Samples Of Bronchial Secretions Research Articles

Comparison of four commercially available chromogenic media to identify Candida albicans and other medically relevant Candida species.

The number of invasive Candida infections has significantly increased in recent decades. For the successful treatment of fungal infections, rapid identification at the species level, particularly in polyfungal infections, is a key factor. In this study, four commercially available chromogenic media, CandiSelect™ 4 (CS4), chromID™ Candida Agar (CCA), BBL™ CHROMagar™ Candida Medium (BBL) and Brilliance™ Candida Agar (BCA) were evaluated for Candida identification. Overall, 181 bronchial secretion samples from intensive care patients were analysed prospectively. In addition, 18 primarily sterile materials, previously tested positive for Candida, were investigated retrospectively. All samples were cultured as recommended by the manufacturer and visually inspected after 24 and 48hours by three independent investigators. As a control, colonies were identified by MALDI-TOF MS. Specificity and sensitivity were determined for Calbicans identification prospectively. CS4 and BCA showed the best overall consensus with the identification results reached by MALDI-TOF MS for Candidaalbicans and species. A clear differentiation between the species could be ascertained via easily identifiable, species-specific coloration in contrast to BBL and CCA. Sensitivity for Calbicans (n=73) identification varied between 32% (BCA) and 69% (CS4 and CCA) after 24hours and 68% (BBL) and 82% (BCA) after 48hours incubation, while specificity ranged between 62% (BBL) and 81% (CCA) after 24hours and 82% (BBL) and 85% (CS4) after 48hours. CS4 and BCA are recommended for routine identification of Candida species in human samples.

Clinical disease and lung lesions in calves experimentally inoculated with Histophilus somni five days after metaphylactic administration of tildipirosin or tulathromycin.

To compare clinical disease and lung lesions in calves experimentally inoculated with Histophilus somni 5 days after metaphylactic administration of tildipirosin or tulathromycin. ANIMALS Twenty-four 3-month-old Holstein and Holstein-crossbreed steers. Calves were randomly allocated to 3 groups of 8 calves. On day 0, calves in group 1 received tildipirosin (4 mg/kg, SC), calves in group 2 received tulathromycin (2.5 mg/kg, SC), and calves in group 3 received isotonic saline (0.9% NaCl) solution (1 mL/45 kg, SC; control). On day 5, calves were inoculated with 10 mL of a solution containing H somni strain 7735 (1.6 × 10(9) CFUs/mL, intrabronchially; challenge). Calves were clinically evaluated on days 5 through 8 and euthanized on day 8. The lungs were grossly evaluated for evidence of pneumonia, and bronchial secretion samples underwent bacteriologic culture. The mean clinical score for each group was significantly increased 12 hours after challenge, compared with that immediately before challenge, and was significantly lower for tildipirosin-treated calves on days 6, 7, and 8, compared with those for tulathromycin-treated and control calves. The mean percentage of lung consolidation for tildipirosin-treated calves was significantly lower than those for tulathromycin-treated and control calves. Histophilus somni was isolated from the bronchial secretions of some tulathromycin-treated and control calves but was not isolated from tildipirosin-treated calves. Results indicated that metaphylactic administration of tildipirosin to calves 5 days prior to H somni challenge prevented subsequent culture of the pathogen from bronchial secretions and was more effective in minimizing clinical disease and lung lesions than was metaphylactic administration of tulathromycin.

Concomitant tuberculosis and lung cancer diagnosed by bronchoscopy

INTRODUCTION: Tuberculosis (TB) in patients with lung cancer may be masked by cancer symptoms; in the Health District of South Granada (HDSG), as part of the TB monitoring programme, samples of bronchial secretions for studies for TB were obtained in all fibre-optic bronchoscopies (FBS) performed for all indications. The objective was to determine the existence of any association between TB and lung cancer in our area. METHODS: This was a prospective study of all cases of TB diagnosed in the HDSG between 1st January 2003 and 31st December 2010. Absolute and relative frequencies were calculated for qualitative variables and mean and standard deviation were calculated for quantitative variables. Data analyses was performed using the IBM SPSS Statistics 19 software. RESULTS: TB was diagnosed in 319 cases, 272 (85,2%) of which were pulmonary (PTB); the diagnosis was made by FBS in 33 cases. Concomitant TB and lung cancer were diagnosed in 15 cases (5.7% of cases of PTB in patients over 20 years of age). Radiological findings included atelectasis and/or pulmonary infiltrates in 13 cases, cavitated mass and hilar mass associated with milliary pattern in one patient each. Lung cancer stage was III-IV in 9 cases (all died) and I-II in 6 cases, in which both diseases were considered cured. CONCLUSIONS: The high association between TB and lung cancer found in our sample (4.7% of all cases of TB) compared with other studies (1,9%) suggests that it would be advisable to exclude TB in all cases of lung cancer; this is particularly important in areas with a high prevalence of TB, especially because the same FBS can obtain samples for both pathological and microbiological studies.

Concomitant tuberculosis and lung cancer diagnosed by bronchoscopy.

South Granada Health Area (SGHA), Spain. To describe the characteristics of concomitant tuberculosis (TB) and lung cancer cases. A total of 319 TB cases diagnosed between January 2003 and December 2010 were evaluated and identified using a prospective database. During this period, samples of bronchial secretions were obtained from all patients who underwent fibreoptic bronchoscopy (FBS) as part of a TB screening programme. A descriptive study was conducted. Concomitant TB and lung cancer were diagnosed in 15 cases (4.7% of total TB cases). The most common radiographic finding was atelectasis (53.3%), and the most common histological type was epidermoid carcinoma (60%). Lung cancer stage was advanced (III-IV) in 60% of the cases. The association between TB and lung cancer found in the SGHA after implementing a TB screening programme was higher than in other studies. This suggests that it would be advisable to perform acid-fast bacilli smear and mycobacterial culture of bronchial aspirates in all patients with presumed lung cancer, particularly in high TB prevalence areas.

Pharmacokinetics of Ciprofloxacin and Its Penetration into Bronchial Secretions of Mechanically Ventilated Patients with Chronic Obstructive Pulmonary Disease

We evaluated the pharmacokinetic profile of ciprofloxacin and its penetration into bronchial secretions of critically ill patients with chronic obstructive pulmonary disease (COPD). Twenty-five mechanically ventilated patients with severe COPD who were suffering from an acute, infectious exacerbation were included in this prospective, open-label study. All subjects received a 1-hour intravenous infusion of 400 mg ciprofloxacin every 8 h. Serial blood and bronchial secretion samples were obtained at steady state, and concentrations were determined using high-performance liquid chromatography. The pharmacodynamic parameters that are associated with the efficacy of fluoroquinolones against Gram-negative pathogens were also calculated. The mean peak (maximum) concentration (C(max)) and trough (minimum) concentration in plasma were 5.37 ± 1.57 and 1 ± 0.53 mg/liter, respectively. Mean values for volume of distribution, clearance, half-life, and area under the curve from 0 to 24 h (AUC(0-24)) were 169.87 ± 84.11 liters, 26.96 ± 8.86 liters/h, 5.35 ± 2.21 h, and 47.41 ± 17.02 mg · h/liter, respectively. In bronchial secretions, a mean C(max) of 3.08 ± 1.21 mg/liter was achieved in 3.12 ± 1.01 h, and the penetration ratio was 1.16 ± 0.59. The target of AUC(0-24)/MIC of ≥125 was attained in all patients, in the majority of them (76%), and in none at MICs of 0.125, 0.25, and 1 μg/ml, respectively. Slightly better results were obtained for the ratio C(max)/MIC of ≥10. In conclusion, ciprofloxacin demonstrates excellent penetration into bronchial secretions. There is wide interindividual variability in its pharmacokinetic parameters in critically ill COPD patients and inadequate pharmacodynamic exposure against bacteria with MICs of ≥0.5 μg/ml.

Comparison of direct antimicrobial susceptibility testing methods for rapid analysis of bronchial secretion samples in ventilator-associated pneumonia

Two hundred and fifty tracheal aspirates were subjected to direct antimicrobial susceptibility testing by disk diffusion, Etest and inoculation on antibiotic-enriched MacConkey agar plates. Results were compared with those obtained using an automated system on microorganisms recovered from standard quantitative culture. A total of 255 microorganisms were isolated from 194 positive samples by the standard quantitative procedure. A total of 85.1%, 82.5% and 72.5% agreement between direct disk diffusion, Etest and antibiotic-enriched MacConkey agar plates, respectively, and the standard procedure was observed in 64 microorganisms obtained from monomicrobial cultures that corresponded to 240 individual microorganism–antimicrobial agent combinations. Three (1.3%) and four (1.7%) very major errors for direct disk diffusion and Etest methods were observed, respectively. The antibiotic-enriched MacConkey agar plate method compared with the standard procedure demonstrated an unacceptable rate of very major (6.7%) and major errors (14.2%). Clinical evaluation of direct susceptibility tests based on the speculative impact on clinical practice by guiding patient's early treatment, if all positive cultures corresponded to infection, was correct in 79.9% for the direct disk diffusion test, 77.8% for the direct Etest method and 68.0% for antibiotic-enriched MacConkey agar plates. Direct diffusion tests (Etest or disk diffusion) applied on respiratory samples are rapid techniques that provide results comparable with standard antimicrobial susceptibility testing in <24 h.

Analysis of cephalosporins in bronchial secretions by capillary electrophoresis after simple pretreatment

The applicability of capillary zone electrophoresis (CZE) for analysis of cephalosporin antibiotics has been studied in bronchial secretion as highly viscous, thick and non-homogeneous samples. The lyophilization was found to be a simple but effective pretreatment of these samples to bring them into a form which is suitable for injection to CE capillary. The obtained good recovery data prove that the lyophilization/dissolution of bronchial secretion samples can be reproducibly performed.

Concentrations of ceftibuten in bronchial secretions.

Ceftibuten is a broad-spectrum oral cephalosporin exhibiting antimicrobial activity against a wide range of gram-negative and some gram-positive pathogens. Pharmacokinetic studies have shown that the molecule has an oral bioavailability higher than 90% of the administered dose (reaching peak serum concentrations of 5-19 mg/l after a single dose of 200 and 400 mg). Moreover, ceftibuten has been shown to be useful in the treatment of acute lower respiratory tract infections. This study was performed to determine the distribution of ceftibuten in bronchial secretions from patients affected by the exacerbation of chronic bronchitis. Patients were treated with a single 400-mg oral dose of ceftibuten. Blood and bronchial-secretion samples were obtained just before, and at 0.5, 1, 2, 4, 8, 12, 16 and 24 h after dosing. Cells were separated from bronchial secretions by centrifugation. Ceftibuten in duplicate samples of both serum and bronchial secretion was quantified by HPLC. Ceftibuten reached peak levels 2 and 4 h after oral administration in serum and in bronchial secretions, respectively (18.12 +/- 2.13 and 9.19 +/- 3.1 mg/l, respectively). Falling curves after the peaks showed a monoexponential decay. The absorption was very rapid both in serum and bronchial secretions, but elimination was slower in bronchial secretions than in serum.

Penetration of ciprofloxacin into bronchial secretions from mechanically ventilated patients with nosocomial bronchopneumonia

The aim of the study was to evaluate the penetration of ciprofloxacin into bronchial secretions from mechanically ventilated patients with nosocomial bronchopneumonia. For this purpose, in each patient studied, simultaneous serial blood and bronchial secretion samples were obtained over a 12-h period on days 2 and 4. Eight patients were included in the study. Ciprofloxacin was given at a dose of 200 mg over 30 min by using an automatic pump. Ciprofloxacin was measured by high-performance liquid chromatography. Peak levels of drug in serum were 2.95 +/- 1 mg/liter on day 2 and 2.43 +/- 0.7 mg/liter on day 4. Peak and trough levels in bronchial secretions were 0.95 +/- 0.51 and 0.21 +/- 0.12 mg/liter, respectively, on day 2 and 0.76 +/- 0.17 and 0.18 +/- 0.14 mg/liter, respectively, on day 4. The ratios of peak concentrations in bronchial secretions/serum were 0.32 +/- 0.11 and 0.33 +/- 0.06 on days 2 and 4, respectively. The ratios of the area under the concentration-time curve from 0 to 12 h (AUC0-12) for bronchial secretions/those for serum were 0.66 +/- 0.40 and 0.55 +/- 0.30 on days 2 and 4, respectively. A significant positive correlation was found on day 4 between the AUC0-12 for serum and the AUC0-12 for bronchial secretions. No significant correlations were found between peak values in serum and bronchial secretions.

Penetration of ceftazidime into bronchial secretions in critically ill patients

Five adult patients admitted to ICU, with respiratory failure, required endotracheal intubation and respiratory support. They were treated with ceftazidime because of lower respiratory tract infections. All patients were given ceftazidime at 1, 2 and 3 g dosages in a randomized sequence and timed serum and bronchial secretion samples collected. Mean peak serum concentrations of 60.3, 148.7 and 224.8 mg/L were found in the three treatment groups and mean trough levels of 1.02, 1.85 and 1.63 mg/L respectively. Ceftazidime appeared rapidly in bronchial secretions reaching mean maximal concentrations of 2.2, 4.81 and 5.69 mg/L in the first sampling period (0-2 h). Serum and bronchial secretions AUCs have been calculated showing that both almost doubled their values between 1 and 2 g dosing, while between 2 and 3 g doses only a moderate and non-significant increase were found. On the basis of these results, the existence of a saturable transport mechanism for ceftazidime from serum to bronchial secretions can be postulated.

Penetration of aztreonam into human bronchial secretions.

Nine intubated patients were given a single, 2-g intravenous dose of aztreonam over 5 min. Samples of serum and bronchial secretion were obtained 2, 4, and 8 h after administration and assayed for aztreonam content. The mean concentrations in bronchial secretion ranged from 1.9 to 5.2 micrograms/ml and tended to be highest at 4 h. The concentrations in bronchial secretion varied from patient to patient, but each patient had one or more bronchial secretion samples that contained at least 2.7 micrograms of drug per ml.

Antibodies against Aspergillus fumigatus in bronchial secretions from patients without aspergillosis.

Antibodies to Aspergillus fumigatus were investigated by indirect immunofluorescence (IIF) and enzyme-linked immunosorbent assay (ELISA) in bronchial secretions (BS) and sera from 40 patients with neoplasia, lung infiltrates of non-fungal aetiology or chronic bronchitis. By IIF, IgG aspergillus antibodies were found in 23 samples of BS (58%) (titre range 10-40) and in all 40 sera (titre range 10-1280). IgA aspergillus antibodies were detected in 33 samples of BS (83%) (titre range 10-160) and in 33 sera (83%) (titre range 10-40). IgM aspergillus antibodies occurred in 2 samples of BS (5%) (titre 10 and 40) compared with 35 sera (88%) (titre range 10-40). Antibodies with secretory component (SC) were detected in 20 of 39 BS samples tested (51%) (titre range 10-160). Significantly higher levels of IgA antibodies were detected by ELISA in BS than in serum (2p less than 0.05) and, conversely, significantly higher levels of IgG antibodies were found in serum than in BS (2p less than 0.001). Low levels of antibodies with SC were also detected in BS by ELISA. These results suggest that aspergillus antibodies are produced within the bronchopulmonary system in patients without aspergillosis.

Penetration of cefotaxime into bronchial secretions.

The penetration into bronchial secretions of cefotaxime, a new, highly active cephalosporin, was studied in 45 patients with respiratory infections. Ten patients received 0.75 g and 25 received 1 g of cefotaxime intramuscularly; 10 patients received a 30-min intravenous infusion of 2 g of cefotaxime. Samples of bronchial secretions were obtained by means of fiber-optic bronchoscopy after a single dose in all patients and after three and seven days of treatment in 30 and 15 patients, respectively. Simultaneous serum samples were collected for determination of the relationship between the levels of drug in bronchial secretions and those in serum. Assays were performed by microbiologic agar diffusion. In 30 cases bacteriologic analysis determined the minimal inhibitory concentrations of cefotaxime for the bacteria isolated from sputum. Mean peaks in bronchial secretions reached 1.5-2.5 microgram/ml (according to the groups) after 3 hr; individual concentrations varied according to the dose, the route of administration, and the duration of the treatment. Ratios between the levels in bronchial secretions and the corresponding levels in serum were approximately 8%-25% after 3 hr, as is usual for other cephalosporins. Cefotaxime reached significant concentrations in bronchial secretions, exceeding the minimal inhibitory concentrations for microorganisms responsible for respiratory infections.

Study of the Diffusion of Cefotiam in the Bronchial Secretions

The objective of this study was to evaluate the concentration in the bronchial secretions of a new injectable cephalosporin, cefotiam, which is characterized by an excellent antibacterial activity, stability against beta-lactamases and interesting pharmacokinetic properties. 30 patients suffering from acute exacerbation of a chronic bronchitis or bronchiectasis with expectoration, received either 1 g i. v. of cefotiam in a single dose or four doses of 1 g each over a period of 3 days. The bronchial secretion samples were obtained by fibroscopy, 1, 2, or 4 h after the last dose, in order to evaluate the kinetics of the bronchial concentration of cefotiam. Blood samples were taken simultaneously in order to establish a possible correlation between the bronchial and serum levels of the drug. The results of the study show a rapid and significant transfer of the drug through the bronchoalveolar capillaries, elevated bronchial concentrations starting from the 2nd h, reaching 10 micrograms/ml (or more) in certain cases, slow elimination with bronchial concentrations persisting at high levels for up to 4 h and a ratio between bronchial and serum concentrations of 25-60% at the 2nd h and more than 100% at the 3rd and 4th h. These results confirm the excellent diffusion of cefotiam, especially in the respiratory tract, allowing bronchial levels largely superior to the minimum inhibitory concentrations required to kill the bacteria usually responsible for lower respiratory tract infections.

Penetration of ampicillin into human bronchial secretions.

Ampicillin concentrations in serum and bronchial secretions after oral administration of bacampicillin were evaluated. Twenty-eight hospitalized patients with acute bronchopulmonary infections received a single dose of 800 mg of bacampicillin. Samples of bronchial secretions were obtained during diagnostic bronchoscopy and blood samples were drawn simultaneously. Significant concentrations of ampicillin were found in bronchial secretions, the peak level, reached after approximately two hours, being 0.27 micrograms/ml on an average. The penetration of ampicillin into the bronchial secretions after the administration of bacampicillin could be correlated with the degree of bronchial inflammation, as illustrated either by macroscopic purulence or protein concentration in the secretions. The results suggest that bacampicillin is a useful drug in acute bronchopulmonary infections.

Usefulness of transtracheal puncture and aspiration in the bacteriological diagnosis of pulmonary tuberculosis

Transtracheal puncture enables two samples of bronchial secretions to be taken-the product of transtracheal aspiration and simultaneously expectorated sputum (obtained in 71% of the cases)-for the purpose of testing for Mycobacterium tuberculosis in cases of suspected pulmonary tuberculosis. Two groups of patients were studied: Group I: 100 patients who were poor expectorators and who all underwent transtracheal puncture; Group II (Control): 100 patients who expectorated well or who had been given gastric lavages immediately on admission. Laboratroy analyses revealed M. tuberculosis in at least one of the samples obtained from each of the 200 patients. The authors compare the efficiency of the methods used within each group and between the two groups. Samples obtained by transtracheal aspiration and simultaneous expectoration (75% of positive results) more often contained M. tuberculosis than the other Group I samples (64% of total positive results; 64% of positive results for spontaneous sputa, 65% for gastric fluids), and as often as the Group II samples (76% of total positive results), particularly the expectoration samples (78% of positive results). Simultaneously expectorated sputum more frequently contained M. tuberculosis (82% of positive results) than transtracheal aspiration (69% of positive results). Transtracheal puncture and/or simultaneous expectoration were the only examinations revealing M. tuberculosis in 34 patients in Group I. Non-specific bacteriological findings are not relevant. However, the authors point out that this technique is not always innocuous (although no serious complications were observed in this series), and that transtracheal puncture must always be carried out by physicians trained in the technique.