Pneumonia in the surgical patient

Polk, Hiram C.; Heinzelman, Michael; Mercer-Jones, Mark; Malangoni, Mark A.; Cheadle, William G.

doi:10.1016/s0011-3840(97)80012-3

Cited by 26 publications

(4 citation statements)

References 189 publications

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“…The same is true for mechanical ventilation, which has been shown to increase the incidence of pulmonary infection. 5 Together, these 4 contributing factors mandate aggressive antimicrobial treatment in the severely burned patient. The combination of early surgical debridement and improved antibiotic therapy has made a major impact on mortality due to infection in burned patients.…”

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confidence: 99%

Comparison of Wound Culture and Bronchial Lavage in the Severely Burned Child

et al. 1998

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Background: The relationship of the burn wound flora to microbial pathogens in the tracheobronchial tree has important implications for antimicrobial therapy in the severely burned patient. Management of septic complications is bolstered by surveillance quantitative wound cultures (QWC) and bronchial lavage fluid (BLF) cultures. Objectives: To compare the organisms present in BLF with those found in QWC and to determine if QWC can predict BLF results. Design: Results of BLF cultures from all patients who underwent bronchial lavage from January 1, 1996, to December 31, 1996, at our institution were compared with QWC data from the same date. Criteria for a positive match included an identical antibiotic susceptibility pattern and biotype. Match rates were calculated qualitatively and quantitatively. Results: In 30 (48%) of the 62 BLF cultures, there was a match between the organism identified in the BLF and the QWC. When strict quantitative criteria were applied, the match rate was only 9 (14%) of 62. Burn size and inhalation injury had no significant effect on match rate. Conclusions: Whereas the microbial pathogens were similar in the QWC and BLF, linear regression showed no value of QWC in predicting BLF culture results. The difference between qualitative and quantitative match rates suggests cross-colonization between the burn wound and tracheobronchial tree, but little to no cross-infection. The QWC and BLF cultures must be performed independently in determining antimicrobial specificity in the burned patient.

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confidence: 99%

Comparison of Wound Culture and Bronchial Lavage in the Severely Burned Child

et al. 1998

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“…The prevalence of so-called rare bacterial infections increases, contributing considerably to morbidity and mortality following thoracic surgery. [14] In our case, we prescribed the most appropriate treatment based on the results of sensitivity testing. Antibiotic susceptibility to Hafnia alvei was evaluated using a disk diffusion method according to the guidelines published by the National Committee for Clinical Laboratory Standards.…”

Section: Discussionmentioning

confidence: 99%

A rare case of Hafnia alvei pneumonia presenting with chronic obstructive pulmonary disease

Karamanli¹

2017

Turk Gogus Kalp Dama

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ÖZHafnia alvei, insanlarda nadir rastlanan bir patojendir. Bu yazıda, şiddetli alt solunum yolu enfeksiyonu olan 58 yaşında bir erkek Hafnia alvei olgusu sunuldu. Göğüs röntgeni ve bilgisayarlı tomografisinde sağ akciğerde belirgin konsolidasyon ve anlamlı infiltrasyon izlendi. Balgam kültürü, Hafnia alvei olarak tespit edilen Gram negatif basiller açısından pozitif idi. Hastaya enfeksiyon eradikasyonu için meropenem tedavisi verildi. Bu yazıda Hafnia alvei'nin neden olduğu nadir bir solunum yolu enfeksiyonu olgusu sunuldu. ABSTRACTHafnia alvei is a rarely seen pathogen in humans. In this article, we present a 58-year-old male case of Hafnia alvei with respiratory impairment due to a severe lower respiratory tract infection. Chest X-ray and computed tomography showed consolidation and significant infiltration in the right lung. Cultures of sputum were positive for Gram-negative rods, which were identified as Hafnia alvei. The patient was prescribed meropenem therapy for the eradication of the infection. This report presents a unique case of respiratory tract infection caused by Hafnia alvei.Keywords: Chronic obstructive pulmonary disease; Hafnia alvei; pnemonia.Hafnia alvei (H. alvei) is a Gram-negative, facultative anaerobic, rod-shaped bacterium of the Enterobacteriaceae family.[1] It is typically defined as a gastrointestinal organism [1] and is infrequently considered as a pathogen.[2] It only expresses one virulence factor found in enteropathogenic Escherichia.[3] In 1991, this organism was first described as an gastrointestinal pathogen. [3] Although, H. alvei is typically considered as a commensal organism of the enteric tract, recent reports have suggested that it has the potential to be a serious human pathogen.[2] Herein, we report a 58-year-old male case with respiratory impairment due to a severe lower respiratory tract infection caused by H. alvei. CASE REPORTA 58-year-old man with severe chronic obstructive pulmonary disease (COPD) who had a history of smoking 40 packs/day over the course of several years was admitted to the emergency department due to progressive dyspnea, fever, cough, and increasing sputum for three days. O admission, the patient was pale, dyspneic, febrile, and in a poor condition. Physical examination revealed a body weight of 65 kg, a height of 168 cm, a pulse rate of 104 beats/min, a blood pressure of 108/65 mmHg, a body temperature of 39.4 °C, and a respiration rate of 24 breaths/min. Abdominal examination findings were unremarkable. On auscultation of the lungs,

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“…Often this type of infection will persist for long periods unless the abscesses are drained (14). Neutrophils appear to localize less well to chronic abscesses than to acute ones (1).…”

Section: Discussionmentioning

confidence: 99%

Effect of Zinc-Reversible Growth-Inhibitory Activity in Human Empyema Fluid on Antibiotic Microbicidal Activity

Sohnle

Hahn

2000

Antimicrob Agents Chemother

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Abscess fluid supernatants have zinc-reversible microbial growth-inhibitory activity that is mediated by calprotectin, a zinc-binding protein. Because it inhibits microbial growth, this activity might interfere with killing by antibiotics that require their target organisms to be proliferating. In the present study, we cultured bacteria in human empyema fluid and used zinc to overcome the growth-inhibitory effect of calprotectin. We then compared the effect of zinc on killing by the beta-lactams ampicillin and cefazolin with that of the fluoroquinolone trovafloxacin, since the latter may be better able to kill nonproliferating organisms. In empyema fluid diluted 1:5 in normal saline, addition of zinc (30 M) increased growth of two strains of Staphyloccocus aureus and two strains of Escherichia coli but did not affect the MICs or MBCs of the three antibiotics in Mueller-Hinton broth. For one strain of S. aureus, no effect of zinc was found on killing by either ampicillin or cefazolin. However, with the other strain of S. aureus and both strains of E. coli, significant enhancement of killing by both drugs was observed with zinc addition. On the other hand, no effect on the killing of any of the organisms was observed for trovafloxacin when zinc was added. These results suggest that the zinc-reversible growth-inhibitory activity of abscess fluid may interfere with the microbicidal activity of antibiotics requiring proliferating target organisms, although antibiotics better able to kill nonproliferating organisms may be less affected by this phenomenon.

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Pneumonia in the surgical patient

Cited by 26 publications

References 189 publications

Comparison of Wound Culture and Bronchial Lavage in the Severely Burned Child

Comparison of Wound Culture and Bronchial Lavage in the Severely Burned Child

A rare case of Hafnia alvei pneumonia presenting with chronic obstructive pulmonary disease

Effect of Zinc-Reversible Growth-Inhibitory Activity in Human Empyema Fluid on Antibiotic Microbicidal Activity

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