Tracheal Secretions Research Articles

TRALI as a Cause of Massive Tracheal Secretions during Cardiac Surgery

TRALI as a Cause of Massive Tracheal Secretions during Cardiac Surgery

Mycobiota recovered from the trachea and lungs of pigeons (Columba livia) captured in a grain mill

Respiratory diseases are commonly related to grain mills in association with fungi. Pigeons (Columba livia) are a potential source of pathogenic fungi and a public health concern, causing economic damages in urban areas. We aimed to determine the tracheal and pulmonary mycobiota of pigeons captured in a grain mill, identifying potentially pathogenic fungi. Captured pigeons were euthanized for the collection of tracheal secretion and lungs in saline suspensions for culture (100µL) in Sabouraud dextrose agar with chloramphenicol (48h/28°C). Yeasts were evaluated after Gram staining in microscopy and cultured in Hicrome®Candida agar, while lactophenol cotton blue solution was used in filamentous fungi/molds. Mycological identification keys were used for the genus determination. 207 fungal (9 genus) were isolated from the trachea and lungs of 21 pigeons captured: 199 molds (96.14%) and 8 yeast (3.86%). Aspergillus spp., Rhizopus spp., Penicillium spp. and Candida spp. were the most prevalent, mainly in lungs. We confirmed yeasts and molds from pigeons, increasing the potential risks for chronic or acute diseases after contact with several fungi from pigeons. A greater control of the presence of pigeons in the work environment is necessary.

Fatal Breakthrough Candidemia in an Immunocompromised Patient in Kuwait Due to Candida auris Exhibiting Reduced Susceptibility to Echinocandins and Carrying a Novel Mutation in Hotspot-1 of FKS1

Candida auris is an emerging yeast pathogen that has recently caused major outbreaks in healthcare facilities worldwide. Clinical C. auris isolates are usually resistant to fluconazole and readily develop resistance to echinocandins and amphotericin B (AMB) during treatment. We describe here an interesting case of C. auris infection in an immunocompromised patient who had previously received AMB and caspofungin treatment. Subsequently, C. auris was isolated from tracheal (tracheostomy) secretions and twice from urine and all three isolates were susceptible to AMB and micafungin. The patient received a combination therapy with AMB and caspofungin. Although the C. auris was cleared from the urine, the patient subsequently developed breakthrough candidemia and the bloodstream isolate exhibited a reduced susceptibility to micafungin and also showed the presence of a novel (S639T) mutation in hotspot-1 of FKS1. Interestingly, C. auris from the tracheal (tracheostomy) secretions recovered one and four days later exhibited a reduced susceptibility to micafungin and S639Y and S639T mutations in hotspot-1 of FKS1, respectively. Although the treatment was changed to voriconazole, the patient expired. Our case highlights a novel FKS1 mutation and the problems clinicians are facing to treat invasive C. auris infections due to inherent or developing resistance to multiple antifungal drugs and limited antifungal armamentarium.

Culture and Sensitivity Patterns of Various Bacteriological Agents among Children Admitted in Pediatric Department

The Culture of numerous contaminated fluids of the body are commonly used to determine the aetiology of infection and to help medicine specialists and pediatricians to select the suitable antimicrobial treatment. The objective of this analysis is to govern the culture and sensitivity patterns to bacteriological agents’ grownup in children. Methods: This descriptive cross-sectional study was held at the Paediatric Medicine department of Abbasi Shaheed Hospital Karachi, for one-year duration from November 2020 to November 2021. All ≤15-year-old children who met the criteria for sepsis and systemic inflammatory response syndrome were included in the study. Any body fluids or blood were cultivated in the suitable medium as specified. The sensitivity pattern and profile of the cultured microorganisms were recorded and documented in a pre-designed data sheet. SPSS v.22 was applied for data analysis. Results: Of the 300 patients enrolled, 51 (17%) developed multiple organisms in culture and these have been described in more detail. Of these 51 patients with positive culture, 47.1% were male with a M:F ratio of 1.3: 1. Of the 51 patients, 21 (41.2%) were less than one- year old, and 14 (27.5%) were one to five years old, 9 (17.6%) was between 5 and 10 years old and 7 (13.7%) were 10 to 15 years of age. Twenty-three patients (45.1%) showed an increase in microorganisms in the blood smear. Throat swab, tracheal secretions and sputum cultures were positive in 11 patients (21.6%), CSF cultures were positive in 13 (25.5%), and urine cultures in 10 (19.6%), Swabs (ear and skin) cultures were positive in 7 (13.7%) and 3 (5.9%) have positive pleural fluid cultures. The most frequently isolated microorganism is Salmonella spp. (17.6%), Klebsiella spp. (15.7%), Escherichia coli (11.8%), Acinetobacter (9.8%), Staphylococcus aureus (7.8%), Pseudomonas aeruginosa (13.7%), Streptococcus pyogenes (7.8%), Stenotrophomonas maltophilia (3.9%) and Enterobacter spp. (7.23%). Conclusions: The most frequently isolated microorganisms were Salmonella spp., Staphylococcus aureus, Klebsiella spp., E coli and Streptococcus pyogenes. The antibiotics resistance in various cultures is a warning in contradiction of overuse of antibiotics.

Protease-anti-protease compartmentalization in SARS-CoV-2 ARDS: Therapeutic implications.

SummaryBackgroundInterleukin-6 (IL-6) is elevated in SARS-CoV-2 infection. IL-6 regulates acute-phase proteins, such as alpha-1 antitrypsin (AAT), a key lung anti-protease. We investigated the protease-anti-protease balance in the circulation and pulmonary compartments in SARS-CoV-2 acute respiratory distress syndrome (ARDS) compared to non-SARS-CoV-2 ARDS (nsARDS) and the effects of tocilizumab (IL-6 receptor antagonist) on anti-protease defence in SARS-CoV-2 infection.MethodsLevels and activity of AAT and neutrophil elastase (NE) were measured in plasma, airway tissue and tracheal secretions (TA) of people with SARS-CoV-2 ARDS or nsARDS. AAT and IL-6 levels were evaluated in people with moderate SARS-CoV-2 infection who received standard of care +/- tocilizumab.FindingsAAT plasma levels doubled in SARS-CoV-2 ARDS. In lung parenchyma AAT levels were increased, as was the percentage of neutrophils involved in NET formation. A protease-anti-protease imbalance was detected in TA with active NE and no active AAT. The airway anti-protease, secretory leukoprotease inhibitor was decreased in SARS-CoV-2-infected lungs and cleaved in TA. In nsARDS, plasma AAT levels were elevated but TA samples had less AAT cleavage, with no detectable active NE in most samplesInduction of AAT in ARDS occurred mainly through IL-6. Tocilizumab down-regulated AAT during SARS-CoV-2 infection.InterpretationThere is a protease-anti-protease imbalance in the airways of SARS-CoV-2-ARDS patients. This imbalance is a target for anti-protease therapy.

A Comparison of Pharyngeal Swabs and Tracheal Secretions for the Diagnosing of COVID-19.

The aim of this study was to compare the test results from patients who, within a short timescale, have been tested for COVID-19 using both a pharyngeal swab and tracheal secretion. Data were collected from the database of AUH, from patients hospitalized between 1 March 2020 and 1 March 2021 who, due to symptoms of COVID-19, were tested by a pharyngeal swab and by tracheal secretion. We found great agreement between oropharyngeal swab and tracheal secretion RT-PCR testing for the diagnosis of COVID-19, with 98.5% of double tests being concordant and only 1.5% being discordant. This finding may advocate a single-test strategy being either an oropharyngeal swab RT-PCR testing or tracheal secretion, although this study revealed 15.9% false negative oropharyngeal swabs.

To Determine the Frequency of Mortality in Neonates with Sepsis Having High MPV

Introduction: A high MPV on admission in septic patients may be a useful indicator associated with poor outcome especially when it is associated with decreasing platelet numbers. Objective: To determine the frequency of mortality in neonates with sepsis having high MPV. Material & Method: Study design: Descriptive case series study Settings: NICU, Shifa International Hospital, Islamabad Methodology: All newborns of both genders up to 28th day of life who have culturally proven sepsis or probable sepsis with gestational age of ≥28 weeks, birth weight > 700gms were enrolled. The initial investigations on admission was carried out as per NICU septic screening protocol includes complete blood count CBC, C-Reactive Protein (CRP), electrolytes, renal function tests, blood C/S, urine R/E urine C/S, x-ray chest while the other investigations including CSF analysis, gram staining and culture, tracheal secretions and catheter tips for culture and sensitivity are performed when indicated clinically. Outcome was measured till discharge or death. Results: Mean age of the patients was mean ±SD 6.58 ±5.72 days. Most of the neonates 59 (62.1%) were males whereas 36 (37.9%) were females. Mean CRP, TLC count, platelet count, TLC count at baseline were 21.23 ±42.34, 15190.5 ±4619.32, 254348.42 ±101479.87 respectively. MPV at baseline 10.56 ±0.85 and at 48 hours was 9.96 ±0.81 respectively. Mortality was observed in 22 (23.2%) neonates. Conclusion: The frequency of mortality was found to be 23.2% in neonates with sepsis having high MPV. Keywords: Mortality, Neonates, Sepsis, Mean Platelet Volume

Microbiological profile and antibiotic susceptibility pattern of gram-negative isolates from tracheal secretions in a tertiary care setup

Among intensive care unit patients, lower respiratory tract infections (LRTI) are one of the most common infections to occur. The aim of this study was to determine the microbiological profile and antibiogram of pathogens isolated from tracheal secretions. Place of study. Dr. D. Y. Patil Medical college; Type of study - Retrospective study and cross-sectional study; Study period- April 2020 to September 2020 (6 months).152 isolates from non-repeated samples received for culture and sensitivity were considered for the study. Sample -Tracheal secretions. The sample was processed on blood and MacConkey's agar, identification done by standard biochemical tests, and antibiotic sensitivity was performed by disk diffusion (Kirby-Bauer test) method on Muller Hinton agar According to CLSI 2020 guidelines. Total- 152 tracheal aspirates; Positive samples- 148. The most commonly reported among the isolates was Klebsiella pneumoniae 51, (64.7%) followed by Acinetobacter Spp 45(30.40%) and Pseudomonas 37(25%). Alarming rate of resistance was seen in gram-negative isolates in tracheal secretions to carbapenems but good sensitivity was seen in tigecycline and colistin both. So, with a lack of new antibiotics, the current scenario presents a major threat in dealing with these pathogens in the future.

Molecular identification and biofilm-forming ability of Elizabethkingia species

Recently, Elizabethkingia species have gained attention as a cause of life-threatening infections. The identification via phenotypic methods of three important species- Elizabethkingia meningoseptica, E. anophelis and E. miricola is difficult. Our objectives were to re-assess 30 archived Flavobacterium meningosepticum isolates using 16S rRNA gene sequencing, ERIC-PCR, and biofilm formation assay. Twenty-four isolates were re-identified as E. anophelis and 6 as E. miricola. All of them had the ability to form biofilm as shown in microtiter plate assay based on crystal violet staining. Overall, E. anophelis had a higher specific biofilm formation index compared to E. miricola. A total of 42% (10 out of 24) of E. anophelis were classified as strong, 29% (7 out of 24) as moderate and 29% (7 out of 24) as weak biofilm producers. E. miricola, 17% (1 out of 6) isolates were strong biofilm producers, 50% (3 out of 6) moderate and 33% (2 out of 6) were weak producers. E. anophelis from tracheal secretions were significantly associated with (p = 0.0361) strong biofilm formation. In summary, this study showed that the isolates originally identified as F. meningosepticum were re-classified using the 16S rRNA gene as one of two Elizabethkingia species. The ability of E. anophelis to form strong biofilm in endotracheal tubes indicates their probable role in the pathogenesis of Elizabethkingia infections.

Bronchopneumonia in sheep associated with Providencia stuartii

Bacteria of the genus Providencia are opportunistic pathogens in humans, widely distributed in the environment and associated with greater resistance to antibiotics, and this being uncommon the association with clinical diseases. This study reports the isolation of P. stuartii in two sheep that presented clinical signs of pneumonia. At necropsy there was severe and acute fibrinopurulent bronchopneumonia. Histologically, there were infiltrated neutrophils and fibrin in the alveolar lumen, and the alveolar septa presented multifocal thickening with moderate proliferation of pneumocytes and mononuclear interstitial infiltrate. Providencia sp. was isolated in the microbiological tests of the lung and tracheal secretions. The isolate was subjected to DNA extraction, polymerase chain reaction (PCR) for the 16SrRNA gene and sequencing of genomic DNA, which demonstrated 100% homology with P. stuartii. This is the first report of the presence of this microorganism as a cause of interstitial and fibrinopurulent bronchopneumonia in sheep. Therefore, it is suggested that epidemiological surveillance strategies should be carried out in animals to better understand their role in the dissemination of this pathogen.

Culture and sensitivity patterns of bacteriological agents in children admitted to a tertiary care hospital

Background: Culture from various infected body fluids is one of the commonly used investigations to establish the etiology of infections and helps clinicians to select appropriate antimicrobial therapy. This study is aimed to determine the culture and sensitivity patterns of bacteriological agents grown in children admitted to a tertiary care center.
 Patients and methods: This descriptive cross-sectional study was conducted at the Department of Pediatric Medicine, The Children’s Hospital and the Institute of Child Health, Lahore from April 2019 to December 2019. All admitted children of age £ 15 years who fulfilled the criteria of systemic inflammatory response syndrome and sepsis were enrolled in the study. Blood and other body fluids were cultured in appropriate medium as indicated. Profile of microorganisms grown and their sensitivity patterns were noted and recorded on a predesigned data sheet. Statistical analysis was performed by SPSS v.22.
 Results: A total of 500 patients were enrolled in the study. Eighty-three of them (16.6%) had growth of different microorganisms on culture and were further analyzed. Total 58 of these 83 (69.87%) were <5 years of age, Male to female ratio was 1.2:1. Blood culture was positive in 36 patients (43.37%). Cultures from throat swabs, sputum and tracheal secretions showed growth of organisms in 15 (18.10%), while cerebrospinal fluid culture was positive in 14 (16.87%) and urine culture in 11 (13.25%). Microorganism isolated were: Klebsiella spp. (15.66%), Salmonella spp. (14.45%), Escherichia coli (13.25%), Staphylococcus aureus (12.04%), Acinetobacter (12.04%), Streptococcus pyogenes (10.84%), Pseudomonas aeruginosa (10.84%), Enterobacter spp. (7.23%) and Stenotrophomonas maltophilia (3.61%). Klebsiella spp. and E. coli showed resistant to various antibiotics including penicillin, co-amoxiclav, cephalosporin, fluoroquinolones and nalidixic acid. Salmonella spp. was mostly sensitive to meropenem and azithromycin. Staphylococcus aureus was sensitive to cephalosporin, amikacin, vancomycin and linezolid.
 Conclusion: Commonest micro-organism isolated were Klebsiella spp., Salmonella spp., Escherichia coli, Staphylococcus aureus and Streptococcus pyogenes. Resistance to commonly used antibiotics was observed in most cultures, which is a whistle blower against inappropriate use of these drugs.

Hypogammaglobulinemia as a Predictive Factor of Postoperative Complications in Pediatric Cardiac Surgery

Hypogammaglobulinemia, developed as a result of cardiac surgery accompanied by cardiopulmonary bypass (CPB), may be caused by hemodilution, destruction of immunoglobulin, extravasation into the interstitial space related to systemic inflammation, and capillary leak syndrome. Therefore, to address this gap, we analyzed the characteristics of the infants who developed hypogammaglobulinemia after cardiac surgery and could benefit from Immunoglobulin supplementation. Methods: This is a retrospective study evaluating infants undergoing surgery for repair of congenital heart defects from October 1, 2019 to June 30th, 2020 in the neonatal unit of our institution. Due to its retrospective design, informed consent was not required. Patients were divided in two groups: Group 1 (IgG >= 340mg/dL) and Group 2 (IgG < 340mg/dL). The value cut point was defined taking into consideration p10 level of Immunoglobulin according to Fujimura. Results: From October 1, 2019 to June 30th, 2020, 62 children were born or admitted in our neonatal unit. Among them, 19 (30%) have their IgG dosed, according to attending physician decision. Among patients with hypogammaglobulinemia, Pseudomonas sp was present in 87.5% of blood stream and/or tracheal secretion cultures. Regarding survival analysis, mortality was not different between Group 1 and 2. Conclusion: Hypogammaglobulinemia has proved to be a predictor factor of postoperative complications in pediatric cardiac surgery. However, prospective trials are needed to determine the incidence of this problem, its real impact on survival, and the appropriate therapy.

Bacteriological Profile and antibiogram of isolates from tracheal secretions of patients in an intensive care unit

Hospital-acquired pneumonia (HAP) is defined as an infection in patients admitted in hospital for more than 48hours, and ventilator associated pneumonia (VAP) can be defined as infection occurring in patients admitted in ICU after 48hrs endotracheal intubation and mechanical ventilation. VAP has a mean of 7.3/1000 ventilator days for medical ICU patients and 13.2/1000 ventilator days for surgical ICU patients. The crude mortality rates for HAP are approximately 10% and are higher for VAP, ranging from 20% to 60%. The culture of endotracheal (ET) aspirates will help know the etiological agent and formulate the antibiotic policy for early treatment. To isolate the bacterial pathogens of ET secretions from patients with VAP and know their antibiotic susceptibility pattern. In the present study, out of 102 endotracheal secretions from cases of VAP, 88 samples (86.27%) were culture positive, and the remaining 14 samples (13.73%) were culture negative. Out of the 88 positive cultures, 62 samples (60.78%) showed growth of single isolates, and 26 samples (25.49%) showed multiple isolates. Out of the 114 isolates, 18 isolates (15.8%) were gram positive organisms, and 96 isolates (84.2%) were gram negative organisms. Of the gram positive isolates, the predominant organism was Methicillin resistant (MRSA) (55.56%), followed by Methicillin sensitive (MSSA) (22.22%) and (22.22%). Out of the gram negative isolates, the predominant organism was (36.46%), followed by Acinetobacter spp (25%), (23.96%), (12.5%), (1.04%), and Proteus mirabilis (1.04%). In the present study, Gram positives isolates showed the highest susceptibility to vancomycin and linezolid (100%), and gram negative isolates showed the highest susceptibility to polymyxin B (100%) and meropenem (47.92%). The study gives insight into the bacterial pathogens and their antibiotic susceptibility patterns of isolates from endotracheal secretions of mechanically ventilated patients to prevent the mortality and morbidity of mechanical ventilation and VAP, helping in formulating an antibiotic policy for appropriate empirical therapy.

Clinical Pearls

Moral distress occurs when an individual faces constraints in doing the right thing, which challenges the ability to preserve integrity and can result in adverse outcomes such as burnout, diminished well-being, and poor quality patient care. During a pandemic, these constraints can be greatly increased, with health care staff experiencing greater moral distress.Thomas and colleagues conducted a survey with staff in a pediatric intensive care unit, including physicians/advanced practice providers, registered nurses, and respiratory therapists, to explore the extent and sources of moral distress during the COVID-19 pandemic. They found Although more research is needed, the authors suggest that moral resilience can be cultivated by organizations providing support and strategies to promote a healthy work environment.See Article, pp e80–e98Having a family member in the intensive care unit (ICU) can be a very stressful experience and can lead to the development of post–intensive care syndrome in families. Cognitive behavioral therapy (CBT) has been used to treat patients’ psychological distress both in-person and with mobile health apps. However, it is unknown if a CBT mobile app would be effective with family members.Petrinec and colleagues examined the feasibility of using a mobile app to deliver CBT to family members of adult ICU patients. They found Although a larger, randomized controlled trial is needed, the findings support the feasibility of using a mobile health app for family members of ICU patients.See Article, pp 451–458Microaspiration is the leaking of oral or gastric secretions into the lower airway that often occurs in patients receiving mechanical ventilation. Such leakage can result in ventilator-related complications such as ventilator-associated pneumonia. Pepsin A found in tracheal secretions is a biomarker of microaspiration of gastric secretions.Talbert and colleagues examined the association between pepsin A found in tracheal secretions and clinical outcomes in adult patients in the intensive care unit (ICU) who were expected to receive ventilation for at least 36 hours. They found Prevention bundles such as elevating the head of the bed 30º, management of endotracheal tube cuff pressure, and oropharyngeal suctioning were standard care during this study. Further research is needed to better understand the factors that affect microaspiration and ventilator-related events.See Article, pp 443–450Workplace turbulence is known to contribute to burnout and turnover in critical care nurses. Research shows that healthy work environments (HWEs) improve both nurse and patient outcomes. The American Association of Critical-Care Nurses (AACN) developed an HWE framework with 6 evidence-based standards to improve work settings—skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership.Pena and colleagues implemented interventions using the AACN framework and evaluated the effect on nurse satisfaction and retention 2 years later. They found The findings reinforce the value of using an evidence-based framework to implement and evaluate strategies to improve workplace environments. The authors recommend further development of sustainable interventions to improve staff stability.See Article, pp 426–433

Pepsin A in Tracheal Secretions From Patients Receiving Mechanical Ventilation.

In patients in the intensive care unit (ICU) receiving mechanical ventilation, aspiration of gastric contents may lead to ventilator-associated events and other adverse outcomes. Pepsin in pulmonary secretions is a biomarker of microaspiration of gastric contents. To evaluate the association between tracheal pepsin A and clinical outcomes related to ventilator use. A subset of 297 patients from a larger clinical trial on aspiration of oral secretions in adults receiving mechanical ventilation consented to have pepsin A measured in their tracheal aspirate samples. A concentration ≥6.25 ng/mL indicated a positive result. Abundant microaspiration was defined as pepsin A in ≥30% of samples. Statistical analyses included analysis of variance, analysis of covariance, and χ2 tests. Most patients were White men, mean age 59.7 (SD, 18.8) years. Microaspiration was found in 43.8% of patients (n = 130), with abundant microaspiration detected in 17.5% (n = 52). After acuity was controlled for, patients with tracheal pepsin A had a longer mechanical ventilation duration (155 vs 104 hours, P < .001) and ICU stay (9.9 vs 8.2 days, P = .04), but not a longer hospital stay. Microaspiration of gastric contents occurred in nearly half of patients and was associated with a longer duration of mechanical ventilation and a longer stay in the ICU. Additional preventative interventions beyond backrest elevation, oropharyngeal suctioning, and management of endotracheal tube cuff pressure may be needed. Also, the timing of pepsin measurements to capture all microaspiration events requires additional exploration.

English

BACKGROUND The term tracheostomy refers to forming an opening in the trachea.1,2 Its advantages include easy and direct access to lower respiratory tract, reduced risk of aspiration, faster weaning from ventilation support and improved physical and psychological comfort. But a common problem in tracheostomised patients is increased risk of colonisation of lower respiratory tract by exogenous bacteria because of direct exposure.1,3 This study was done to recognise pathogens in tracheal secretions collected from tracheostomised patients and their antibiotic sensitivity to treat them with appropriate antibiotics. METHODS This prospective study was done in 138 tracheostomised patients from October 2020 to March 2021 in intensive care unit (ICU) of Chettinad Hospital and Research Institute. Under sterile aseptic precautions, Day 0 and Day 7 cultures posttracheostomy was obtained and their antibiotic sensitivity was studied. Data was analysed using Statistical Package for Social Sciences (SPSS version 19) and presented in proportion, mean and standard deviation (Descriptive statistics). RESULTS In this study, of the 56 cases who had growth in their culture and sensitivity reports on day 0, the most common organism was Pseudomonas aeruginosa (33.9 %) sensitive to imipenem (94.7 %) followed by klebsiella (25 %) sensitive to teicoplanin, vancomycin, amikacin, cefoperazone/tazobactam, linezolid and piperacillin/tazobactam. On day 7, the growth of organisms isolated in tracheal culture got reduced from 56 cases to 16 cases. The prevalence of Pseudomonas reduced to 18.8 % in day 7 whereas Klebsiella pneumonia and Acinetobacter remained almost same from day 0 to day 7. CONCLUSIONS This study concludes the predominant pathogen as Pseudomonas aeruginosa with sensitivity to imipenem followed by Klebsiella with sensitivity to teicoplanin, vancomycin, amikacin, cefoperazone/tazobactam, linezolid and piperacillin/tazobactam on day 0 with reduction in the number of organisms on day 7 due to the fact that all our patients were admitted in ICU several days prior to tracheostomy and were started on antibiotics soon after admission as per choice of the treating physician. Hence, a clear understanding of bacterial colonisation post tracheostomy and its change in course is essential for timely intervention with empirical antibiotics for reducing the incidence of lower respiratory tract infections after tracheostomy in future. KEY WORDS Tracheostomy, Lower Respiratory Tract Infections, Pseudomonas Aeruginosa, Empirical Antibiotics.

FIGHT AGAINST SUPERBUGS IN A BURN CENTRE: ARE WE DOING ENOUGH

Objective: To determine the superbug infection in a burn centre, its impact on mortality/morbidity and to review all preventive/therapeutic steps taken to fight this menace.&#x0D; Study Design: Retrospective cross sectional study.&#x0D; Place and Duration of Study: Department of Burns &amp; Plastic Surgery, Army Burn Centre, Combined Military Hospital Kharian, from Oct 2018 to Sep 2019.&#x0D; Methodology: A detailed retrospective audit of departmental data was carried out. Parameters like direct admission vs transferred patient, percentage of burns (Total Burn Surface Area-TBSA%), records of all burns related deaths and all culture/sensitivity reports were analysed using SPSS-20. As a standard practice in our unit blood, tracheal secretions and pus culture specimens of all patients are collected at the time of admission and then periodically fresh samples are taken every week or earlier when-ever required.&#x0D; Results: Out of 515 patients, 283 (54.95%) were children under the age of 12 years. The overall survival rate improved by 13.43% as compared to last year. Out of 584 bacteriology reports 396 (67.81%) were positive and 188 (32.19%) were negative. On culture 508 organisms were isolated, majority of which were Carbapenem Resistant Pseudomonas, Acinetobacter, Enterobacteriaceae and Methicillin resistant staphylococcus aureus.&#x0D; Conclusion: Multi drug resistant superbug infection is a worldwide menace. The best clinical practices, strict contact isolation, enhanced environmental cleaning and judicious use of appropriate antibiotics are the main strategies in this war. Need for newer more effective antibiotics cannot be overemphasized.

Prevalence of Nosocomial Infection Microorganisms and the Presence of Antimicrobial Multi-Resistance

BACKGROUND AND OBJECTIVES: hospitals represent the place where multidrug-resistant bacteria are concentrated and from where they spread within the institution and to the community. Thus, this research aimed to verify the profile of microorganisms related to nosocomial infection and to analyze the existence of multidrug-resistant bacteria at the Hospital de Caridade de Santo Ângelo/RS, the largest hospital in the city. METHODS: hospital infection data from 100 medical records, from August/2016 to March/2017, maintained by the Hospital Infection Control Committee were used. Bacterial identification was carried out by the Microbiology Laboratory of the hospital using morpho-tinting and biochemical methods; and antimicrobial susceptibility was determined by the disk diffusion method. Bacterial multidrug-resistance was considered based on resistance to three or more classes of antimicrobials. RESULTS: the three most prevalent microorganisms were Acinetobacter baumannii (17%), Escherichia coli (16%), and Staphylococcus aureus (8%). The hospital unit with the highest number of isolates was the adult Intensive Care Unit, with 41% of the cases. Tracheal secretion, urine, and wound secretion samples provided the highest number of isolates. Sixteen different species/groups of multidrug-resistant bacteria were identified, as follows: Morganella morganii (100%), Hafnia alvei (100%), Enterobacter sakazaki (100%), Serratia spp. (100%), Enterobacter aerogenes (100%), Proteus vulgaris (100%), Acinetobacter baumannii (100%), Klebsiella pneumoniae (83%), Enterobacter spp. (75%), Klebsiella ozaenae (66%), coagulase-negative Staphylococcus (66%), Escherichia coli (56%), Serratia rubidaea (50%), Serratia marcensces (50%), Staphylococcus aureus (37%) e Pseudomonas aeruginosa (28%). CONCLUSION: the large number of multidrug-resistant isolates reinforces the importance of isolation and restriction strategies to avoid cross-contamination to inside and outside the hospital.

Application across species of a one health approach to liquid sample handling for respiratory based -omics analysis

Airway inflammation is highly prevalent in horses, with the majority of non-infectious cases being defined as equine asthma. Currently, cytological analysis of airway derived samples is the principal method of assessing lower airway inflammation. Samples can be obtained by tracheal wash (TW) or by lavage of the lower respiratory tract (bronchoalveolar lavage (BAL) fluid; BALF). Although BALF cytology carries significant diagnostic advantages over TW cytology for the diagnosis of equine asthma, sample acquisition is invasive, making it prohibitive for routine and sequential screening of airway health. However, recent technological advances in sample collection and processing have made it possible to determine whether a wider range of analyses might be applied to TW samples. Considering that TW samples are relatively simple to collect, minimally invasive and readily available in the horse, it was considered appropriate to investigate whether, equine tracheal secretions represent a rich source of cells and both transcriptomic and proteomic data. Similar approaches have already been applied to a comparable sample set in humans; namely, induced sputum. Sputum represents a readily available source of airway biofluids enriched in proteins, changes in the expression of which may reveal novel mechanisms in the pathogenesis of respiratory diseases, such as asthma and chronic obstructive pulmonary disease. The aim of this study was to establish a robust protocol to isolate macrophages, protein and RNA for molecular characterization of TW samples and demonstrate the applicability of sample handling to rodent and human pediatric bronchoalveolar lavage fluid isolates. TW samples provided a good quality and yield of both RNA and protein for downstream transcriptomic/proteomic analyses. The sample handling methodologies were successfully applicable to BALF for rodent and human research. TW samples represent a rich source of airway cells, and molecular analysis to facilitate and study airway inflammation, based on both transcriptomic and proteomic analysis. This study provides a necessary methodological platform for future transcriptomic and/or proteomic studies on equine lower respiratory tract secretions and BALF samples from humans and mice.

High rate of HSV-1 reactivation in invasively ventilated COVID-19 patients: Immunological findings.

SARS-CoV-2 infection can lead to severe acute respiratory distress syndrome with the need of invasive ventilation. Pulmonary herpes simplex-1 (HSV-1) reactivation in invasively ventilated patients is a known phenomenon. To date very little is known about the frequency and the predisposing factors of HSV-1 reactivation in COVID-19. Therefore, we evaluated our cohort of invasively ventilated COVID-19 patients with severe pneumonia for HSV-1 in respiratory specimens and combined these results with functional immunomonitoring of the peripheral blood. Tracheal secretions and bronchial lavages were screened by PCR for HSV-1 positivity. Comprehensive immunophenotyping and quantitative gene expression analysis of Interferon-stimulated genes (IFI44L, MX1, RSAD2, ISIG15 and IFIT1) and IL-1 beta were performed in whole blood. Time course of infection beginning at symptom onset was grouped into three phases (“early” phase 1: day 1–10, “middle” phase 2: day 11–30 and “late” phase 3: day 31–40). Pulmonary HSV-1 reactivation was exclusively observed in the later phases 2 and 3 in 15 of 18 analyzed patients. By FACS analysis a significant increase in activated CD8 T cells (CD38+HLADR+) in phase 2 was found when compared with phase 1 (p<0.05). Expression of Interferon-stimulated genes (IFI44L, RSAD2 ISIG15, MX1, IFIT1) was significantly lower after HSV-1 detection than before. Taken together, reactivation of HSV-1 in the later phase of SARS-CoV-2- infection occurs in parallel with a drop of antiviral innate responsiveness as shown by decreased expression of Interferon-stimulated genes and a concurrent increase of highly activated CD38+HLADR+ CD8 T cells.