Successful treatment of Purpureocillium lilacinum pulmonary infection with isavuconazole: A case report

BACKGROUND Purpureocillium lilacinum(P.lilacinum)is a saprophytic fungus widespread in soil and vegetation.As a causative agent,it is very rarely detected in humans,most commonly in the skin.CASE SUMMARY In this article,we reported the case of a 72-year-old patient with chronic lymphocytic leukemia who was admitted with cough and fever.Computed tomography revealed an infection in the right lower lobe.Bronchoalveolar lavage fluid culture and metagenomic next-generation sequencing were ultimately confirmed to have a pulmonary infection with P.lilacinum.She was eventually discharged with good outcomes after treatment with isavuconazole.CONCLUSION Pulmonary infection with P.lilacinum was exceedingly rare.While currently there are no definitive therapeutic agents,there are reports of high resistance to amphotericin B and fluconazole and good sensitivity to second-generation triazoles.The present report is the first known use of isavuconazole for pulmonary P.lilacinum infection.It provides new evidence for the characterization and treatment of clinical P.lilacinum lung infections.

Development and validation of a postoperative pulmonary infection prediction model for patients with primary hepatic carcinoma

BACKGROUND There are factors that significantly increase the risk of postoperative pulmonary infections in patients with primary hepatic carcinoma(PHC).Previous reports have shown that over 10%of patients with PHC experience postoperative pulmonary infections.Thus,it is crucial to prioritize the prevention and treatment of postoperative pulmonary infections in patients with PHC.AIM To identify the risk factors for postoperative pulmonary infection in patients with PHC and develop a prediction model to aid in postoperative management.METHODS We retrospectively collected data from 505 patients who underwent hepatobiliary surgery between January 2015 and February 2023 in the Department of Hepatobiliary and Pancreaticospleen Surgery.Radiomics data were selected for statistical analysis,and clinical pathological parameters and imaging data were included in the screening database as candidate predictive variables.We then developed a pulmonary infection prediction model using three different models:An artificial neural network model;a random forest model;and a generalized linear regression model.Finally,we evaluated the accuracy and robustness of the prediction model using the receiver operating characteristic curve and decision curve analyses.RESULTS Among the 505 patients,86 developed a postoperative pulmonary infection,resulting in an incidence rate of 17.03%.Based on the gray-level co-occurrence matrix,we identified 14 categories of radiomic data for variable screening of pulmonary infection prediction models.Among these,energy,contrast,the sum of squares(SOS),the inverse difference(IND),mean sum(MES),sum variance(SUV),sum entropy(SUE),and entropy were independent risk factors for pulmonary infection after hepatectomy and were listed as candidate variables of machine learning prediction models.The random forest model algorithm,in combination with IND,SOS,MES,SUE,SUV,and entropy,demonstrated the highest prediction efficiency in both the training and internal verification sets,with areas under the curve of 0.823 and 0.801 and a 95%confidence interval of 0.766-0.880 and 0.744-0.858,respectively.The other two types of prediction models had prediction efficiencies between areas under the curve of 0.734 and 0.815 and 95%confidence intervals of 0.677-0.791 and 0.766-0.864,respectively.CONCLUSION Postoperative pulmonary infection in patients undergoing hepatectomy may be related to risk factors such as IND,SOS,MES,SUE,SUV,energy,and entropy.The prediction model in this study based on diffusion-weighted images,especially the random forest model algorithm,can better predict and estimate the risk of pulmonary infection in patients undergoing hepatectomy,providing valuable guidance for postoperative management.

Assessing the Effectiveness of Montelukast Sodium in Managing Pulmonary Infections in Lung Cancer Patients

Objective:To investigate the efficacy of montelukast sodium in the treatment of lung cancer patients with pulmonary infections.Methods:A total of 330 patients diagnosed with lung cancer and pulmonary infection,who were admitted to the First Affiliated Hospital of Xi’an Medical University from 2020 to 2022,were selected as research subjects.They were randomly divided into two groups:a control group receiving conventional treatment and an observation group receiving conventional treatment combined with montelukast sodium.Each group consisted of 165 cases.The time required for clinical symptom improvement,the resolution of lung infection signs,and the levels of serum inflammatory factors before and after treatment were compared between the two groups.Results:The observation group exhibited significantly faster improvement in clinical symptoms compared to the control group(P<0.001).ELISA assays were conducted to detect the expression levels of IL-1β,IL-6,IL-8,and TNF-αin the serum of both groups at 1 week and 2 weeks into the treatment.The results indicated that,as the treatment progressed,the observation group displayed significantly lower levels of the four serum inflammatory factors compared to the control group(P<0.001).Conclusion:Montelukast sodium demonstrates efficacy in the treatment of patients with lung cancer complicated by pulmonary infections.These findings suggest its potential for further verification and clinical application.

Secondary pulmonary infection by Fusarium solani and Aspergillus niger during systemic steroid treatment for COVID-19:A case report

BACKGROUND Coronavirus disease 2019(COVID-19)-associated invasive pulmonary aspergillosis presents a diagnostic challenge due to its non-specific clinical/imaging features,as well as the fact that the proposed clinically diagnostic algorithms do not necessarily apply to COVID-19 patients.In addition,Fusarium spp.is a rare cause of opportunistic life-threatening fungal infections.Disseminated Fusarium infection in an immunocompromised host is intractable,with a high likelihood of resulting mortality.To our knowledge,this is the first case of secondary pulmonary infection by Fusarium solani(F.solani)and Aspergillus niger(A.niger)during systemic steroid treatment for COVID-19.CASE SUMMARY A 62-year-old male was transported to our hospital by ambulance with a complaint of fever and dyspnea.We established a diagnosis of pneumococcal pneumonia,complicated with COVID-19 and septic shock,together with acute renal failure.He was admitted to the intensive care unit,to be treated with piperacillin/tazobactam,vancomycin,and 6.6 mg per day of dexamethasone sodium phosphate,along with noradrenaline as a vasopressor,ventilator management,and continuous hemodiafiltration.His condition improved,and we finished the vasopressor on the fifth hospital day.We administered dexamethasone for ten days,and finished the course of treatment.On the eleventh day,patient respiratory deterioration was observed,and a computed tomography scan showed an exacerbation of bilateral ground-glass-opacity-like consolidation,together with newly appeared cavitary lesions in the lung.we changed antibiotics to meropenem plus vancomycin.In addition,a fungal infection was considered as a possibility based on microscopic findings of sputum,and we began coadministration of voriconazole.However,the pneumonia worsened,and the patient died on the seventeenth day of illness.Later,F.solani and A.niger were identified from sputum collected on the twelfth day.It was believed that he developed a cell-mediated immune deficiency during COVID-19 treatment,which led to the complication of pneumonia caused by the above-mentioned fungi,contributing to his death.CONCLUSION Because early initiation of intense antifungal therapy offers the best chance for survival in pulmonary fusariosis,computed tomography scans and appropriate microbiologic investigations should be obtained for severely immunocompromised patients.

Analysis of factors related to postoperative pulmonary infection in lung cancer patients after recovery from COVID-19

Objective:To explore factors related to postoperative pulmonary infection in lung cancer patients after recovery from COVID-19 and to provide methods for preventing and reducing the incidence of postoperative lung infection in patients with lung cancer.Methods:A total of 92 patients who underwent lung cancer surgery in the Department of Thoracic and Cardiac Surgery of Yichang Central People’s Hospital from January 28,2023,to March 3,2023,were selected.They were divided into a pulmonary infection group(47 cases)and a nonpulmonary infection group(45 cases)according to whether pulmonary infection occurred.General clinical data of patients were collected and collated to analyse the related influencing factors of pulmonary infection in lung cancer patients after recovery from COVID-19.Results:Univariate analysis showed that patient age(≥60 years),fever after COVID-19 infection,oral and laryngeal symptoms,digestive tract symptoms,neurological symptoms,long-term smoking history,hypertension history,and operation time(≥3 h)were correlated with pulmonary infection(all P<0.05).There was no significant correlation between postoperative pulmonary infection and sex,ocular,nasal and tongue symptoms,systemic symptoms,duration of COVID-19,COPD,lobectomy site,incision pain,mechanical ventilation time(≥6 h),drainage tube retention time(3 d),surgical method(P>0.05).Logistic multivariate analysis showed that age(≥60 years old),long operation time(≥3 h)and long-term smoking history were independent influencing factors for postoperative pulmonary infection in patients with radical resection of lung cancer(P>0.05).Conclusion:In this study,older age(≥60 years old),long-term smoking history,and long operation time(≥3 h)were risk factors for pulmonary infection after lung cancer surgery.In the future,active treatment measures can be taken to address these risk factors during the perioperative period to reduce the incidence of postoperative pulmonary infection.

Role of MexA-MexB-OprM Efflux Pump System in Chronic Pseudomonas Aeruginosa Pulmonary Infection in Mice

In order to investigate the role of the MexA-MexB-OprM efflux pump system in the pathogenesis of Pseudomonas aeruginosa(PA)-induced pulmonary infection,pulmonary infection models were established by intratracheal injection of K767(wild type),nalB(MexA-MexB-OprM up-regulated mutant),and △m exB(knockout) strains,separately.All mice were treated with Meropenem(intraperitoneal injection,100 mg/kg body weight,twice every day),and strain-related pathology,bacteria count,cytokine level,myeloperoxidase(MPO,indicator of neutrophil recruitment) activity,and macrophage inflammatory protein-2(MIP-2) expression were evaluated at early(3rd day post-infection) and late(7th and 14th day post-infection) stages of infection.E-test showed that △mexB was more significantly sensitive to panipenan(ETP),meropenem(MP) and imipenem(IP) than K767 and nalB strains.There was no significant difference in sensitivity to cefepime(TM) among the three stains.In contrast to the K767 and nalB groups,the △ mexB group showed decreased bacteria burden over time and less extensive pathological change.Additionally,MPO activity and levels of inflammatory cytokines(IL-1b,IL-12,and TNF-α) were increased at the early stage(day 3) and decreased at the later stage(day 14).Serum MIP-2 expression level was steadily increased in all three groups from early to late stages,but significantly higher in △m exB group than in K767 and nalB groups(P<0.05).In conclusion,the MexA-MexB-OprM efflux pump system might play an important role in PA-induced chronic pulmonary infection.High expression of the MexA-MexB-OprM efflux pump could increase antibacterial resistance and promote infection.

Bronchopulmonary infection with lophomonas blattarum:two cases report and literature review

Objective： To improve the recognition and diagnosis on the bronchopulmonary infection with Lophomonas blattarum （L. blattarum）. Methods： The clinical characteristics of 2 patients diagnosed and treated in our hospital were reported, and 42 cases that had been reported from years 1993 to 2007 are analyzed. Results： In our report, the first patient attacked serious asthma time after time, the second patient suffered from bronchiectasis with a protracted infection course. Forty-four cases all have pathogen examination and parasitic expertise. The most common symptoms are fever, cough and expectoration. 1/3 of the patients have increased acidophilic granulocyte in peripheral blood. Chest X film and CT scanning suggest changes were similar to pneumonia. Chronic cases are manifested with bronchial asthma, bronchiectasis and pulmonary abscess. L. blattarum found in phlegm or specimen collected by bronchoscopy provides the most reliable evidence for the diagnosis of this disease. Conclusion： Bronchopulmonary L. blattarum infection is a new kind of diseases. The clinical manifestations are similar to pneumonia, asthma, bronchiectasis infection or pulmonary abscess. L. blattarum found in sputum smear, bronchoscopic brush smear, bronchoscopic biopsy smear, or hronchoalceolar lavage under microscope is the foundation of the diagnosis. The pathogen species has not been finally confirmed. It is still unclear how the pathogen exists in the natural environment, how to transmit to persons and what kind of people would suffer from the disease more easily. Treatment only with antibiotics is not effective to this disease. Metronidazole with dosage of 0.5 g per time and twice per day was effective to most patients, the period of treatment need to last 14-38 d, but multidrug resistance case had been reoorted.

Expression of IL-4 in a rat model of chronic pulmonary infection with biofilm formation induced by Pseudomonas aeruginosa

The expression of IL-4 in a rat model of chronic pulmonary infection biofilm formation induced by Pseudomonas aeruginosa was investigated, in which SPF Wister rats were infected via trachea with 0.1 ml P. aeruginosa strain PAO579 （ 10^9 CFU/ml） in alginate beads or the planktonic form of this bacterial strain （109 CFU/ml）, and on 3, 7 and 14 d after infection, the bacteriological and pathological changes were observed as well as the expression of the cytokine IL-4 was determined. It was demonstrated that the count of CFU per lung tissue in case of bacteria in alginate beads was significantly higher than that of bacteria in planktonic form, with more severe gross pathologic changes and inflammatory reactions in the alginate bead group in comparison with that of the planktonic forms （ P = 0. 002, P = 0. 004 and P = 0. 002, respectively）. In addition, the expression of IL-4 in the alginate bead group was also higher than that in the planktonic form （P = 0.02, P = 0.02 and P = 0.022, respectively）. A positive correlation between the level of IL-4 expression and the gross lung pathology in alginate bead group existed as demonstrated by simple regression analysis （r = 0.78, P 〈 0.02）. It is concluded that the chronic pulmonary infection with biofilm formation induced by P. aeruginosa tends to have the priority to the Th2 immune response.

Nutritional status in chronically hospitalized stroke patients complicated with pulmonary infection

Complicated pulmonary infection following stroke has traditionally been considered an aspirated infection by many physicians, and little attention has been paid to concomitant protein-energy malnutrition. In the present study, we hypothesized that protein-energy malnutrition may be present in hospitalized chronic stroke patients complicated with pulmonary infection. The results revealed that body protein and fat stores were significantly depleted in stroke patients with pulmonary infection. Protein-energy malnutrition was present in 12 of 27 patients with pulmonary infection. In comparison, only eight of 42 stroke patients without pulmonary infection exhibited protein-energy malnutrition. A significantly higher prevalence of protein-energy malnutrition was found in the pulmonary infection group, suggesting that protein-energy malnutrition is more likely to be present in hospitalized chronic stroke patients with pulmonary infection.

Clinical diagnosis,treatment,and medical identification of specific pulmonary infection in naval pilots:Four case reports

BACKGROUND Specific pulmonary infection could seriously threaten the health of pilots and their companions.The consequences are serious.We investigated the clinical diagnosis,treatment,and medical identification of specific pulmonary infections in naval pilots.CASE SUMMARY We analyzed the medical waiver and clinical data of four pilots with specific pulmonary infections,who had accepted treatment at the Naval Medical Center of Chinese People’s Liberation Army between January 2020 and November 2021,including three cases of tuberculosis and one of cryptococcal pneumonia.All cases underwent a series of comprehensive treatment courses.Three cases successfully obtained medical waiver for flight after being cured,while one was grounded after reaching the maximum flight life after being cured.CONCLUSION Chest computed tomography scanning should be used instead of chest radiography in pilots’physical examination.Most pilots with specific pulmonary infection can be cured and return to flight.

Antibacterial activity of panipenem/betamipron in vitro and its pharmacokinetics and therapeutic efficacy in patients with pulmonary infection

Objective: To investigate the in vitro antimicrobial activity of panipenem/betamipron to common clinical isolates, determine its pharmacokinetics in patients with pulmonary infection and evaluate its effectiveness and safety in treatment of pulmonary infection. Methods: (1) The minimal inhibition concentrations of panipenem/betamipron were determined in 247 clinical isolates by agar dilution method. The minimal bactericidal concentrations of panipenem/betamipron for some clinical isolates were also determined. (2) Twenty cases of pulmonary infection were treated with intravenous dripping of panipenem/betamipron at 500/500 mg every 12 h for 3-7 d. Panipenem/betamipron concentration in the plasma was consecutively measured, and bacterial culture was conducted and the efficacy was evaluated. Results: (1) The in vitro antimicrobial activity of panipenem/betamipron was almost the same as that of panipenem, indicating that panipenem played the major role in antimicrobial reaction. Panipenem/betamipron had a strong antimicrobial activity against Staphylococcus aureus including methicillin-resistant Staphylococcus aureus, Staphylococcus epidermidis, β-Streptococcus hemolytic, Streptococcus pneumonia, micrococcus, Escherichia coli and Klebsiea pneumonia. The drug also showed a potent effect against Haemophilus influenzae,Enterobacter cloacae, Proteus and Pseudomonas aeruginosa (2) The peak value of panipenem/betamipron in plasma was (30.25±5.43) mg/L and the level decreased to (0.66±0.34) mg/L 6 h later. The half-life of distribution and elimination of panipenem in the plasma was (0.34±0.18) h and (1.42±0.31) h, respectively. (3) The eradication rate of bacteria was 77.8% and the effective healing rate was 75%. No adverse drug reaction was found. Conclusion: Panipenem/betamipron has a strong antimicrobial activity against clinical isolates and is effective and safe for treatment of pulmonary infection.

Tanreqing injection auxiliary in the treatment of heart failure with pulmonary infection:A systematic review

Objective:To systematically evaluate the clinical efficacy and safety of Tanreqing injection in the treatment of heart failure complicated with pulmonary infection.Methods:The database of CNKI,SinoMed,VIP full text database,Wanfang database,Cochrance Library,Web of Science and PubMed were searched.The retrieval time was from the inception to August 2021.Clinical randomized controlled trial of Tanreqing injection in the treatment of heart failure complicated with pulmonary infection was collected,and two researchers independently screened the document data.Meta-analysis was performed using RevMan 5.4.1 software.Results:A total of 10 documents were included,including 862 cases of heart failure complicated with pulmonary infection,including 431 cases in the test group,and 431 cases in the control group.The Meta analysis showed that compared to the control group,the test group increased clinical efficiency[OR=4.56,95%CI(2.79,7.52),P<0.00001],reduced the value of C-reactive protein[MD=-7.55,95%CI(-11.40,-3.69),P=0.0001],reduced the time required to correct heart failure[OR=-4.04,95%CI(-4.59,-3.49),P<0.00001],reduced the number of days of the average hospitalization[MD=-4.78,95%CI(-6.67,-2.89),P<0.00001],and there were no statistically significant differences in the incidence of adverse reactions.Conclusion:Tanreqing injection,as an auxiliary treatment for heart failure complicated with pulmonary infection,has significantly effective effect on improving efficiency.Tanreqing injection has a certain advantage in reducing C-creative protein values,shortening the time of correcting heart failure,and reducing the number of days of the average hospitalization,and the adverse reactions are smaller.However,the overall quality of the included studies is low,and more high-quality randomized controlled trials are needed to increase the evidence-based basis.

Risk Factors and Distribution of Pathogens for Pulmonary Infection in Patients with Severe Acute Pancreatitis

Objective:To investigate risk factors and distribution of pathogens for pulmonary infection in patients with severe acute pancreatitis.Methods:The clinical data of 285 patients with severe acute pancreatitis were retrospectively analyzed.Sputum specimens of patients with lung infections were studied.Univariate analysis and logistic regression were performed to screening the factors correlating to lung infections.Results:Gram-negative bacilli were the principal microorganisms isolated from those lung infections,and these bacterial pathogens demonstrated a marked pattern of antibiotic resistance.It was identified that age(OR 1.05,95%CI 1.01-1.09,p=0.01),Ranson scores(OR 3.01,95%CI 1.13-8.03,p=0.03)and surgical treatment(OR4.27,95%CI 1.03-17.65,p=0.04)were independent risk factors of lung infections in patients with severe acute pancreatitis.Conclusion:Analysis of pathogen spectrum and drug sensitivity will contribute to choosing antibiotics empirically.And preventive measures aimed at risk factors could help reduce the incidence of lung infections in patients with severe acute pancreatitis.

Study on Characteristics and Influencing Factors of Coagulation Indexes in Pulmonary Infection Sepsis

Objective:To explore the characteristics and influencing factors of coagulation indexes in patients with pulmonary infection sepsis.Methods:104 patients in Shaanxi Provincial Hospital of Chinese Medicine from January 2015 to April 2021 were collected and divided into case group(52 cases)and control group(52 cases).The general data and coagulation indexes of the two groups were statistically analyzed.The difference was statistically significant(P<0.05).Binary logistic regression analysis was used.Results:The indexes of age PT,APTT,TT,FDP,D-Dimer,INR and PLT in the control group were significantly higher than those in the control group(P<0.05);There was no significant difference in FIB-C(P>0.05);Binary logistic regression analysis showed that D-Dimer and PLT were the risk factors of pulmonary infection sepsis(OR>1,P<0.05).Conclusion:FDP and D-Dimer are risk factors for the development of pneumonia into sepsis.

Clinical analysis on nosocomial pulmonary infection in patients with indwelling tracheal tube

Tracheal intubation by tracheotomy or by placing a tracheal tube through larynx into trachea,is not only one of important measures which are taken to rescue critically ill patients with respiratory failure etc.,but a commonly used method to prevent patients from airway obstruction in the postoperative period and facilitate mechanical ventilation.Meanwhile,the incidence rate of pulmonary infection,a complication caused by indwelling tracheal tubes,especially the incidence rate of hospital acquired pulmonary infection is apparently increasing.Particularly,pulmonary infection of this kind has characteristics of easily recurrent seizures,long treatment period and high drug-resistance.Hence,it is required for medical personnel to summarize,analyze and study not only general nursing,airway nursing and prevention of pulmonary infection,but also antibiotic selection as well as how and when to use those drugs after the incidence of pulmonary infection for the benefit of patients with indwelling tracheal tube.This article is based on a case collected from Comprehensive Surgery Department of the Third Affiliated Hospital of Inner Mongolia Medical University.The patient’s history is as follows:1.Pulmonary infection;2.Indwelling tracheal catheter after tracheotomy;3.Carbon monoxide toxic cerebrosis,mute state.By means of this case analysis,it is expected to make an early detection,and give an early and proper treatment to patients with pulmonary infection caused by indwelling tracheal tubes in clinical practice.

Risk factors and subsequent prognostic impact of pulmonary infection in patients with acute myocardial infarction undergoing IABP implantation

Background Mortality in patients with acute myocardial infarction(AMI)undergoing an intra-aortic balloon pump(IABP)implantation remains high.This study aims to analyze the risk factors and subsequent prognostic impact of pulmonary infection in these populations.Methods Data of patients with AMI treated with the IABP between August 2017 and May 2018 was collected retrospectively.A total of 104 AMI patients who underwent the IABP and complicated with postoperative pulmonary infection were assigned to the observation group,meanwhile,73 patients without pulmonary infection were chosen as the control group.The clinical characteristics were compared between two groups of patients,the risk factors and outcomes for the postoperative pulmonary infections were analyzed.Results Pulmonary infection can prolong CCU duration(11.7±8.2 vs.6.5±4.1,P<0.001)and lead to higher in-hospital death(31.5%vs.12.5%,P=0.002).Killip>2 was an independent risk factor for pulmonary infection.In addition,multivariate logistic regression analysis indicated that Killip>2,diabetes,current smoking,and pulmonary infection were independently associated with in-hospital death.Conclusions Postoperative pulmonary infection was a risk factor for poor outcomes in patients with AMI undergoing IABP.It is necessary to take corresponding interventions to reduce the risk of postoperative pulmonary infection.

Pulmonary arterial hypertension confirmed by right heart catheterization following COVID-19 pneumonia: A case report and review of literature

BACKGROUND Pulmonary arterial hypertension(PAH)is a disease of the arterioles resulting in an increased resistance in pulmonary circulation with associated high pressures in the pulmonary arteries,causing irreversible remodeling of the pulmonary arterial walls.Coronavirus disease 2019(COVID-19)has been associated with development of new onset PAH in the literature leading to symptoms of dyspnea,cough and fatigue that persist in spite of resolution of acute COVID-19 infection.However,the majority of these cases of COVID related PAH were diagnosed using echocardiographic data or via right heart catheterization in mechanically ventilated patients.CASE SUMMARY Our case is the first reported case of COVID related PAH diagnosed by right heart catheterization in a non-mechanically ventilated patient.Right heart catheterization has been the gold standard for diagnosis of pulmonary hypertension.Our patient had right heart catheterization four months after her initial COVID-19 infection due to persistent dyspnea.CONCLUSION This revealed new onset PAH that developed following her infection with COVID-19,an emerging sequela of the infection.

Lung imaging characteristics in a patient infected with Elizabethkingia miricola following cerebral hemorrhage surgery: A case report

BACKGROUND Elizabethkingia miricola is a non-fermenting gram-negative bacterium,which was first isolated from the condensate of the Russian peace space station in 2003.Most studies on this bacterium have been carried out in the laboratory,and clinical case studies are rare.To date,a total of 6 clinical cases have been reported worldwide.CASE SUMMARY We present the first case of postoperative pulmonary infection in a patient with intracerebral hemorrhage due to Elizabethkingia miricola.The imaging character-istics of pulmonary infection were identified and the formulation and selection of the clinical treatment plan for this patient are discussed.CONCLUSION Elizabethkingia miricola infection is rare.When pulmonary infection occurs,computed tomography imaging may show diffuse distribution of a ground glass density shadow in both lungs,the air containing bronchial sign in local areas,thickening of bronchial vascular bundle,and pleural effusion.

Application of fiberoptic bronchscopy in patients with acute exacerbations of chronic obstructive pulmonary disease during sequential weaning of invasive-noninvasive mechanical ventilation

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 reventilatJon and the occurrence rate of ventilator-associated pneumonia(VAP);2) the convenience and safety of FOB manipulation.The results were compared using Student's f 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.

Pathogenic effects of biofilm with chronic pseudomonas aeruginosa lung infection in rats

Objective： To establish an animal model of P.aeruginosa biofilm associated with chronic pulmonary infection and investigate the pathogenic effects of biofilm. Methods： Experiments in vitro, measuring the MICS, MBCS of levofloxacin（LFX）, ceftazidime（CAZ） in PAO579 in alginate beads and planktonic PAO579. Rats were challenged with 0.1 ml of PAO579（109CFU/ml） in alginate beads or 0.1 ml of planktonic PAO579（109CFU/ml）, 3,7,14 days after challenging, bacteriological, pathological features were observed. Results： The MICS, MBCS of LFX, CAZ in PAO579 in alginate beads were higher than those in planktonic PAO579 in vitro. CFU/lung in alginate beads group was significantly higher than that in planktonic bacteria group（P = 0.002, P = 0.004, P = 0.002, respectively）; macroscopic lung pathology and the inflammation in alginate beads group were significantly more severe compared to those in planktonic bacteria group in vivo. Conclusion： P.aeruginosa biofilm protected bacterium from killing of antibiotics and might mediate the host immune damage in the lung tissue and made bacterium evade the host immune defense.