Duyarlılık sonuçları European Committee&#x0D; on Antimicrobial Susceptibility Testing (EUCAST) ve&#x0D; gerektiğinde Clinical &amp; Laboratory Standards Institute&#x0D; (CLSI) önerileri doğrultusunda değerlendirildi. Aynı&#x0D; hastaya ait tekrarlayan üremeler değerlendirme dışı&#x0D; bırakıldı.&#x0D; Bulgular&#x0D; Değerlendirilen süre zarfında 1031 adet ETA örneğinden&#x0D; 413’ü (%90,2) gram negatif, 45’i (%9,8) gram&#x0D; pozitif olmak üzere toplam 458 (%44,4) bakteri izole&#x0D; edildi. Gram negatif bakterilerden en sık Acinetobacter&#x0D; baumannii (%43,9), gram pozitif etkenlerden en&#x0D; sık Staphylococcus aureus (%5,9) tespit edildi. İzole&#x0D; edilen A. baumannii suşlarınının tüm yıllarda birçok&#x0D; antibiyotiğe yüksek direnç gösterdiği tespit edilmiş&#x0D; olup, en yüksek direnç %96,6 oranıyla karbapenem&#x0D; grubuna karşı saptandı. Genişlemiş spektrumlu beta&#x0D; laktamaz (GSBL) pozitifliği Escherichia coli suşlarında&#x0D; %48,1; Klebsiella pneumoniae suşlarındaysa&#x0D; %70,8 oranlarında tespit edildi. Çalışmamızda Metisiline&#x0D; dirençli Staphylococcus aureus (MRSA) %20,7,&#x0D; metisiline dirençli Koagülaz negatif Stafilokok (KNS),&#x0D; %76,9 oranında tespit edildi.&#x0D; Sonuç&#x0D; YBÜ’sinde yatan hastalarda gelişen enfeksiyonların&#x0D; belirgin özelliği sıklıkla antibiyotiklere dirençli patojenlerin&#x0D; etken olmasıdır. Enfeksiyona neden olan etkenin&#x0D; tanımlanması, antibiyotik direnç profilinin belirlenmesi&#x0D; antibiyotik seçimine yön verecek ve YBÜ’deki uygunsuz&#x0D; antibiyotik kullanımının önüne geçilmesine ve direnç&#x0D; oranlarını azaltmaya katkı sağlayacaktır.

Investigation of Microbial Etiology in Endotracheal Aspirate Samples of Severe Pneumonia Patients by Multiplex PCR and Culture Method

Objectives: The probability of detecting viral and atypical agents in pneumonia patients has increased with the molecular methods used in recent years. We aimed to investigate pneumonia pathogens in endotracheal aspiration samples (ETA) of patients with severe community-acquired (CAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP) by multiplex polymerase chain reaction (m-PCR) and culture method. Methods: A prospective study was performed between December 2019 and October 2020. Patients 18 years and older with pneumonia followed in ICU on the mechanical ventilator were included. COVID-19 patients were excluded. Patients were grouped as CAP, HAP, and VAP. Two ETA samples were obtained from patients within 48 hours of the pneumonia diagnosis. Respiratory pathogens were investigated in samples by viral-bacterial m-PCR and bacterial culture methods. Results: 74 patients were included in the study. m-PCR of ETA samples achieved pathogen detection in 87.8% of patients compared with 58.1% with culture methods. The most common pathogen detected by m-PCR was Streptococcus pneumoniae in both CAP and HAP patients and Klebsiella spp. in VAP patients. The most common pathogen isolated by culture was Staphylococcus aureus in both CAP and HAP patients and Klebsiella spp. in VAP patients. Atypical pneumonia pathogens were positive for 14.9% of the patients. Atypical pathogens were recovered from 28.5% of CAP patients and 23.1% of HAP patients. Viruses constituted all of the atypical pathogens recovered from HAP patients. No atypical pathogen was found in VAP patients. Conclusion: In this study, S. pneumoniae was the most common pathogen detected with m-PCR, and S. aureus and Klebsiella spp. were the most common pathogens detected with culture. Determination of microbial etiology of lower respiratory tract samples by molecular methods for diagnosing severe CAP and HAP may be beneficial in terms of treatment. Keywords: pneumonia, multiplex PCR, endotracheal aspirate, conventional methods

P455 Identification of Cryptic species of Aspergillus using Beta-tubulin gene in a tertiary care center in South India

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM ObjectivesTo identify cryptic species of the genus Aspergillus using Beta-tubulin gene by sequence typing.Methods Aspergillus grown from various clinical samples (Ear swab, Bronchial wash, Endotracheal Aspiration, Paranasal sinus, BAL, Sputum) was subcultured on Sabouraud's Dextrose Agar/Oatmeal Agar.Tease mount/Slide culture was done to study the morphological features of the hyphae, size, shape, and arrangement of the conidia.DNA Extraction using phenol-chloroform method: DNA was extracted and purified directly from 4-day-old culture and used as a template for polymerase chain reaction (PCR) amplification.DNA Amplification: A fragment of the target gene were amplified using PCR.The primer pairs used for Beta-tubulin gene was Bt2a (Forward primer) and Bt2b (Reverse primer).Beta-tubulin.Bt2a FGGTAACCAAATCGGTGCTGCTTTCBt2b RACCCTCAGTGTAGTGACCCTTGGCDNA Purification: The PCR product was purified with multi-screen filter plates.Gel electrophoresis: The amplified DNA product was subjected to agarose gel electrophoresis and specific band formation was to be observed for the species of Aspergillus.DNA Sequencing: The purified product will be used as a template for sequencing. An applied biosystem 3730 sequencer will be used to obtain DNA sequences.Phylogenetic Analysis: Parsimony analysis of individual and combined matrices will be conducted using PAUP version 4.0b10 software/free software at phylogeny.fr by the maximum parsimony (MP) and Neighbor-joining methods.The results will be represented using a dendrogram.ResultsA total of 30 Aspergillus isolates were collected and identified using Phenotypic methods.The DNA extraction and PCR amplification were done and sent for Sequencing. The results of Sequence typing are awaited.ConclusionCryptic species are morphologically indistinguishable forms of Aspergillus and their identifications can be confirmed exclusively by using molecular techniques which have led to the description of previously unknown or rare species among different Aspergillus species complex. According to studies, the frequency of such species was found to be 10% in TRANSNET study U.S and 12% in FILPOP study Spain. Most of these species are less susceptible and certain species are multidrug-resistant (azoles and amphotericin B) and the emergence of antifungal-resistance among the Aspergillus species forms the importance in identifying Cryptic species.

P211 Fungal and bacterial co-infections of the respiratory tract among patients with COVID-19 hospitalized in intensive care units

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM BackgroundsThe pandemic of COVID-19 has created a global public health crisis. ICU patients with COVID-19 are prone to infections of bacterial and/or fungal origins due to several risk factors. Consequently, the current study was conducted to evaluate the frequency, demographic characteristics, underlying conditions, and etiologic agents of fungal and bacterial co-infections of the respiratory tract among ICU patients with COVID-19 in Iran.Materials and MethodsFrom May to October 2020, sputa and endotracheal aspirates were collected from ICU patients hospitalized with COVID-19 who also were suspected of bacterial and/or fungal co-infections according to inclusion criteria. The etiologic agents of bacterial co-infections were identified using the VITEK 2 identification method. For fungal identification, all samples were analyzed by direct microscopy using KOH 10% and culture. Furthermore, all isolates were subjected to the sequencing method.ResultsA total of 73 lung specimens were obtained from patients who met the inclusion criteria. Of these, in 15 cases (20.54%) fungal and/or bacterial co-infections were confirmed. Males were more infected (73.33%) and all of them were between 49 and 79 years. Candida albicans (n = 8, 61.53%) and Klebsiella pneumonia (n = 5, 38.46%) were the most frequent etiologic agents related to fungal and bacterial co-infections, respectively. Pneumonia (n = 15, 100%) and diabetes mellitus (n = 8, 53.33%) were documented as the most prevalent underlying conditions. In the current study, 3 out of 15 patients (20%) died.ConclusionThe frequency of bacterial co-infections of the respiratory tract in ICU patients hospitalized with COVID-19 was relatively high. According to the results, one of the causes of death in these patients could be a secondary infection.

P401 Identification and characterization of cryptic species of Aspergillus isolated from clinical samples

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM Background and ObjectiveMolds are emerging as a major cause of life-threatening infections in immunocompromised patients. There is an increasing recognition of the cryptic Aspergillus species, which are organisms that are morphologically indistinguishable yet can be differentiated by molecular methods. These organisms have been known to show a higher minimal inhibitory concentration for the majority of the antifungal agents in vitro. Therefore, correct identification of these cryptic species is very important to administer a proper antifungal agent.In this study, we wish to identify and characterize the cryptic species of Aspergillus from all clinical samples.MethodsPatient routine samples like broncho alveolar lavage, endo-tracheal aspirate, sputum, pus, tissue, and CSF from various wards, OPDs, and ICUs of All India Institute of Medical Sciences, New Delhi which were processed in the Mycology laboratory, department of Microbiology showing growth of Aspergillus species were included in this study. Identification of the isolates was done using phenotypic methods and by Matrix Assisted Laser Desorption Ionization-Time of Flight (MALDI-TOF). For the analysis of cryptic species, the isolates underwent PCR and then sequencing of the ß-tubulin gene was done. Antifungal susceptibility testing was done using micro broth dilution as per the CLSI method.ResultsOf the 92 isolates, using morphological methods, 53 were identified as A. fumigatus, 33 were identified as A. flavus, 3 as A. nidulans, 2 as A. terreus, and 1 as A. niger MALDI-TOF (Vitek MS database) misidentified 2 isolates of A. nidulans and 1 isolate of A, stellatus as A. fumigatus and 1 isolate of A. tubingensis as A. niger. The ß-tubulin sequence analysis for the identification of cryptic species revealed that 2 isolates (2.08%) were cryptic, one was A. stellatus morphologically identified as A. nidulans and another one was A. tubingensis morphologically identified as A. niger.ConclusionCurrently the available data on cryptic Aspergillus species is very limited. Because of its varied susceptibility pattern, it is important to identify the Aspergillus isolates to its species level. There is also a need for expansion of the number of strains for each species in MALDI-TOF MS databases for convenient, faster, and correct identification.

Microbial isolates and their antimicrobial resistance pattern from endotracheal aspirates: a retrospective observational study over one year at a tertiary care hospital of Bangladesh

Background: Emergence of multidrug resistant (MDR) organisms causing ventilator-associated pneumonia (VAP) is an increasing threat with substantial mortality in critically ill patients. Aetiology and treatment of VAP in mechanically ventilated patients can be evaluated by analysis of culture reports periodically for better understanding of microbial isolates and their antimicrobial susceptibility pattern. The present study aimed to analyze the culture and sensitivity pattern of endotracheal aspirates in intensive care unit (ICU) patients.&#x0D; Methods: A hospital-based retrospective study was done in the Department of Microbiology, BIRDEM General Hospital, Dhaka, Bangladesh from January to December, 2019. Data were obtained from the laboratory record book conserved in the Department of Microbiology. Isolates of endotracheal aspirates from 715 patients were identified and their antibiotic susceptibility were (done by standard microbiological methods) recorded.&#x0D; Results: Out of total 715 endotracheal aspirates, growth was obtained from 482 (67.4%) samples. Among the 482 culture positive samples, 714 isolates were identified of which 250 (51.9%) yielded single organism and 232 (48.1%) were double organisms. Among total isolates, 642 (89.9%) were bacteria and 72 (10.1%) were fungi. Gram negative bacilli were mostly isolated organisms (85.6%) followed by fungi (10.1%) and gram positive cocci (4.3%). Acinetobacter sp. (40.6%) was the most prevailing of all isolates followed by Klebsiella sp.(29.4%), Pseudomonas sp. (11.2%), Candida sp. (8.7%), Staph. aureus (3.8%), Esch. coli (2.8%) and Aspergillus sp. (1.3%). Almost all (90-100%) of the Acinetobacter sp., Klebsiella sp., and Esch. coli showed resistance to 3rd generation cephelasporin, aztreonam, amoxicillin-clavulunate and ciprofloxacin and lowest resistance was noted to tigecycline (5.2%, 13% and 0% respectively). Imipenem was found resistant to 97.6%, 77.4% and 30% in Acinetobactersp, Klebsiella sp. and Esch.coli respectively. Resistant pattern of Pseudomonas sp. to ceftazidime (72.5%), aztreonam (81.2%), imipenem (75%), aminoglycosides (70-76%), ciprofloxacin (72.5%), piperacillintazobactum (41.2%) and colistin (11.2%) were also noted. Methicillin-resistant Staph. aureus (MRSA)were 77.8% and 75% Enterococcus sp. showed high level resistance to gentamicin (HLGRE). No vancomycin resistant Staph. aureus(VRSA) or Enterococcus sp. (VRE) was detected in this study.&#x0D; Conclusion: Gram negative isolates were large-scale than any other microorganism. Of them, Acinetobacter sp. was most quotidian followed by Klebsiella sp. Acinetobacter sp. and Klebsiella sp. were highly resistant to different antibiotics including imipenem and piperacillin-tazobactum. High rate of colistin resistant Pseudomonas sp. were also observed. Combined clinical, microbiological and infection control strategies can guide appropriate patient management and antimicrobial stewardship program to combat antibiotic resistance in critical care set up in Bangladesh.&#x0D; BIRDEM Med J 2022; 12(3): 195-200

Lateral flow test performance in children for SARS-CoV-2 using anterior nasal and buccal swabbing: sensitivity, specificity, negative and positive predictive values

ObjectiveTo determine if the sensitivity of the lateral flow test is dependent on the viral load and on the location of swabbing in the respiratory tract in children.DesignPhase 1: Routinely...

420.1: Successful Transplantation From Selected SARS-CoV-2 RNA Positive Deceased Donors

Introduction: In the UK, the SARS-CoV-2 status of deceased donors is assessed by specific questionnaire and by universal Nucleic Acid Test (NAT) for SARS-CoV-2 RNA in nose and throat swabS (NTS) and endotracheal aspirateS (ETA). Initially, only asymptomatic and NAT-negative donors were accepted. Improved understanding of the relationship of SARS-CoV-2 replication to viral RNA detection as well as a more detailed testing approach have enabled consideration of NAT-positive donors. Methods: Donor information and detailed SARS-CoV-2 RNA screening results were collected in real-time. SARS-CoV-2 NAT positivity triggered repeat sampling for the clarification of significance. Laboratory-proven diagnosis of SARS-CoV-2 infection in deceased donors or recipients of solid organs in England were captured by data linkage between the organ transplant registry and the National laboratory reporting system. Recipient infection within 14 days from organ transplantation was reviewed for the possibility of donor-transmitted infection. Results: Between 1st March 2020 and 9th February 2022, 3537 potential donors were assessed in the UK. Thirty-seven tested NAT positive during donor assessment, with 17 not proceeding to donation due to the result (15) or due to other reasons (2). Of the remaining 20, the majority had a result profile indicating previous resolved infection, with detection of residual viral RNA; in the absence of evidence of previous infection some of the very weakly reactive NAT results might have been due to false positivity. Two donors had results compatible with current but resolving asymptomatic infection. Organs from these 20 donors were offered for transplantation, resulting in 57 organ transplants into 53 recipients (3 heart, 14 liver, 3 pancreas, 31 kidney). Six lungs were transplanted from donors with NAT negative ETA and whose positive NTS results were at the limit of assay detection and not repeatable upon re-sampling. No donor-transmission of virus has been identified, with good transplant outcomes achieved. Conclusion: SARS-CoV-2 RNA positivity should be verified and interpreted in conjunction with clinical, epidemiological and virological information. In an asymptomatic individual, other than a current infection, positivity could also be due to previous, resolved infection with detection of residual viral RNA; current, resolving infection; or a false-positive result. This enables consideration of organs that would otherwise be deemed unsafe for transplantation. Our preliminary results suggest that organs other than lungs can be safely transplanted, without SARS-CoV-2 transmission, from selected NAT-positive deceased donors in whom SARS-CoV-2 infection is considered either historical or non-evolving.

Microbiological profile and anti-microbial susceptibility pattern of isolates from endo tracheal aspirate and endo tracheal tube tips in ICU patients

Background: There has been a surge of sufferers contracting healthcare-acquired infections (HAIs) in recent times. This has been further exacerbated by the SARS-CoV-2 pandemic which, beginning in 2020, has severely affected the majority of the world's nations, and one of the biggest problems caused by this infection was the high number of patients who required critical care. Aim: We sought to identify the microbiological profile and antimicrobial susceptibility pattern of bacteria isolated from tracheal aspirate and endotracheal tube (ETT) tips of patients who had to undergo ICU admittance. Methodology: We isolated a total of 150 microbial samples from 131 patients, of which 97 came from endo tracheal aspirates and the remaining 53 samples were obtained from ETT tips, following which the isolation and identification of bacteria was then done according to requisite microbiological assays. The Kirby-Bauer Technique with Mueller-Hinton agar was used to conduct the antimicrobial susceptibility testing in accordance with Clinical and Laboratory Standards Institute (CLSI) 2016 standards. Results: 53 (35%) of the 150 total specimens were from ETT tips, whereas 97 (65%) came from tracheal aspirates. 101 (67%) of the organisms were gram-negative, and 49 (33%) were gram-positive.

Host Respiratory Transcriptome Signature Associated with Poor Outcome in Children with Influenza-Staphylococcus aureus Pneumonia.

Respiratory coinfection of influenza with Staphylococcus aureus often causes severe disease; methicillin-resistant S. aureus (MRSA) coinfection is frequently fatal. Understanding disease pathogenesis may inform therapies. We aimed to identify host and pathogen transcriptomic (messenger RNA) signatures from the respiratory compartment of pediatric patients critically ill with influenza-S. aureus coinfection (ISAC), signatures that predict worse outcomes. Messenger RNA extracted from endotracheal aspirate samples was evaluated for S. aureus and host transcriptomic biosignatures. Influenza-MRSA outcomes were worse, but of 190 S. aureus virulence-associated genes, 6 were differentially expressed between MRSA-coinfected versus methicillin-susceptible S. aureus-coinfected patients, and none discriminated outcome. Host gene expression in patients with ISAC was compared with that in patients with influenza infection alone. Patients with poor clinical outcomes (death or prolonged multiorgan dysfunction) had relatively reduced expression of interferons and down-regulation of interferon γ-induced immune cell chemoattractants CXCL10 and CXCL11. In ISAC, airway host but not pathogen gene expression profiles predicted worse clinical outcomes.

Effects of endotracheal suctioning on respiratory parameters in Pediatric Intensive Care Unit: a prospective observational study

Introduction The endotracheal suctioning is an invasive practice performed in critical care units that allows removal of the pulmonary secretions in intubated patients. During this procedure, patients are exposed to potential risks that health professionals, should prevent or minimize. At date is a shortage of published studies on the frequency of endotracheal suction in pediatric critically ill patients. It is supposed that the endotracheal suction does not affect significantly the assessment of short-term respiratory parameters and therefore may be deferred by the clinical condition of the patient. Methods The study carried out from 1 January to 30 September 2016 in mechanically ventilated pediatric patients at pediatric intensive care unit of Salesi children’s Hospital of Ancona. The study involved the collection of two venous blood samples taken from a central venous catheter: the first blood gas analysis was performed on each patient 1 minute before endotracheal aspiration and after a time interval of about 30 minutes from the endotracheal suctioning a second sample from the same vascular access device. Mean and percentages were calculated for qualitative variables, mean and standard deviation were calculated for quantitative parameters. For inferential purposes, to evaluate the effects of endotracheal aspiration on respiratory parameters detected by blood gas analysis, the student T test was performed for paired data with a 95% confidence interval. Results A total of 40 patients were recruited, of which 14 were females (35%) and 26 were males (65%). The results were as follows: For pH, the mean of the difference in values is .0065 [95% CI -0.0067 - 0.0197]. According to T test for paired data, a p=.3256 was obtained. From the inferential point of view, this difference is not considered statistically significant. For the pO2 the mean of the difference in values is .03 [95% CI-1.62 -1.67]. According to T tests for paired data, a p =.9756 was obtained. For the pCO2, the mean of the difference in values is -1.88 [95% CI -3.81 - 0.06] with a p value = .0577.&#x0D; Discussion Our findings highlighted no statistically significant differences between pre and post endotracheal aspiration values of pH, pO2 and pCO2. This suggests that the aspiration has beneficial effects on the pulmonary mechanics. Therefore, it is declared that the reduction of the frequency of endotracheal aspiration pediatric cause a reduction of the related infectious risks, reducing costs and respiratory nosocomial infections leading to reduced length of hospital stay.&#x0D;

TÉCNICAS DE FISIOTERAPIA RESPIRATÓRIA EM PACIENTES VENTILADOS MECANICAMENTE ELEITAS PELA MAIOR EFICÁCIA PELA PRÁTICA CLÍNICA E LITERATURA

Patients on Invasive Mechanical Ventilation constantly present impaired mucociliary clearance, where respiratory physiotherapy techniques are important in their care. The objective of the study was to analyze and describe the bronchial hygiene maneuvers most used in the clinical practice of physical therapists working in the Intensive Care Unit. The sample consisted of 50 physical therapists who worked in Intensive Care Units, and who answered the questionnaire applied. For the analysis of the results, an electronic database was created and descriptive analysis was used. 50 online questionnaires were answered. The most common maneuvers were: endotracheal aspiration, early mobilization, manual chest compression maneuver, vibrocompression and postural drainage. The reasons for choosing these techniques were “I see them being more effective in clinical practice” and “The literature shows them to be more effective”. It is necessary to carry out more studies to ensure the benefits and disadvantages in the practice of these maneuvers.

Neonatal Staphylococcus Aureus Sepsis: a 20-year Western Australian experience

ObjectivesThe purpose of this study was to characterise neonatal Staphylococcus aureus (SA) sepsis in Western Australia (WA) between 2001 and 2020 at the sole tertiary neonatal intensive care unit (NICU), examine risk factors for sepsis in the cohort, and compare short- and long-term outcomes to control infants without any sepsis.MethodsRetrospective cohort study at the Neonatal Directorate at King Edward Memorial Hospital (KEMH) and Perth Children’s Hospital, using electronic databases and patient medical records.ResultsThe overall incidence of SA sepsis was 0.10 per 1000 live births (62/614207). From 2001 to 2010 the incidence was 0.13/1000 live births, reducing to 0.07/1000 live births from 2011 to 2020. SA was most frequently isolated from endotracheal aspirates, and infants with SA sepsis had longer median duration of ventilatory support than those without any sepsis (31 days vs 18 days respectively, p < 0.001). In our cohort, SA sepsis was associated with worse neurodevelopmental outcomes compared to infants without any sepsis.ConclusionsThe incidence of neonatal SA sepsis has reduced over the last 20 years, suggesting potential effectiveness of the preventative interventions implemented. Endotracheal tube (ETT) colonisation and prolonged ventilation may be under-recognised as potential sources of SA infection. Our study suggests SA sepsis may negatively impact neurodevelopmental outcomes.

Bacterial and fungal communities in tracheal aspirates of intubated COVID-19 patients: a pilot study

Co-infections with bacterial or fungal pathogens could be associated with severity and outcome of disease in COVID-19 patients. We, therefore, used a 16S and ITS-based sequencing approach to assess the biomass and composition of the bacterial and fungal communities in endotracheal aspirates of intubated COVID-19 patients. Our method combines information on bacterial and fungal biomass with community profiling, anticipating the likelihood of a co-infection is higher with (1) a high bacterial and/or fungal biomass combined with (2) predominance of potentially pathogenic microorganisms. We tested our methods on 42 samples from 30 patients. We observed a clear association between microbial outgrowth (high biomass) and predominance of individual microbial species. Outgrowth of pathogens was in line with the selective pressure of antibiotics received by the patient. We conclude that our approach may help to monitor the presence and predominance of pathogens and therefore the likelihood of co-infections in ventilated patients, which ultimately, may help to guide treatment.