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Franquet T, Domingo P. Pulmonary Infections in People Living with HIV. Radiol Clin North Am 2022; 60:507-520. [DOI: 10.1016/j.rcl.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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2
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Sakamoto N, Tsuchiya K, Hikone M. Community-acquired necrotizing pneumonia with bacteremia caused by Pseudomonas aeruginosa in a patient with emphysema: An autopsy case report. Respir Investig 2018; 56:189-194. [PMID: 29548659 DOI: 10.1016/j.resinv.2017.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/02/2017] [Accepted: 12/20/2017] [Indexed: 11/16/2022]
Abstract
We report the case of a 47-year-old man with chronic obstructive pulmonary disease who was referred to our hospital for acute dyspnea. The radiologic findings revealed consolidation with a cavity in the left upper lobe of the lung. Blood/sputum cultures detected Pseudomonas aeruginosa. Despite intensive care, the patient died from respiratory failure. Autopsy revealed multiple small necrotizing cavities that had coalesced. Although P. aeruginosa is a known causative pathogen of community-acquired pneumonia in patients with structural lung disease, the radiologic findings were non-specific. Irrespective of imaging findings, P. aeruginosa should be considered a cause of community-acquired pneumonia.
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Affiliation(s)
- Naoya Sakamoto
- Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan.
| | - Kyohei Tsuchiya
- Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan
| | - Mayu Hikone
- Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan
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3
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Abstract
Due to the high morbidity and mortality, nosocomial pneumonia represents a serious risk in hospitalized patients. The increased risk of infections with multidrug-resistant (MDR) pathogens makes a timely diagnosis and prompt therapy indispensable. A newly occurring or progressive infiltrate in any patient who has been hospitalized for more than 48 h should be viewed with suspicion. In contrast to community acquired pneumonia (CAP), radiography plays a limited role in the diagnosis of hospital-acquired pneumonia (HAP). This is partly due to the technical challenges in imaging of patients who are in a lying position as well as the numerous other possible differential diagnoses. Careful analysis of the various radiological features, such as temporal progression, distribution and appearance can help to narrow down the differential diagnoses. In the absence of a single gold standard, clinical features and appropriate radiological features in addition to cultures obtained from respiratory secretions can help to maximize the diagnostic efficacy and expedite the treatment with appropriate antibiotic therapy.
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4
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Abstract
Chest radiography serves a crucial role in imaging of the critically ill. It is essential in ensuring the proper positioning of support and monitoring equipment, and in evaluating for potential complications of this equipment. The radiograph is useful in diagnosing and evaluating the progression of atelectasis, aspiration, pulmonary edema, pneumonia, and pleural fluid collections. Computed tomography can be useful when the clinical and radiologic presentations are discrepant, the patient is not responding to therapy, or in further defining the pattern and distribution of a radiographic abnormality.
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Affiliation(s)
- Matthew R Bentz
- Department of Radiology, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, L340, Portland, OR 97239, USA.
| | - Steven L Primack
- Division of Pulmonary Medicine, Department of Radiology, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, L340, Portland, OR 97239, USA
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5
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Song RR, Qiu YP, Chen YJ, Ji Y. Application of fiberoptic bronchscopy in patients with acute exacerbations of chronic obstructive pulmonary disease during sequential weaning of invasive-noninvasive mechanical ventilation. World J Emerg Med 2014; 3:29-34. [PMID: 25215035 DOI: 10.5847/wjem.j.issn.1920-8642.2012.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 02/12/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Early withdrawal of invasive mechanical ventilation (IMV) followed by noninvasive MV (NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) with acute respiratory failure (ARF). Using pulmonary infection control window (PIC window) as the switch point for transferring from invasive to noninvasive MV, the time for early extubation can be more accurately judged, and therapy efficacy can be improved. This study aimed to prospectively investigate the clinical effectiveness of fiberoptic bronchscopy (FOB) in patients with AECOPD during sequential weaning of invasive-noninvasive MV. METHODS Since July 2006 to January 2011, 106 AECOPD patients with ARF were treated with comprehensive medication and IMV after hospitalization. Patients were randomly divided into two groups according to whether fiberoptic bronchoscope is used (group A, n=54) or not (group B, n=52) during sequential weaning from invasive to noninvasive MV. In group A, for sputum suction and bronchoalveolar lavage (BAL), a fiberoptic bronchoscope was put into the airway from the outside of an endotracheal tube, which was accompanied with uninterrupted use of a ventilator. After achieving PIC window, patients of both groups changed to NIMV mode, and weaned from ventilation. The following listed indices were used to compare between the groups after treatment: 1) the occurrence time of PIC, the duration of MV, the length of ICU stay, the success rate of weaning from MV for the first time, the rate of reventilation and the occurrence rate of ventilator-associated pneumonia (VAP); 2) the convenience and safety of FOB manipulation. The results were compared using Student's t test and the Chi-square test. RESULTS The occurrence time of PIC was (5.01±1.49) d, (5.87±1.87) d in groups A and B, respectively (P<0.05); the duration of MV was (6.98±1.84) d, (8.69±2.41) d in groups A and B, respectively (P<0.01); the length of ICU stay was (9.25±1.84) d, (11.10±2.63) d in groups A and B, respectively (P<0.01); the success rate of weaning for the first time was 96.30%, 76.92% in groups A and B, respectively (P<0.01); the rate of reventilation was 5.56%, 19.23% in groups A and B, respectively (P<0.05); and the occurrence rate of VAP was 3.70%, 23.07% in groups A and B, respectively (P<0.01). Moreover, it was easy and safe to manipulate FOB, and no side effect was observed. CONCLUSIONS The application of FOB in patients with AECOPD during sequential weaning of invasive-noninvasive MV is effective in ICU. It can decrease the duration of MV and the length of ICU stay, increase the success rate from weaning MV for the first time, reduce the rate of reventilation and the occurrence rate of VAP. In addition, such a method is convenient and safe in patients of this kind.
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Affiliation(s)
- Rong-Rong Song
- Department of Intensive Care Unit, Tongzhou People's Hospital, Nantong 226300, China
| | - Yan-Ping Qiu
- Department of Intensive Care Unit, Tongzhou People's Hospital, Nantong 226300, China
| | - Yong-Ju Chen
- Department of Intensive Care Unit, Tongzhou People's Hospital, Nantong 226300, China
| | - Yong Ji
- Department of Intensive Care Unit, Tongzhou People's Hospital, Nantong 226300, China
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6
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Comparison of high-resolution computed tomography findings between Pseudomonas aeruginosa pneumonia and Cytomegalovirus pneumonia. Eur Radiol 2014; 24:3251-9. [DOI: 10.1007/s00330-014-3326-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 06/25/2014] [Accepted: 07/08/2014] [Indexed: 01/15/2023]
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7
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Okada F, Ono A, Ando Y, Nakayama T, Ishii R, Sato H, Kira A, Tokimatsu I, Kadota J, Mori H. Thin-section CT findings in Pseudomonas aeruginosa pulmonary infection. Br J Radiol 2012; 85:1533-8. [PMID: 22844034 DOI: 10.1259/bjr/54468236] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess clinical and pulmonary thin-section CT findings in patients with acute Pseudomonas aeruginosa (PA) pulmonary infection. METHODS We retrospectively identified 44 patients with acute PA pneumonia who had undergone chest thin-section CT examinations between January 2004 and December 2010. We excluded nine patients with concurrent infections. The final study group comprised 35 patients (21 males, 14 females; age range 30-89 years, mean age 66.9 years) with PA pneumonia. The patients' clinical findings were assessed. Parenchymal abnormalities, enlarged lymph nodes and pleural effusion were evaluated on thin-section CT. RESULTS Underlying diseases included malignancy (n=13), a smoking habit (n=11) and cardiac disease (n=8). CT scans of all patients revealed abnormal findings, including ground-glass opacity (n=34), bronchial wall thickening (n=31), consolidation (n=23) and cavities (n=5). Pleural effusion was found in 15 patients. CONCLUSION PA pulmonary infection was observed in patients with underlying diseases such as malignancy or a smoking habit. The CT findings in patients with PA consisted mainly of ground-glass attenuation and bronchial wall thickening. ADVANCES IN KNOWLEDGE The CT findings consisted mainly of ground-glass attenuation, bronchial wall thickening and cavities. These findings in patients with an underlying disease such as malignancy or a smoking habit may be suggestive of pneumonia caused by PA infection.
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Affiliation(s)
- F Okada
- Department of Radiology, Oita University Faculty of Medicine, Japan.
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8
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Gharabaghi MA, Abdollahi SMM, Safavi E, Abtahi SH. Community acquired Pseudomonas pneumonia in an immune competent host. BMJ Case Rep 2012; 2012:bcr.01.2012.5673. [PMID: 22669213 DOI: 10.1136/bcr.01.2012.5673] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pseudomonas aeruginosa is an uncommon cause of community-acquired pneumonia in immune-competent hosts. It is commonly seen in patients with structural lung abnormality such as cystic fibrosis or in immune compromised hosts. Here, the authors report a case of community-acquired Pseudomonas pneumonia in a 26-year old healthy man who presented with 8-week history of malaise and cough.
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Affiliation(s)
- Mehrnaz Asadi Gharabaghi
- Department of Pulmonary Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
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9
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Wunderink RG. Ventilator-associated tracheobronchitis: public-reporting scam or important clinical infection? Chest 2011; 139:485-488. [PMID: 21362648 DOI: 10.1378/chest.10-2641] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Richard G Wunderink
- Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
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10
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Fujitani S, Sun HY, Yu VL, Weingarten JA. Pneumonia Due to Pseudomonas aeruginosa. Chest 2011; 139:909-919. [DOI: 10.1378/chest.10-0166] [Citation(s) in RCA: 163] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
Chest radiography serves a crucial role in imaging of the critically ill. Its uses include diagnosis and monitoring of commonly encountered pulmonary parenchymal and pleural space abnormalities. It is also important in evaluating monitoring and support devices and associated complications. CT, another useful imaging modality in select patients, can better characterize pulmonary parenchymal and pleural space disease.
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Affiliation(s)
- Joshua R Hill
- Department of Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L340, Portland, OR 97239, USA.
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12
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Sheridan RL, Schulz JT, Ryan CM, McGinnis PJ. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 6-2004. A 35-year-old woman with extensive, deep burns from a nightclub fire. N Engl J Med 2004; 350:810-21. [PMID: 14973211 DOI: 10.1056/nejmcpc049001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Robert L Sheridan
- Burn and Trauma Services, Massachusetts General Hospital, Boston, USA
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13
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Tuengerthal S. Pneumonien. Thorax 2003. [DOI: 10.1007/978-3-642-55830-6_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Ventilator-associated pneumonia (VAP) continues to complicate the course of 8 to 28% of patients receiving mechanical ventilation (MV). In contrast to infections of more frequently involved organs (e.g., urinary tract and skin), for which mortality is low, ranging from 1 to 4%, the mortality rate for VAP ranges from 24 to 50% and can reach 76% in some specific settings or when lung infection is caused by high-risk pathogens. The predominant organisms responsible for infection are Staphylococcus aureus, Pseudomonas aeruginosa, and Enterobacteriaceae, but etiologic agents widely differ according to the population of patients in an intensive care unit, duration of hospital stay, and prior antimicrobial therapy. Because appropriate antimicrobial treatment of patients with VAP significantly improves outcome, more rapid identification of infected patients and accurate selection of antimicrobial agents represent important clinical goals. Our personal bias is that using bronchoscopic techniques to obtain protected brush and bronchoalveolar lavage specimens from the affected area in the lung permits physicians to devise a therapeutic strategy that is superior to one based only on clinical evaluation. When fiberoptic bronchoscopy is not available to physicians treating patients clinically suspected of having VAP, we recommend using either a simplified nonbronchoscopic diagnostic procedure or following a strategy in which decisions regarding antibiotic therapy are based on a clinical score constructed from seven variables. Selection of the initial antimicrobial therapy should be based on predominant flora responsible for VAP at each institution, clinical setting, information provided by direct examination of pulmonary secretions, and intrinsic antibacterial activities of antimicrobial agents and their pharmacokinetic characteristics. Further trials will be needed to clarify the optimal duration of treatment and the circumstances in which monotherapy can be safely used.
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Affiliation(s)
- Jean Chastre
- Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, France.
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Shah RM, Wechsler R, Salazar AM, Spirn PW. Spectrum of CT findings in nosocomial Pseudomonas aeruginosa pneumonia. J Thorac Imaging 2002; 17:53-7. [PMID: 11828213 DOI: 10.1097/00005382-200201000-00007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to evaluate CT findings in nosocomial Pseudomonas aeruginosa Pneumonia (PAP) and to compare features of PAP in patients with isolated P. aeruginosa cultures and those with coexistent infections. A retrospective database search revealed 28 patients with nosocomial PAP (12 men, 16 women; mean age, 57 years) in which thoracic CT had been performed within a mean of 1.7 days from the time of respiratory culture. Two chest radiologists blinded to culture data performed a consensus reading noting distribution and pattern of consolidation, ground-glass opacity, nodules, peribronchial infiltration, necrosis, effusions, and pleural enhancement. Coexistent respiratory cultures were recorded. Consolidation was present in all patients, involving multiple lobes in 23 (82%) and demonstrating upper zonal involvement in 23 (82%). Nodular features were present in 14 (50%), including tree-in-bud patterns with centrilobular distributions in 9 (64%) and larger, randomly distributed nodules in 5 (36%). Five of five patients with consolidations limited to the lower lung zones had associated upper lung nodules. Ground-glass opacity was seen in nine (31%) and peribronchial infiltration in 16 (57%). Necrosis was present in eight (29%). Thirteen (46%) bilateral and five (18%) unilateral pleural effusions were present with enhancement occurring in two (1%). Coexistent positive respiratory cultures were identified in 13 patients. The distribution of consolidation, frequency and distribution of nodules, and frequency of necrosis did not differ significantly between patients with and without other positive cultures. With CT, PAP most commonly presents with multifocal airspace consolidation. Nodular features were identified in half, with one-third demonstrating tree-in-bud opacities. Unsuspected necrosis occurred in one-third of cases. CT findings in patients with and without other respiratory isolates did not differ in the distribution and frequency of consolidations, nodularity, or necrosis.
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Affiliation(s)
- Rosita M Shah
- Department of Radiology, Thomas Jefferson University Hospital Philadelphia, PA, USA
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16
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Abstract
Infection of the lower respiratory tract, acquired by way of the airways and confined to the lung parenchyma and airways, typically presents radiologically as one of three patterns: (1) focal nonsegmental or lobar pneumonia, (2) multifocal bronchopneumonia or lobular pneumonia, and (3) focal or diffuse "interstitial" pneumonia. These patterns can be useful in identifying the etiological organism in the appropriate clinical setting. To serve the purpose of this article, these patterns are used as the primary method of classification of pulmonary infections caused by different organisms. Mycobacterial and fungal pulmonary infections are reviewed separately because of their wide range of radiographic appearance that depend on the stage of the disease at presentation. This article discusses the clinical and radiographic features of the most common causes of pneumonia, primarily in the adult population of the United States.
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MESH Headings
- Adult
- Humans
- Lung Diseases, Fungal/classification
- Lung Diseases, Fungal/diagnostic imaging
- Lung Diseases, Fungal/epidemiology
- Lung Diseases, Fungal/microbiology
- Lung Diseases, Parasitic/classification
- Lung Diseases, Parasitic/diagnostic imaging
- Lung Diseases, Parasitic/epidemiology
- Lung Diseases, Parasitic/parasitology
- Pneumonia/classification
- Pneumonia/diagnostic imaging
- Pneumonia/epidemiology
- Pneumonia/microbiology
- Pneumonia, Bacterial/classification
- Pneumonia, Bacterial/diagnostic imaging
- Pneumonia, Bacterial/epidemiology
- Pneumonia, Bacterial/microbiology
- Pneumonia, Viral/classification
- Pneumonia, Viral/diagnostic imaging
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/virology
- Reproducibility of Results
- Risk Factors
- Tomography, X-Ray Computed/standards
- United States/epidemiology
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Affiliation(s)
- A M Gharib
- Department of Radiology, University of Louisville, Louisville, Kentucky, USA
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Cordero L, Sananes M, Coley B, Hogan M, Gelman M, Ayers LW. Ventilator-associated pneumonia in very low-birth-weight infants at the time of nosocomial bloodstream infection and during airway colonization with Pseudomonas aeruginosa. Am J Infect Control 2000; 28:333-9. [PMID: 11029131 DOI: 10.1067/mic.2000.109884] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE To study retrospectively the incidence of ventilator-associated pneumonia (VAP) at the time of Pseudomonas aeruginosa nosocomial bloodstream infection (BSI) and at the time of P aeruginosa airway colonization. MATERIALS AND METHODS Fifteen very low-birth-weight infants who had P aeruginosa BSI and 33 others who did not but who had P aeruginosa airway-colonization were studied. We correlated clinical data, blood cultures (BCs), and tracheal cultures (TCs) with radiologic findings from radio-graphs taken within 2 days before, the day of, and 1 day after BCs or TCs were first positive for P aeruginosa. Chest radiographs were graded by using semiquantitative scores for bronchopulmonary dysplasia and for pneumonia. RESULTS Mean birth weight, gestational age, and age when BC or TC became positive were similar for patients with BSI and colonization. At the time of BSI, 2 infants had airway colonization with P aeruginosa; the TCs of the remaining 13 grew P aeruginosa as a new pathogen. Thirteen of 15 patients with BSI, but none of 33 infants with colonization, died within 2 days of positive BC. VAP was diagnosed in 13 of 15 patients with BSI and in 3 of 33 infants with colonization. CONCLUSION Mechanically ventilated very low-birth-weight infants whose TCs yield P aeruginosa but whose BCs remain negative infrequently have VAP are presumed airway-colonized and are expected to survive. Conversely, VAP is likely to be found when BCs and TCs simultaneously grow P aeruginosa, and high mortality is anticipated.
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Affiliation(s)
- L Cordero
- Newborn Services and the Department of Pediatrics, The Ohio State University Medical Center, Columbus, OH 43210-1228, USA
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18
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Sar B, Oishi K, Wada A, Hirayama T, Matsushima K, Nagatake T. Induction of monocyte chemoattractant protein-1 (MCP-1) production by Pseudomonas nitrite reductase in human pulmonary type II epithelial-like cells. Microb Pathog 2000; 28:17-23. [PMID: 10623560 DOI: 10.1006/mpat.1999.0320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Monocyte chemoattractant protein-1 (MCP-1), a chemoattractant for monocytes, is presumed to play a pivotal role in the recruitment and accumulation of monocytes in various diseases including pulmonary infections. We examined here whether or not Pseudomonas nitrite reductase (PNR), a recently identified IL-8 inducer in various respiratory cells, could stimulate human pulmonary type II epithelial-like cells (A549) to induce MCP-1 production. A time- and dose-dependent induction of MCP-1 protein synthesis associated with an increase of MCP-1 mRNA expression by A549 cells was observed in response to PNR. New protein translation was not required for PNR-mediated MCP-1 mRNA expression in the same cells. When anti-human MCP-1 monoclonal antibody was used for neutralizing of monocyte chemotactic factor (MCF) activities in the culture supernatants of these cells stimulated with PNR, significant reductions of MCF activities (the mean reduction rate; 49-59%, P<0. 05) were observed. These data suggest that PNR may contribute to monocyte migration, through inducing pulmonary epithelial cell-derived MCP-1 production in the airway of patients with pneumonia due to P. aeruginosa.
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Affiliation(s)
- B Sar
- Department of Internal Medicine, Institute of Tropical Medicine, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
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Sar B, Oishi K, Matsushima K, Nagatake T. Induction of interleukin 8 (IL-8) production by Pseudomonas nitrite reductase in human alveolar macrophages and epithelial cells. Microbiol Immunol 1999; 43:409-17. [PMID: 10449247 DOI: 10.1111/j.1348-0421.1999.tb02424.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Interleukin-8 (IL-8) participates in the generation of dense neutrophil accumulations in bronchopulmonary infections caused by Pseudomonas aeruginosa (P. aeruginosa). We have recently reported that nitrite reductase, a bifunctional enzyme located in the periplasmic space of P. aeruginosa, induces IL-8 generation in bronchial epithelial cells (K. Oishi et al. Infect. Immun. 65: 2648-2655, 1997). We examined whether or not Pseudomonas nitrite reductase (PNR) could also stimulate human alveolar macrophages (AM) and pulmonary type II epithelial-like cells (A549) to induce IL-8 production and mRNA expression as well as the production of TNF alpha and IL-1beta. We demonstrated a time- and dose-dependent IL-8 protein synthesis and IL-8 mRNA expression, but no TNF alpha or IL-1beta production, by A549 cells in response to PNR. New protein translation was not required for PNR-mediated IL-8 mRNA expression in the same cells. Furthermore, simultaneous stimulation of PNR with serial doses of TNF alpha or IL-1beta resulted in additive IL-8 production in A549 cells. In adherent AM, PNR enhanced IL-8 protein synthesis and IL-8 mRNA expression in a time-dependent fashion. PNR similarly induced a time-dependent production of TNF alpha and IL-1beta by human adherent AM. Neutralization of TNF alpha or IL-1beta did not influence the levels of IL-8 production in adherent AM culture. We also evaluated whether the culture supernatants of the A549 cells or AM stimulated with PNR could similarly mediate neutrophil migration in vitro. When anti-human IL-8 immunoglobulin G was used for neutralizing neutrophil chemotactic factor (NCF) activities in the culture supernatants of these cells stimulated with 5 microg/ml of PNR, the mean percent reduction of NCF activities were 49-59% in A549 cells and 24-34% in AM. Our present data support that PNR directly stimulates AM and pulmonary epithelial cells to produce IL-8. PNR also mediates neutrophil migration, in part, through IL-8 production from AM and pulmonary epithelial cells. These data suggest the contribution of PNR to the pathogenesis of bronchopulmonary infections due to P. aeruginosa.
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Affiliation(s)
- B Sar
- Department of Internal Medicine, Institute of Tropical Medicine, Nagasaki University, Japan.
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Sar B, Oishi K, Wada A, Hirayama T, Matsushima K, Nagatake T. Nitrite reductase from Pseudomonas aeruginosa released by antimicrobial agents and complement induces interleukin-8 production in bronchial epithelial cells. Antimicrob Agents Chemother 1999; 43:794-801. [PMID: 10103183 PMCID: PMC89209 DOI: 10.1128/aac.43.4.794] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We have recently reported that nitrite reductase, a bifunctional enzyme located in the periplasmic space of Pseudomonas aeruginosa, could induce interleukin-8 (IL-8) generation in a variety of respiratory cells, including bronchial epithelial cells (K. Oishi et al. Infect. Immun. 65:2648-2655, 1997). In this report, we examined the mode of nitrite reductase (PNR) release from a serum-sensitive strain of live P. aeruginosa cells during in vitro treatment with four different antimicrobial agents or human complement. Bacterial killing of P. aeruginosa by antimicrobial agents induced PNR release and mediated IL-8 production in human bronchial epithelial (BET-1A) cells. Among these agents, imipenem demonstrated rapid killing of P. aeruginosa as well as rapid release of PNR and resulted in the highest IL-8 production. Complement-mediated killing of P. aeruginosa was also associated with PNR release and enhanced IL-8 production. The immunoprecipitates of the aliquots of bacterial culture containing imipenem or complement with anti-PNR immunoglobulin G (IgG) induced twofold-higher IL-8 production than did the immunoprecipitates of the aliquots of bacterial culture with a control IgG. These pieces of evidence confirmed that PNR released in the aliquots of bacterial culture was responsible for IL-8 production in the BET-1A cells. Furthermore, the culture supernatants of the BET-1A cells stimulated with aliquots of bacterial culture containing antimicrobial agents or complement similarly mediated neutrophil migration in vitro. These data support the possibility that a potent inducer of IL-8, PNR, could be released from P. aeruginosa after exposure to antimicrobial agents or complement and contributes to neutrophil migration in the airways during bronchopulmonary infections with P. aeruginosa.
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Affiliation(s)
- B Sar
- Department of Internal Medicine, Nagasaki University, Japan.
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Crouch Brewer S, Wunderink RG, Jones CB, Leeper KV. Ventilator-associated pneumonia due to Pseudomonas aeruginosa. Chest 1996; 109:1019-29. [PMID: 8635325 DOI: 10.1378/chest.109.4.1019] [Citation(s) in RCA: 242] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Ventilator-associated pneumonia (VAP) caused by Pseudomonas aeruginosa has been associated with higher case fatality rates than VAP caused by other bacterial etiologies. The causes of this excess mortality are unclear. DESIGN Retrospective review of 38 consecutive ventilated patients with Pseudomonas pneumonia, documented by highly reliable methods. Charts of five additional patients were unavailable for review. SETTING Medical ICUs of a university-affiliated Veterans Affairs Medical Center and a university-affiliated municipal hospital. MEASUREMENTS Prospectively collected hospital admission acute physiologic and chronic health examination (APACHE) II scores and cause of ICU admission. Retrospectively calculated organ failure and APACHE scores, VAP score. Clinical and microbiologic variables. Antibiotic treatment and outcome. Direct cause of death by standard definitions. RESULTS Overall mortality was 69% (26/38), significantly higher than the APACHE II predicted mortality of 42.6% (p=0.037). At least 38% (10/26) of deaths were directly attributable to Pseudomonas VAP. Multivariate analysis of factors associated with death found infectious cause for ICU admission (odds ratio [OR]=8.67; 95% confidence interval [CI], 0.86 to 85.94) and number of organ dysfunctions on the day of diagnosis (OR=1.73, 95% CI, 1.02 to 2.92) were significant. Septic shock from Pseudomonas VAP, septic shock from subsequent infection, and multiple organ dysfunction syndrome were the most common immediate causes of death. Mortality increased linearly with increasing APACHE III score on the day of diagnosis. Of initial antibiotic regimens, 67% (26/36) were considered failures. Persistent pneumonia occurred in 35% of patients while recurrent pneumonia was unusual (1/38). CONCLUSIONS Development of Pseudomonas pneumonia results in a mortality rate in excess of that due to the presenting illness. The attributable mortality determined by several means appears to approach 40%. The excess mortality appears to be related to the host defense response to the pneumonia rather than any characteristic of the pneumonia. Even standard antibiotic regimens fail frequently and do not prevent the excess mortality. Since at least 38% of deaths can be directly attributable to the Pseudomonas pneumonia, improvement in therapy is needed.
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Affiliation(s)
- S Crouch Brewer
- Department of Medicine, University of Tennessee, Memphis, USA
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