Tracheal Secretions Research Articles

Inhaled amikacin for pneumonia treatment and dissemination prevention: an experimental model of severe monolateral Pseudomonas aeruginosa pneumonia

BackgroundPseudomonas aeruginosa pneumonia is commonly treated with systemic antibiotics to ensure adequate treatment of multidrug resistant (MDR) bacteria. However, intravenous (IV) antibiotics often achieve suboptimal pulmonary concentrations. We therefore aimed to evaluate the effect of inhaled amikacin (AMK) plus IV meropenem (MEM) on bactericidal efficacy in a swine model of monolateral MDR P. aeruginosa pneumonia.MethodsWe ventilated 18 pigs with monolateral MDR P. aeruginosa pneumonia for up to 102 h. At 24 h after the bacterial challenge, the animals were randomized to receive 72 h of treatment with either inhaled saline (control), IV MEM only, or IV-MEM plus inhaled AMK (MEM + AMK). We dosed IV MEM at 25 mg/kg every 8 h and inhaled AMK at 400 mg every 12 h. The primary outcomes were the P. aeruginosa burden and histopathological injury in lung tissue. Secondary outcomes included the P. aeruginosa burden in tracheal secretions and bronchoalveolar lavage fluid, the development of antibiotic resistance, the antibiotic distribution, and the levels of inflammatory markers.ResultsThe median (25–75th percentile) P. aeruginosa lung burden for animals in the control, MEM only, and MEM + AMK groups was 2.91 (1.75–5.69), 0.72 (0.12–3.35), and 0.90 (0–4.55) log10 CFU/g (p = 0.009). Inhaled therapy had no effect on preventing dissemination compared to systemic monotherapy, but it did have significantly higher bactericidal efficacy in tracheal secretions only. Remarkably, the minimum inhibitory concentration of MEM increased to > 32 mg/L after 72-h exposure to monotherapy in 83% of animals, while the addition of AMK prevented this increase (p = 0.037). Adjunctive therapy also slightly affected interleukin-1β downregulation. Despite finding high AMK concentrations in pulmonary samples, we found no paired differences in the epithelial lining fluid concentration between infected and non-infected lungs. Finally, a non-significant trend was observed for higher amikacin penetration in low-affected lung areas.ConclusionsIn a swine model of monolateral MDR P. aeruginosa pneumonia, resistant to the inhaled AMK and susceptible to the IV antibiotic, the use of AMK as an adjuvant treatment offered no benefits for either the colonization of pulmonary tissue or the prevention of pathogen dissemination. However, inhaled AMK improved bacterial eradication in the proximal airways and hindered antibiotic resistance.

Analysis of the cases of infection by Acinetobacter baumannii in intensive care units in Alagoas between 2014 and 2018

Introduction: The infection by Acinetobacter baumannii, an aerobic, gram-negative, ubiquitous coccobacillus, assumes endemic proportions with notable spread in Intensive Care Units. Aim: To analyze the cases of Acinetobacter baumannii infection in Adult Intensive Care Units in Alagoas between 2014 and 2018. Outlining: A transversal, descriptive and retrospective research was carried out with sample of 120 patients. Data collection was carried out through a questionnaire in the documents of two public hospitals in the city of Maceió-Alagoas, one of these is a referral in emergence and the other is referral in infectious diseases. Results: Of the 120 patients, 80 (66.7%) were from Hospital A and 40 (33.3%) from Hospital B. There was a prevalence of males (71.7%) and of the 18 to 40 age range (49.2%) in both hospitals. The antibiotic meropenem showed a higher frequency of use. Antimicrobial resistance and sensitivity profiles were higher for cephalosporins, carbapenems, and fluoroquinolones, as well as aminoglycosides, respectively. The most frequent bacterial isolation material was the tracheal secretion associated with mechanical ventilation. The most mentioned outcome was death. Implications: The study exposed high rates of mortality and antimicrobial resistance, as well as evidence that can contribute to the implementation of prophylactic measures for Acinetobacter baumannii.

Мониторинг микробиоты родильниц — необходимое условие диагностики инфекции у новорожденных в раннем неонатальном периоде

Background: maternal and child healthcare is considered a priority area of the public health services in all countries. Aim: to assess the birth canal microbiota in pregnant women and puerperia for diagnosing potential infections of newborn infants in the early neonatal period. Patients and Methods: this retrospective study analyses the results of microbiological examination of the samples taken from various loci of 1915 pregnant women and/or puerperia and newborn infants in the period of February 1, 2020, to February 28, 2022. The biological material samples for microbiological examination were obtained from the following locations: 1) in the pregnant women and/or puerperia: the posterior vaginal vault, cervical canal, afterbirth, and the uterine cavity; 2) in the newborn infants: the blood, cerebrospinal fluid, tracheal secretions, and the catheter Results: in 38.1% of puerperia, the caesarean section was performed to deliver a baby. In 513 (26.8%) women in labor and their newborns, microbiological tests were not carried out, as they did not have clinical manifestations of infectious diseases. Based on the monitoring of the results of microbiological examination of the biomaterial samples taken from various loci, the following three groups were formed: group 1 — the samples were taken only from the newborns (n=458); group 2 — the samples were taken only from the mothers (n=294); group 3 — the samples were taken both from the mothers and newborns (n=650). Then, group 3 was divided into the following subgroups: the growth of microorganisms was not detected or the normal flora was found (n=459); the potential causative agents of infectious and inflammatory diseases were found in the mother, but not in the newborn (n=161); the same potential causative agents of infectious and inflammatory diseases were detected in the newborn and the mother (n=19); different potential causative agents of infectious and inflammatory diseases were found in the newborn and the mother (n=6); potential causative agents of infectious and inflammatory diseases were detected in the newborns, but not in the mothers (n=5). Escherichia coli (31.6%) and Streptococcus agalactiae (15.7%) were the most prevalent microorganisms in the birth canal of the pregnant women and puerperia. In the newborns, the same agents were most frequently found in the blood or the tracheal secretions. Conclusion: the microbiological monitoring of the birth canal of pregnant women and puerperia, as well as of newborn infants is necessary for a timely prevention or treatment of infectious diseases. KEYWORDS: monitoring, microbiota, puerperia, newborns, infection, bacterial carriage. FOR CITATION: Boronina L.G., Samatova E.V., Asnovskaya A.G. et al. Monitoring the puerperium microbiota is a necessary condition for diagnosing newborn infections in the early neonatal period. Russian Journal of Woman and Child Health. 2023;6(1):13–19 (in Russ.). DOI: 10.32364/2618-8430-2023-6-1-13-19.

Resistance profile from staphylococcus aureus and pseudomonas aeruginosa obtained from tracheostomized children in the four seasons of the year

Objective: The objective of this study was to microbiologically characterize the tracheal secretion of tracheostomized children, evaluate biofilm formation and study the phenotypic and molecular profile of the antimicrobial resistance of Sthapylococcus aureus and Pseudomonas aeruginosa isolates. Methods: 88 samples of tracheal secretions were collected. The material was processed to perform phenotypic tests and bacterial identification. Tests were used to identify biofilms using Congo red agar test and microdilution in a 96-well plate, and the qPCR method was used to verify resistance. Results: Twelve Staphylococcus aureus samples and 30 Pseudomonas aeruginosa were isolated of pediactric tracheostomized patients. All the S. aureus samples were positive to biofilm formation in Congo red agar test. In the antibiogram test, S. aureus showed resistance to seven antimicrobials. Regarding the identification of resistance genes, blaZ was amplified in 57.1% and mecA in 28.6% of the isolated S. aureus. Pseudomonas aeruginosa showed blaOXA with 66,7% e blaKPC with 58,3%. In plasmid DNA, blaNDM stood out with 58,3% positive. Conclusions: The control of resistant bacteria involved in biofilms in the stoma of tracheostomized patients is a great challenge, since the simple cannula change does not always allow the control of the microbiota, which increases the vulnerability of patients to future respiratory complications.

1183. Serotype Prevalence and Antimicrobial Resistance Patterns of Streptococcus pneumoniae in Ecuador

Abstract Background Streptococcus pneumoniae is a leading cause of pneumonia and meningitis in the world, and it is under-researched in Ecuador. Reported mortality in this country was 280 cases per year. The national policy of the country established the obligatory application of the pneumococcal vaccine to infants in 2010, but there is no such law for adults. The serotypes' distribution and resistance patterns are unknown. This study aims to describe the serotypes and resistance patterns of Strepcococcus pneumoniae isolations in Ecuador. Methods A retrospective study of all positive cultures for Streptococcus pneumoniae (blood, other sterile liquids, respiratory, ocular, and ear samples) was conducted in three hospitals and one reference laboratory in Ecuador. Serotype data, E-test results for penicillin and ceftriaxone, resistance patterns and susceptibility to other antibiotics by the Kirby-Bauer test were collected. Results A total of 214 samples were evaluated: 18.8% (39) were tracheal secretions, 36.7% (76) sputum, 5.7% (11) cerebrospinal fluid, 17.4% (36) blood, 2.9% (6) pleural fluid, and 27.9% (37) others: ocular, abdominal, and ear secretions. A wide distribution of serotypes was observed. The most prevalent were 19A, 14 and 3. Figure 1 shows penicillin resistance increased per year. However, 93,3% (166) of the strains were ceftriaxone susceptible and 100% of the isolates tested showed susceptibility to vancomycin. Susceptibility to levofloxacin was 99.2%; only one isolate was resistant. No microorganism tested for linezolide was resistant. For other antibiotics, a high level of resistance was identified; 69.3% (54) for trimethoprim sulfamethoxazole, 47.5% (107) for erythromycin and 37.6% (104) for clindamycin. Figure 1.S. pneumoniae penicillin susceptibility percet by year in Ecuador Conclusion It is important to know the resistance patterns and serotypes of S. pneumoniae for therapeutic and epidemiologic decisions. In countries with more than 12% ceftriaxone resistance to Streptococcus pneumoniae, it is suggested for use as an empiric vancomicyn. Nowadays, in Ecuador, the resistance patterns don’t apply to extended vancomycin use. We do not recommend the empirical use of trimethoprim sulfamethoxazole, macrolides and clindamycin for S. pneumoniae infections. Disclosures All Authors: No reported disclosures.

Essential oils from citri reticulatae pericarpium: Optimization of hydrodistillation extraction and effects of stir-frying processing on chemical components and multiple biological activities

This study aims to investigate the chemical components and biological activities such as antioxidant, antibacterial, expectorant, and antitussive activities of essential oils (EOs) from raw and stir-frying Citri Reticulatae Pericarpium (ORP and OSP, respectively). The process for EOs extraction by hydrodistillation was optimized by response surface methodology . The optimized condition included soaking time of 7.20 h, liquid–solid ratio of 17.22:1, and extraction time of 4.18 h. The extraction rates of EOs from ORP and OSP were 2.11 % and 1.58 %, and 34 and 32 chemical components were identified by gas chromatography–mass spectrometry (GC-MS) with the highest proportion of monoterpene hydrocarbons (83.61 % and 93.64 %), respectively. The main components of ORP and OSP were limonene (69.43 % and 75.04 %) and γ-terpinene (8.93 % and 9.94 %). In the antitussive and expectorant tests, OSP significantly promoted tracheal secretion and inhibited cough. The cough frequency of OSP at low dose (100 mg/kg) was lower than that of theobromine . The phenol red secretion and cough incubation period of OSP at a high dose (400 mg/kg) was close to that of the positive control theobromine and ambroxol. ORP and OSP demonstrated strong antitussive and expectorant activities and also possessed certain antioxidant and antibacterial activities. These activities of OSP were significantly better than those of ORP. Hence, OSP shows great application potential in food, medicine, and chemical industries. The traditional processing technology plays a very important role in improving activities. • Extraction of essential oils from raw Citri Reticulatae Pericarpium (ORP) was optimized. • The antitussive and expectorant potentials of ORP were explored for the first time. • Stir-frying processing significantly enhanced the bioactivities of ORP. • Stir-frying processing influenced ORP content rather than categories.

Safe position check of gastric tubes: an often underestimated topic to prevent possible severe complications

The insertion of agastric tube in the operating room (OR) or in an intensive care unit (ICU) is aroutine procedure. Although the tube is often inserted by nursing staff, the indications and selection of the procedure for position control remain the physician's responsibility. For immediate position control, the injection of air through the inserted tube with simultaneous auscultation of the epigastrium is probably the most simple and common clinical method. Atypical "bubbling" is often regarded as asufficiently reliable sign of correct gastric tube position. This procedure can be described as aroutine standard both in the OR and the ICU; however, numerous examples from clinical practice and quality reviews show gastric tube mispositioning in esophageal, bronchial, pulmonary or even pleural positions in individual cases. Since auscultation findings are misinterpreted as tracheal, bronchial, or pleural secretions, mispositioning may remain undetected. In addition, adequate documentation of the procedure is lacking. In the worst case, hyperosmolar tube feeding occurs via the malpositioned tube into the lungs or pleural space causing subsequent severe pneumonia or pleuritis, which is often fatal for the patient outcome. In contrast to many other similar procedures in intensive care medicine, such as the installation of central venous catheters or endotracheal intubation, to our knowledge there is no uniform standard for forensic verification of the correct position after gastric tube positioning. The present work provides an overview of existing practices and the scientific background for confirmation of gastric tube positioning without ionizing radiation.

Use of an innovative cuff pressure control and subglottic secretions drainage system in COVID-19 ARDS patients undergoing pronation

We conducted a proof of concept study where Anapnoguard endotracheal tubes and its control unit were used in 15 patients with COVID-19 acute respiratory distress syndrome. Anapnoguard system provides suction, venting, rinsing of subglottic space and controls cuff pressure detecting air leakage through the cuff. Alpha-amylase and pepsin levels, as oropharyngeal and gastric microaspiration markers, were assessed from 85 tracheal aspirates in the first 72 h after connection to the system. Oropharyngeal microaspiration occurred in 47 cases (55%). Episodes of gastric microaspiration were not detected. Patient positioning, either prone or supine, did not affect alpha-amylase and pepsin concentration in tracheal secretions. Ventilator-associated pneumonia (VAP) rate was 40%. The use of the AG system provided effective cuff pressure control and subglottic secretions drainage. Despite this, no reduction in the incidence of VAP has been demonstrated, compared to data reported in the current COVID-19 literature. The value of this new technology is worth of being evaluated for the prevention of ventilator-associated respiratory tract infections.

Bacteriological Profile and Antibiotic Susceptibility Pattern of Tracheal Secretions Isolates Among Intensive Care Unit Patients at Tertiary Care Hospital

Introduction: Respiratory infections are associated with high morbidity and mortality, especially in critically ill patients. The excessive use of broad-spectrum antibiotics has led to the development of drug resistance, thus resulting in the emergence of pathogens which are difficult to treat. Materials and Methods: A total of 632 tracheal secretions were received in the Bacteriology section of the microbiology department of a tertiary care hospital from November 2019 to February 2020. Tracheal secretions were processed for culture according to standard operating procedures. Identification, phenotype detection, and antibiotic sensitivity testing were performed by automated VITEK-2 Compact system. Results: In total, 632 tracheal secretions were received during the study period, 559 cultures yielded significant pathogens and no organisms were isolated in 73 cultures. Among the Gram-negative organism 540 (97%), Klebsiella pneumoniae (30%) was the most common isolates. Gram-positive organisms 12 (2%) and Candida spp. 7 (1%) were isolated. The most common phenotype detected in Escherichia coli and K. pneumoniae was extended-spectrum beta-lactamase producer. Conclusions: K. pneumoniae was the most common isolate from tracheal secretion among intensive care unit patients. Colistin, followed by tigecycline, was found to be the most susceptible antibiotics. K. pneumoniae was found to be sensitive to tigecycline (69%) with minimum inhibitory concentrations of ≤ 1. 0.6%. K. pneumoniae was colistin resistant.

BACTERIAL TRACHEITIS IN A PATIENT AFTER INTUBATION

BACTERIAL TRACHEITIS IN A PATIENT AFTER INTUBATION

Susceptibility Pattern of Bacteria Isolated from Patients Admitted in Medical ICU with Pneumonia

Background: Patients in ICU presenting with severe disease suffer from multidrug-resistant bacteria, resuting in reduced therapeutic options which cover ICU pathogens spectrum. Identification of causative organism and its antibiotics sensitivity pattern has become cornerstone for antibiotic selection. β-Lactams i.e. cephalosporins, carbapenems, penicillins, and monobactams constitute 60% of total antibacterials used, however; with high usage of such antibiotics the emergence of resistance. Aim: To determine prevalence of local type of bacterial isolates and their antibiotic susceptibility. Study Design: Cross sectional study Place and Duration of Study: Medical ICU, Pakistan Ordinance Factories Hospital, Wah Cantt from 1st January 2020 till 31st July 2021. Methodology: One hundred patients were enrolled. Samples were taken from blood, sputum, bronchoalveolar lavage and tracheal secretions of the patient and sent to microbiologist for culture and sensitivity reports. Results: The mean age was 57.52+13.427 years, 47 females and 53 male patients. 72 patients were shifted out and remaining 28 died. In 57 patients, sputum specimen was taken, blood specimen of 24 patients, tracheal secretion of 8 patients and 11 patients bronchoalveolar lavage was taken. 33 were positive for Klebsiella pneumoniae, 29 patients were positive for acinetobacter baumanii. Pseudomonas aeuriginosa was positive in 18 patients, 05 patients for E. coli. In gram positive category; 05 patients were positive for staph aureus, 06 patients for MRCONS, 3 to MRSA and 1 patient for coagulase negative staphylococcus species. Conclusion: The high levels of antibiotic resistance are seen among both gram negative and gram positive isolates. Presence of elevated resistance to multiple drugs is an indicator for high prevalence of multi-drug resistant gram positive as well as gram negative organisms, so proper identification of organism in order to ascertain administration of emperical drugs most effective against the isolated organism is recommended in severe cases. Keywords: Antibiogram, Bacterial isolate, Pneumonia, Sensitivity

Vegetable glycerin e-cigarette aerosols cause airway inflammation and ion channel dysfunction.

Vegetable glycerin (VG) and propylene glycol (PG) serve as delivery vehicles for nicotine and flavorings in most e-cigarette (e-cig) liquids. Here, we investigated whether VG e-cig aerosols, in the absence of nicotine and flavors, impact parameters of mucociliary function in human volunteers, a large animal model (sheep), and air-liquid interface (ALI) cultures of primary human bronchial epithelial cells (HBECs). We found that VG-containing (VG or PG/VG), but not sole PG-containing, e-cig aerosols reduced the activity of nasal cystic fibrosis transmembrane conductance regulator (CFTR) in human volunteers who vaped for seven days. Markers of inflammation, including interleukin-6 (IL6), interleukin-8 (IL8) and matrix metalloproteinase-9 (MMP9) mRNAs, as well as MMP-9 activity and mucin 5AC (MUC5AC) expression levels, were also elevated in nasal samples from volunteers who vaped VG-containing e-liquids. In sheep, exposures to VG e-cig aerosols for five days increased mucus concentrations and MMP-9 activity in tracheal secretions and plasma levels of transforming growth factor-beta 1 (TGF-β1). In vitro exposure of HBECs to VG e-cig aerosols for five days decreased ciliary beating and increased mucus concentrations. VG e-cig aerosols also reduced CFTR function in HBECs, mechanistically by reducing membrane fluidity. Although VG e-cig aerosols did not increase MMP9 mRNA expression, expression levels of IL6, IL8, TGFB1, and MUC5AC mRNAs were significantly increased in HBECs after seven days of exposure. Thus, VG e-cig aerosols can potentially cause harm in the airway by inducing inflammation and ion channel dysfunction with consequent mucus hyperconcentration.

The Molecular Detection of Class B and Class D Carbapenemases in Clinical Strains of Acinetobacter calcoaceticus-baumannii Complex: The High Burden of Antibiotic Resistance and the Co-Existence of Carbapenemase Genes.

The emergence of carbapenem-resistant Acinetobacter calcoaceticus-baumannii complex (CRACB) in clinical environments is a significant global concern. These critical pathogens have shown resistance to a broad spectrum of antibacterial drugs, including carbapenems, mostly due to the acquisition of various β-lactamase genes. Clinical samples (n = 1985) were collected aseptically from multiple sources and grown on blood and MacConkey agar. Isolates and antimicrobial susceptibility were confirmed with the VITEK-2 system. The modified Hodge test confirmed the CRACB phenotype, and specific PCR primers were used for the molecular identification of blaOXA and blaNDM genes. Of the 1985 samples, 1250 (62.9%) were culture-positive and 200 (43.9%) were CRACB isolates. Of these isolates, 35.4% were recovered from pus samples and 23.5% from tracheal secretions obtained from patients in intensive care units (49.3%) and medical wards (20.2%). An antibiogram indicated that 100% of the CRACB isolates were resistant to β-lactam antibiotics and β-lactam inhibitors, 86.5% to ciprofloxacin, and 83.5% to amikacin, while the most effective antibiotics were tigecycline and colistin. The CRACB isolates displayed resistance to eight different AWaRe classes of antibiotics. All isolates exhibited the blaOXA-51 gene, while blaOXA-23 was present in 94.5%, blaVIM in 37%, and blaNDM in 14% of the isolates. The blaOXA-51, blaOXA-23, and blaOXA-24 genes co-existed in 13 (6.5%) isolates. CRACB isolates with co-existing blaOXA-23, blaOXA-24, blaNDM, blaOXA-51 and blaVIM genes were highly prevalent in clinical samples from Pakistan. CRACB strains were highly critical pathogens and presented resistance to virtually all antibacterial drugs, except tigecycline and colistin.

Investigation on the Expectorant Effect of Extracts from Primula veris L.

BACKGROUND: At present, coughing can be regulated by medications such as dextromethorphan and codeine, which are associated with side effects, including drug drowsiness or dependency. Thus, there is an increasing demand for drugs that promote expectorant activities with fewer adverse effects. The root of Primula veris L. (Primulaceae) is an herbal medicine that has been used as an expectorant drug for thousands of years in folk medicine. AIM: The present study aims to create an in-depth pharmacological study of the expectorant activity of P. veris to create new drugs in different directions which are appropriate and promising. MATERIALS AND METHODS: The expectorant effect of thick extracts of the study plant was studied on the influence of the motor activity of the ciliated epithelium and the secretory function of the bronchi. The expectorant activities of the ethanol extracts of leaves and rhizomes with roots from P. veris were evaluated using classical animal models. The expectorant assay was performed with phenol red secretion in the mouse trachea. After gastric administration of the test extracts in mice, 2.5% phenol red solution was injected intraperitoneally. The trachea was dissected and the optical density of tracheal secretion was measured. RESULTS: The results of the studies showed that a thick extract of primrose rhizomes with roots has a high ability to secrete sputum, which is almost not inferior to the Hedelix drops comparator (ivy extract) – 126.6% and 146.4%, respectively. Extract from the leaves of P. veris is characterized by less pronounced activity, which, at a dose of 200 mg/kg, was 74.5%. CONCLUSION: The results of the present study provide evidence that P. veris can be used as an expectorant herbal medicine and that triterpene saponins may be the main active ingredients of Primula veris responsible for its bioactivities.

Association of enteral feeding with microaspiration in critically ill adults

AimThis study explored relationships between enteral feeding and tracheal pepsin A. BackgroundMechanically ventilated (MV) patients receiving enteral feeding are at risk for microaspiration. Tracheal pepsin A, an enzyme specific to gastric cells, was a proxy for microaspiration of gastric secretions. MethodsSecondary analysis of RCT data from critically ill, MV adults was conducted. Microaspiration prevention included elevated head of bed, endotracheal tube cuff pressure management, and regular oral care. Tracheal secretions for pepsin A were collected every 12 h. Microaspiration was defined as pepsin A ≥ 6.25 ng/mL. Positive pepsin A in >30 % of individual tracheal samples was defined as abundant microaspiration (frequent aspirator). Chi-squared, Fisher's Exact test, and generalized linear model (GLM) were used. ResultsTracheal pepsin A was present in 111/283 (39 %) mechanically ventilated patients and 48 (17 %) had abundant microaspiration. Enteral feeding was associated with tracheal pepsin A, which occurred within 24 h of enteral feeding. Of the patients who aspirated, the majority received some enteral feeding 96/111 (86 %), compared to only 15/111 (14 %) who received no feeding. A greater number of positive pepsin A events occurred with post-pyloric feeding tube location (55.6 %) vs. gastric (48.6 %), although significant only at the event-level. Frequent aspirators (abundant pepsin A) had higher pepsin A levels compared to infrequent aspirators. ConclusionsOur findings confirmed the stomach as the microaspiration source. Contrary to other studies, distal feeding tube location did not mitigate microaspiration. Timing for first positive pepsin A should be studied for possible association with enteral feeding intolerance.

Pseudo-outbreak of Stenotrophomonas Maltophilia in an Intensive Care Unit in São Paulo – Brazil

<h3>Background</h3> In April 2020, a group of identical isolates of Stenotrophomonas maltophilia was observed in adult intensive care units (ICU), Covid - 19 units and surgical ICU in a large general hospital in greater São Paulo. The hospital infection control service team (SCIH) of the institution, in agreement with the care team of the intensive care units, started to investigate a possible outbreak, as well as all the processes related to the care of these patients. <h3>Methods</h3> This is a prospective study in which we followed all patients with results of tracheal secretion samples admitted to the ICUs; and we evidenced a significant in-crease in S. maltophilia isolates, which, for the most part, met epidemiological criteria for tracheobronchitis associated with mechanical ventilation, at the time it was not possible to perform typing using pulse field gel electrophoresis (PFGE). <h3>Results</h3> 100% of the cases of tracheobronchitis associated with mechanical ventilation were hospitalized in the ICU and using mechanical ventilation for more than 5 days, all cases remained with the closed suction system during the entire period of mechanical ventilation, this system was only changed if dirt or malfunction. In August 2020, after reviewing the entire process, we changed the closed suction system before collecting tracheal secretions. After this intervention, no other sample of tracheal secretions was isolated from S. maltophilia for three consecutive months. <h3>Conclusions</h3> We cannot exclude the potential for colonization of respiratory rats, but after changing the process, it became evident that this was the most effective measure to control the increase in S. maltophilia cases in ICUs.

Brachycephalic Syndrome in Dogs - Endoscopic Findings in the Airways

Background: Brachycephalic dogs have several abnormalities in the airways, which generate clinical manifestations that impair the quality of life of these animals. Primary alterations promote airflow obstruction and increase intraluminal negative pressure, causing secondary alterations due to a cycle of inflammation with consequent obstruction. With the onset of inflammation and other alterations in the airways, clinical manifestations can be observed, such as snoring, reverse sneezing, coughing, dyspnea, cyanosis, syncope, and vomiting. Endoscopic examination of the airways allows visualization and diagnosis of morphological changes in these animals. This study aimed to evaluate the endoscopic findings of the airways and determine the quantitative and qualitative assessment of the severity of clinical manifestations in 14 dogs with brachycephalic syndrome (BS). Materials, Methods &amp; Results: Historical and anamnesis data and clinical, respiratory, and digestive manifestations were collected from the owners’ reports. The clinical manifestations were classified as mild, moderate, or severe. All animals were subjected to endoscopy of the airways, and image findings were grouped according to the anatomical site where they were observed, then the abnormalities were correlated with the severity of the clinical manifestations. When comparing the frequency of endoscopic abnormalities with the severity of clinical manifestations, it is interesting to observe that animals with severe disease more frequently presented the following alterations: prolongation and thickening of the soft palate, laryngeal changes, presence of hyperemia, lymphoid hyperplasia and polyps in the nasopharynx, hypoplasia and presence of tracheal secretion and thickening of the dorsal tracheal muscle; bronchial collapse, hypoplasia of the main bronchi and bronchial hyperemia and the presence of aberrant nasal turbinates. Comparison between the means of nonparametric variables was performed using the Mann-Whitney test, with a 5% significance level. Discussion: A higher frequency of French Bulldog dogs included in the study was observed, probably due to their greater popularity, although any brachycephalic dog may be affected by BS. Considering that nostril stenosis is a congenital alteration, which is usually diagnosed early, and since the animals included in the study were dogs referred for the rhinoplasty procedure the higher frequency of young dogs in the study was not surprising. The results revealed a significant difference in the endoscopic findings with the severity of the clinical manifestations in different variables, such as prolongation and thickening of the soft palate, eversion of the laryngeal saccules, presence of laryngeal inflammation and collapse, presence of polyps or lymphoid hyperplasia in the nasopharynx, thickening of the dorsal muscle of the trachea, polyps in the trachea and hypoplasia in addition to bronchial hyperemia. The larynx was the most affected anatomical site, with alterations present in 92.8% of the evaluated dogs. Based on these findings, it can be concluded that airway obstruction caused by primary alterations can cause secondary alterations, with consequent clinical manifestations in brachycephalic dogs it is possible to suggest that dogs with this syndrome may present severe manifestations of the disease, regardless of age. Furthermore, it can be concluded that in this study, dogs with BS had frequent laryngeal alterations and that alterations in the main bronchi were present in all animals with severe manifestations of the disease. Keywords: airway obstruction, bronchial collapse, endoscopy, larynx.

An outbreak of Legionnaires’ disease in newborns in Serbia

ABSTRACT Legionnaires’ disease is an atypical pneumonia caused by inhaling small droplets of water containing the bacterium Legionella spp. In newborns, it is a rare event, usually associated with water births and the use of air conditioning systems or air humidifiers. A nosocomial outbreak of Legionnaires’ disease in the maternity ward of a secondary-care hospital in Arandjelovac, Serbia is described. Two male newborns were found to be infected with Legionnella pneumophila. On Days 7 and 6 of life, respectively, they were transferred to a tertiary-care hospital with signs of severe pneumonia which was radiologically confirmed. L. pneumophila was detected in tracheal secretions from both infants by RT-PCR, and its antigens were also positive in urine samples. The source of infection in the secondary-care hospital was the internal hot water heating system, and the main contributory factor to the emergence of the infection was the low temperature of the hot water which did not kill the bacteria during the available exposure time. These two cases highlight the importance of being cautious about possible Legionnaires’ disease in maternity wards with outdated or irregularly maintained internal water supply systems. The adoption of official guidelines for the control and regular maintenance of water supply systems, including the multidisciplinary cooperation of all relevant parties, forms the basis for direct monitoring for Legionella and the prevention of new outbreaks. Abbreviations: BCYE: buffered charcoal yeast extract agar; GVPC: glycine vancomycin polymyxin cycloheximide agar; LD - Legionnaires’ disease; TR-PCR: Reverse transcription polymerase chain reaction

A CLINICAL STUDY OF TRACHEOSTOMY IN TERTIARY CARE HOSPITAL

The study was carried out in Dr. Shankarrao Chavan Government medical college, Nanded at the department of Otorhinolaryngology for a period of 18 months from Jan 2020 to June 2021, was a prospective evaluation of 65 patients of all ages and both gender presenting in the emergency ward or Intensive Care Unit (ICU) or in ENT Out Patient Department for whom tracheostomy was done for various indications. The study aimed to nd out the different indications for tracheostomy, the microbiological study of secretions of tracheostomy stoma or tracheal secretions, and intra and postoperative complications in patients undergoing tracheostomy. The study shows the most common indication for tracheostomy was patients admitted to ICU for prolonged ventilatory support 43% followed by stridor patients presented in the emergency ward about 28% patients. Similarly, the most common complication was haemorrhage followed by stoma infection. This study shows most common organism cultured from tracheal secretion was pseudomonas aeruginosa followed by Acinetobacili barmanni, staphylococcus aureus, Klebsiella pneumoniae, Escherichia coli.

An Outbreak of Leclercia adecarboxylata from a Tertiary Neurocare Center

Background: Hospital-acquired infection (HAI) outbreaks are special-cause events having multiple factors involved in it. HAI outbreaks often reflect problems that are unique, urgent, unusual, or difficult to control. There are only a few case reports and case series of Leclercia adecarboxylata reported in the literature. Materials and Methods: The outbreak occurred in a 1000-bedded tertiary neurocare center. There was sudden isolation of an unusual organism from different samples such as tracheal secretion, ventriculo-peritoneal shunt tip, pus, wound swab, urine, and blood. All the samples were processed according to the standard protocol and antibiotic susceptibility was carried out by Kirby–Bauer disk-diffusion method and interpreted according to the Clinical and Laboratory Standards Institute guidelines. All the isolates were subjected to VITEK-2 system for confirmation. The steps involved in outbreak investigation were (1) case definition, (2) case confirmation, (3) establishing the background rate of disease and finding cases, (4) identification of source, (5) control measures, (6) communicate findings, and (7) maintain surveillance. Results: The organism was identified as L. adecarboxylata. All the isolates were resistant only to ampicillin. However, two isolates isolated from the blood of the same patient were sensitive only to imipenem and colistin. The source could not be identified with extensive efforts; however, the outbreak was controlled with strict practice of hand hygiene and other aseptic precautions. On surveillance, there was no further isolation of the organism. Conclusion: As HAI outbreaks are multifactorial, there should be preparedness for hospital infection outbreaks in all the hospitals to prevent morbidity and mortality.