Current Challenges in Chronic Bronchial Infection in Patients with Chronic Obstructive Pulmonary Disease.

Currently, chronic obstructive pulmonary disease (COPD) patients and their physicians face a number of significant clinical challenges, one of which is the high degree of uncertainty related to chronic bronchial infection (CBI). By reviewing the current literature, several challenges can be identified, which should be considered as goals for research. One of these is to establish the bases for identifying the biological and clinical implications of the presence of potentially pathogenic microorganisms in the airways that should be more clearly elucidated according to the COPD phenotype. Another urgent area of research is the role of long-term preventive antibiotics. Clinical trials need to be carried out with inhaled antibiotic therapy to help clarify the profile of those antibiotics. The role of inhaled corticosteroids in patients with COPD and CBI needs to be studied to instruct the clinical management of these patients. Finally, it should be explored and confirmed whether a suitable antimicrobial treatment during exacerbations may contribute to breaking the vicious circle of CBI in COPD. The present review addresses the current state of the art in these areas to provide evidence which will enable us to progressively plan better healthcare for these patients.

Inflammatory Responses, Spirometry, and Quality of Life in Subjects With Bronchiectasis Exacerbations.

BACKGROUND: Bronchiectasis exacerbations are critical events characterized by worsened symptoms and signs (ie, cough frequency, sputum volume, malaise). OBJECTIVES: Our goal was to examine variations in airway and systemic inflammation, spirometry, and quality of life during steady state, bronchiectasis exacerbations, and convalescence (1 week following a 2-week antibiotic treatment) to determine whether potentially pathogenic microorganisms, including Pseudomonas aeruginosa, were associated with poorer conditions during bronchiectasis exacerbations. METHODS: Peripheral blood and sputum were sampled to detect inflammatory mediators and bacterial densities. Spirometry and quality of life (St George Respiratory Questionnaire [SGRQ]) were assessed during the 3 stages. RESULTS: Forty-eight subjects with bronchiectasis (43.2 ± 14.2 y of age) were analyzed. No notable differences in species and density of potentially pathogenic microorganisms were found during bronchiectasis exacerbations. Except for CXCL8 and tumor necrosis factor alpha (TNF-α), serum inflammation was heightened during bronchiectasis exacerbations and recovered during convalescence. Even though sputum TNF-α was markedly higher during bronchiectasis exacerbations and remained heightened during convalescence, the variations in miscellaneous sputum markers were unremarkable. Bronchiectasis exacerbations were associated with notably higher SGRQ symptom and total scores, which recovered during convalescence. FVC, FEV1, and maximum mid-expiratory flow worsened during bronchiectasis exacerbations (median change from baseline of -2.2%, -0.8%, and -1.3%) and recovered during convalescence (median change from baseline of 0.6%, 0.7%, and -0.7%). Compared with no bacterial isolation, potentially pathogenic microorganism or P. aeruginosa isolation at baseline did not result in poorer clinical condition during bronchiectasis exacerbations. CONCLUSIONS: Bronchiectasis exacerbations are characterized by heightened inflammatory responses and poorer quality of life and spirometry, but not by increased bacterial density, which applies for subjects with and without potentially pathogenic microorganism isolation when clinically stable. (ClinicalTrials.gov registration NCT01761214.).

Microorganismos patógenos y potencialmente patógenos en secreciones genitales de gestantes a término asociados a complicaciones posnatales / Pathogenic and potentially pathogenic microorganisms in genital secretions of pregnant women at term associated with postnatal complications

Introducción: tanto las infecciones puerperales como las neonatales precoces reflejan probablemente los microorganismos que están presentes en la vagina en el período cercano al parto. Objetivo: establecer la relación entre los microorganismos identificados en las secreciones genitales de las gestantes a término y el desarrollo de sepsis neonatal y puerperal, así como vincular dichas complicaciones con los agentes diagnosticados. Métodos: se realizó un estudio longitudinal y prospectivo en los servicios de microbiología, obstetricia, perinatología y neonatología del Hospital General Docente "Dr. "Juan Bruno Zayas Alfonso", de Santiago de Cuba, desde julio de 2009 hasta marzo de 2010. Se identificaron microorganismos en 179 muestras cervicovaginales, las cuales fueron procesadas en el laboratorio de microbiología según las normas vigentes. Resultados: los microorganismos más identificados resultaron los géneros Mycoplasmas y Chlamydias (78,2 y 69,3%, respectivamente) y fueron los que con mayor frecuencia se asociaron. Un porcentaje elevado de las gestantes (67,0 %), tenía más de un agente en sus secreciones genitales. Después del parto hubo un hallazgo mayor de infecciones en el producto de la concepción (21,8 %) que en las puérperas (3,9%) y la mayoría de estas complicaciones se relacionaron con la presencia de 2 o más microorganismos. Conclusiones: las asociaciones de microorganismos patógenos o potencialmente patógenos en las secreciones genitales de embarazadas a término, aumentan el riesgo de complicaciones posnatales.

Introduction: both the puerperal infections and the early neonatal infections probably reflect the organisms which are present in the vagina in the period close to childbirth. Objective: to establish the relationship between the organisms identified in the genital secretions from the pregnant women at term and the development of neonatal and puerperal sepsis, as well as to link these complications with the diagnosed agents. Methods: a longitudinal and prospective study was carried out in the microbiology obstetrics, perinatology and neonatology services of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital, in Santiago de Cuba, from July, 2009 to March, 2010. Organisms were identified in 179 cervix and vaginal samples, which were processed in the microbiology laboratory according to the present norms. Results: the organisms mostly identified were the Mycoplasmas and Chlamydias (78.2 and 69.3 %, respectively) and were those most frequently associated. A high percentage of the pregnant women (67.0%) had more than an organism in their genital secretions. After the childbirth there was a higher finding of infections in the conceptus (21.8%) than in the puerperas (3.9%) and most of these complications were related to the presence of 2 or more organisms. Conclusions: the associations of pathogenic or potentially pathogenic microorganisms in the genital discharge of pregnant women at term, increase the risk of postnatal complications.