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Objective:To analyze the distribution and antimicrobial resistance pattern of bacteria isolated from alveolar lavage fluid in pediatric patients with lower respiratory tract infection from 2016 to 2018.Methods:The alveolar lavage fluid of pediatric patients aged <18 years old with lower respiratory tract infection in ten hospitals from January 2016 to December 2018 were collected, and the pathogenic bacteria were cultured and isolated. The paper diffusion method or minimum inhibitory concentration method was used to conduct drug susceptibility tests for the isolated strains.The distribution of pathogenic bacteria and the source department of the strains were analyzed.Chi-sqare test was used for statistical analysis.Results:Of 1 271 isolates, 606 strains (47.7%) were gram-negative bacteria, 628 strains (49.4%) were gram-positive bacteria, and 37 strains (2.9%) were fungi. The common pathogens were Streptococcus pneumoniae (36.7%, 466/1 271), Acinetobacter baumannii (16.8%, 214/1 271), Staphylococcus aureus (12.7%, 162/1 271), Klebsiella pneumoniae (8.3%, 105/1 271), Haemophilus influenzae (7.4%, 94/1 271), Pseudomonas aeruginosa (6.2%, 79/1 271), Burkholderia cepacia (5.3%, 67/1 271) and Escherichia coli (3.7%, 47/1 271). The main pathogens in the intensive care unit (ICU) were gram-negative bacteria (80.1%, 428/534), among which Acinetobacter baumannii was the most common (3.7%, 199/534). The main pathogens in the non-ICU were gram-positive bacteria (70.8%, 522/737). The detection rates of methicillin-resistant Staphylococcus aureus (MRSA) were 45.1%(23/51) in the ICU and 43.2% (48/111) in the non-ICU, respectively. The detection rates of penicillin-resistant Streptococcus pneumoniae (PRSP) were 10.9%(6/55) in the ICU and 18.5% (76/411) in the non-ICU, respectively. The detection rates of carbapenem-resistant Klebsiella pneumoniae (CRKP) were 57.3%(43/75) in the ICU and 33.3%(10/30) in the non-ICU, respectively. The detection rate of carbapenem-resistant Pseudomonas aeruginosa (CRPA) in the ICU was higher than that in the non-ICU (49.1%(27/55) vs 25.0%(6/24)), and the difference was statistically significant ( χ2=3.98, P=0.046). Eight strains (17.0%) of carbapenem-resistant Escherichia coli were detected, and 164 strains(76.6%) of carbapenem-resistant Acinetobacter baumannii were detected. Seventy-eight Haemophilus influenzae isolates were isolated from non-ICU, and the resistance rate to ampicillin was 57.4%(54/94). Burkholderia cepacia isolates were all isolated from ICU, and the resistance rates to piperacillin-tazobactam, levofloxacin, ciprofloxacin and compound sulfamethoxazole were 13.4%(9/67), 3.0%(2/67), 0(0/67) and 9.0%(6/67), respectively. Conclusions:Streptococcus pneumoniae is still the most common pathogen in pediatric patients with lower respiratory tract infection. Gram-negative bacilli are the main pathogens in pediatric patients with lower respiratory tract infection in the ICU. The dection rates of MRSA, PRSP and carbopenem-resistant gram-negative bacilli are high. And the resistance rate of Haemophilus influenzae to ampicillin is also high. The clinical empirical treatment should be determined according to different clinical background.
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Objective To investigate the risk factors of central airway stenosis after lung transplantation. Methods Clinical data of 155 recipients undergoing lung transplantation in Wuxi People's Hospital Affiliated to Nanjing Medical University from July 2016 to December 2017 were retrospectively analyzed. According to the incidence of central airway stenosis following lung transplantation, all recipients were divided into the stenosis group (n=36) and control group (n=119). The incidence of central airway stenosis after lung transplantation was summarized. The risk factors of central airway stenosis after lung transplantation were assessed by univariate and multivariate logistic regression analyses. Results Among 155 lung transplant recipients, 36 cases (23.2%) developed central airway stenosis. The average incidence time was (53±13) d after lung transplantation. Univariate analysis demonstrated that bilateral lung transplantation, grade 3 primary graft dysfunction (PGD), airway fungal infection, long cold ischemia time, long mechanical ventilation time and long intensive care unit (ICU) stay were the risk factors for central airway stenosis after lung transplantation (all P < 0.05). Multivariate analysis showed that airway fungal infection, long cold ischemia time and long mechanical ventilation time were the independent risk factors for central airway stenosis after lung transplantation (all P < 0.05). Conclusions Airway fungal infection after lung transplantation, long cold ischemia time and long mechanical ventilation time probably lead to central airway stenosis after lung transplantation. Active preventive measures and intimate monitoring should be taken to improve the quality of life of the recipients after lung transplantation.
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Objective:To explore the level of expression, clinical significance of receptor-interacting protein kinase-3(RIPK3) in the bronchoalveolar alveolar lavage fluid (BALF) of mycoplasma pneumoniae pneumonia(MPP) in children and the relationship between RIPK3 and various cytokines.Methods:Using a case-control study, 30 refractory mycoplasma pneumoniae pneumonia children treated in Children′s Hospital of Xuzhou Medical University from February 2019 to February 2021 were selected as the MRPP group, 35 mycoplasma pneumoniae pneumonia children as the RPP group.Meanwhile, 20 sex- and age-matched hospitalized children with bronchial foreign body were selected as the case-control group.In all subjects, protein levels of RIPK3 and mixed lineage kinase domain-like protein(MLKL) were determined by Western Blot.Meanwhile, levels of IL-6, IL-1β and TNF-α were determined by enzyme linked immuno sorbent assay(ELISA). Compare levels of different parameters between the three groups and analyze the correlation between levels of RIPK3 and MLKL, L-6, IL-1β, TNF-α in the BALF of MPP children using Spearman rank correlation analysis.Results:There were statistically significant differences in the levels of RIPK3, MLKL, IL-6, IL-1β and TNF-α in BALF between RMPP group, MPP group and control group (all P<0.001). Pairwise comparisons also showed statistical differences, and the RMPP group was the highest, followed by MPP group, and the control group was the lowest.The level of RIPK3 in BALF of MPP children was positively correlated with MLKL, IL-6, IL-1β and TNF-α ( r=0.711, 0.676, 0.725, 0.651, P<0.001). Linear regression analysis shows: MLKL=0.432×RIPK3. Conclusion:RIPK3 may be involved in the occurrence and development of MPP in children, and is closely related to cytokines such as IL-6, IL-1β and TNF-α.
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Objective: To explore the effect of Da Chengqitang on the lung index,lung index inhibition rate,lung histological morphology,classification changes of inflammatory cells and mitogen-activated protein kinase (MAPK) signal pathway in mice with allergic asthma.Method: Forty female C57BL/6 mice were randomly divided into normal control group,model group,dexamethasone group (0.005 g·kg-1) and Da Chengqitang group (19 g·kg-1).Murine allergic asthma model was established by sensitization and nebulization of ovalbumin (OVA).In brief,asthmatic mice were first sensitized by OVA and Al (OH)3 mixture ip on day 0 and day 14,and then nebulized by OVA from day 21 to 27.At the same time,each mouse in the dexamethasone and Da Chengqitang groups were intragastrically administered with 0.2 mL corresponding medicine one hour before the nebulization challenge,while the normal control group was given with the same amount of normal saline.On day 28,pulmonary morphology was detected by htoxylin eosin (HE) staining and inflammatory cells from the brachial alveolar lavage fluid were counted by Diff staining.The expression levels of key proteins in MAPK signaling pathway were detected by Western blot.Result: As compared with the normal control group,the lung indexes were significantly increased in model group (PP0.01),with a predominant percentage of eosinophils,moreover,the expression levels of phosphorylated p38 MAPK and extracellular signal-regulated kinase 1/2(ERK1/2) were increased obviously in asthmatic mice.After treatment by Da Chengqitang,lung indexes and pulmonary inflammation were significantly decreased,with an inhibitory rate of 68.4% for lung indexes,and inflammatory pathology of lung tissues was obviously improved and inflammatory cell exudation was alleviated,with the obviously lower levels of phosphorylated p38 MAPK and ERK1/2 protein.Conclusion: Da Chengqitang based on "Pulmonary Intestinal Treatment" can effectively improve lung inflammation in mice with allergic asthma,which may be related to the expression of phosphorylated p38 MAPK and ERK1/2 protein.
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OBJECTIVE: To explore the application of alveolar lavage fluid NGS in etiological diagnosis of children with severe pneumonia. METHODS: The clinical data of 34 children with severe pneumonia hospitalized in Pediatric Respiratory Department fromSeptember 2018 toMarch2019 wereretrospectivelyanalyzed. The collectedalveolarlavagefluidwasanalyzed bymetagenomicsNGS. RESULTS: Totally 34 caseswerediagnosedasseverepneumonia. Theresultsof m NGS:32 cases(94.1%)were detected in 34 samples,19 cases(55.9%)of Mycoplasma pneumoniae,6 cases(17.6%)of human adenovirus type 7,1 case(2.9%)of Forsystanella,1 case of Staphylococcus aureus(2.9%);1 cases(2.9%)was not detected,and the positive rate of Mycoplasma pneumoniae was the highest. The mixed infection showed human adenovirus type 7+ Mycoplasma pneumoniae in 2 cases(5.9%),human adenovirus type 7+ Haemophilus influenzae in 1 case(2.9%)and human adenovirus type 7+ Aspergillus fumigatus in 3 cases(8.8%). After anti-infection and symptomatic support treatment,33 cases were improved and discharged,and 1 case died. CONCLUSION: The metagenomics NGS can improve the diagnostic accuracy of the pathogen in severe pneumonia,and early and accurate identification of the pathogen plays an important role in guiding the rational use of antibiotics in clinical practice.
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Clinical data, imaging finding, laboratory and pathology results of 8 patients with eosinophilic granulomatous polyangiitis(EGPA)admitted in our hospital from April 2014 to September 2016 were retrospectively analyzed.There were 7 cases with sinus involvement;8 cases with increased eosinophil counts in peripheral blood, bronchoalveolar lavage fluid(BALF)and induced sputum, and with negative antineutrophil cytoplasmic antibodies(ANCA).Lung function tests showed mild obstructive ventilation dysfunction in 7 cases, positive relaxation test or excitation test in 4 cases, and mild dispersion function decline in 4 cases.Chest CT revealed multiple ground glass shadows and peripheral pulmonary nodules in both lungs in 4 cases,and bronchial wall thickening in 1 case.Transbrochial lung biopsy(TBLB)indicated extravascular infiltration of acidophilic granulocytes.Four cases were treated by glucocorticoid monotherapy, the other 4 cases were treated by glucocorticoids combined with cyclophosphamide.All patients achieved clinical relief after treatment,but 3 cases recurred.For suspicious EGPA patients in addition to paranasal sinus CT,ANCA vasculitis index, urine routine and renal function tests,it is necessary to perform nasal mucosa,bronchial mucosa,transbrochial lung biopsy and BLAF, induced sputum cytology to obtain timely diagnosis and treatment.
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Objective To evaluate the early diagnostic values of soluble triggering receptor expressed on myeloid cell-1 (sTREM-1) in patients with ventilator associated pneumonia (VAP).Methods A total of 112 clinical suspicion VAP ventilator-associated pneumonia (VAP) patients accepted from January 2008 through December 2010 were enrolled for prospective and observational study.Two independent intensivists without aware of the results of the sTREM-1 assay separately made diagnosis of VAP present or absent depending on the clinical symptoms and results of microbial culture.Patients were categorized into two groups:VAP group (n =74) and non-VAP group (n =38).The levels of sTREM-1 in broncho-alveolar lavage fluid (BALF) collected with Gibot method in unemployment of bronchoscope and in serum were measured by enzyme-linked immunosorbent assay (ELISA) on the first day of suspected diagnosis.Comparison of sTREM-1 level between BALF and serum was made by t-test and Receiver Operating Characteristic (ROC) curve.Results A total of 112 clinical suspicion VAP patients admitted from January 2008 through December 2010 were enrolled for prospective and observational study.Two independent intensivists without aware of the results of the sTREM-1 assay made diagnosis of VAP present or absent depending on the clinical symptoms and results of microbial culture.Patients were categorized into two groups:VAP group (n =74) and non-VAP group (n =38).The levels of sTREM-1 in broncho-alveolar lavage fluid (BALF) collected with Gibot method in unemployment of bronchoscope and in serum were measured by enzyme-linked immunosorbent assay (ELISA) on the first day of suspected diagnosis.Comparison of sTREM-1 level between BALF and serum was made by t-test and Receiver Operating Characteristic (ROC) curve.Conlclusions In suspected VAP patients,measurement of sTREM-1 levels in BALF and in serum could help identify VAP in early stage.
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Objective: To observe the change of the levels of tumor necrosis factor-?(TNF-?),interferon-?(IFN-?) and interleukin-10(IL-10) in bronchial alveolar lavage fluid(BALF) from rats with pulmonary fibrosis induced by bleomycin and investigate the intervention by IFN-? on it. Methods: The SD rats were randomly divided into three groups: the normal control group(Group N),the bleomycin-A_5 group(Group B),and the interferon-? treated group(Group I).The pulmonary fibrosis model was established by a single intratracheal injection of 5 mg/kg of bleomycin.The rats were sacrificed at day 17,21,28 after modeling in batch.Semi-quantitative analysis of the histopathologic changes stained with Haematoxylin-eosin(H-E) was performed.The levels of TNF-?,IFN-? and IL-10 in BALF were measured with ELISA.The content of hydroxyproline in the lungs was determined by digestion method.Results:①The scores of pulmonary alveolitis and pulmonary fibrosis in Group I and Group B were significantly higher from 17d after bleomycin administration compared with Group N(all P
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Objective To study the protective effect of a hyperoxic solution on phosgene-induced lung injury by observing the changes in W/D ratio, lung water (LW), and L/B, and MDA contents, GSH-PX activity, and protein contents in broncho-alveolar lavage fluid (BALF). Methods The rabbits were divided into normal control group, hyperoxic solution (HO) and balance salt(BS) groups.Group HO and Group BS inhaled phosgene, and hyperoxic solution was given intravenously in group HO, but BS was given in group BS. W/D, LW, L/B, and MDA contents,GSH-PX activity,protein contents in broncho-alveolar lavage fluid (BALF) were determined. Results The MDA contents, W/D, LW and L/B were increased, and GSH-PX activity was decreased significantly in Group HO and Group BS compared with control group (P