Prospective study of colonization and infection because of Pseudomonas aeruginosa in mechanically ventilated patients at a neonatal intensive care unit in China

Hu, Hongbo; Huang, Hailin; Peng, Qiaoying; Lu, Jia; Lei, Xing-yun

doi:10.1016/j.ajic.2010.02.012

Cited by 8 publications

(6 citation statements)

References 18 publications

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“…Several observational studies found that potentially pathogenic GNR become more prevalent in the airway as the duration of mechanical ventilation increases. 4,9,14,15 The median age when the first respiratory culture was obtained in this cohort was 6 weeks of life, later than the 2 to 4 week time point used in most other neonatal studies. 2,4,9,10 The lack of a prospective schedule for obtaining respiratory cultures may also affect our results.…”

Section: Discussionmentioning

confidence: 88%

The Association between Positive Tracheal Aspirate Cultures and Adverse Pulmonary Outcomes in Preterm Infants with Severe Bronchopulmonary Dysplasia

et al. 2016

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Bacterial colonization of the airway may contribute to the development of bronchopulmonary dysplasia. Whether airway colonization increases risk for later adverse respiratory outcomes is less clear. We described tracheal aspirate culture results obtained from preterm infants receiving mechanical ventilation at 36 weeks postmenstrual age (PMA) and evaluated the association between bacteria type and the risk for prolonged supplemental oxygen use. We conducted a retrospective, single-center cohort study comparing infants (1) with and without a tracheal aspirate culture that grew a Gram-negative rod (GNR) and (2) with and without a culture that grew a Gram-positive cocci (GPC). Among 121 infants, 65 (53.7%) and 51 (42.2%) had a tracheal aspirate culture that grew a potentially pathogenic GNR and GPC prior to 36 weeks PMA, respectively. GNR were associated with increased risk for death or use of supplemental oxygen at discharge (adjusted odds ratio [aOR], 6.2; 95% confidence interval [CI], 1.8-21.1), and use of supplemental oxygen at discharge among survivors (aOR, 5.5; 95% CI, 1.6-19.0). GPC did not affect the risk for any study outcomes. GNR but not GPC in the airways of preterm infants receiving mechanical ventilation at 36 weeks PMA is associated with increased risk for prolonged supplemental oxygen use.

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Section: Discussionmentioning

confidence: 88%

The Association between Positive Tracheal Aspirate Cultures and Adverse Pulmonary Outcomes in Preterm Infants with Severe Bronchopulmonary Dysplasia

et al. 2016

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Section: Resultsmentioning

confidence: 99%

“…However, two studies were excluded after inspection of the full-text documents, both describing prospective studies; Mammina et al (2008) described investigation of colonization by antibiotic-resistant P. aeruginosa but did not describe an outbreak of P. aeruginosa infection or state that this work followed such an outbreak and Mammina et al (2008) and Hu et al (2010) described prospective surveillance of P. aeruginosa colonization among mechanically ventilated neonates. Therefore, 15 studies (Garcia et al, 1989;Verweij et al, 1993;Garland et al, 1996;Archibald et al, 1998;Muyldermans et al, 1998;Foca et al, 2000;Moolenaar et al, 2000;Loureiro et al, 2002;Gras-Le Guen et al, 2003;Majumdar et al, 2004;Schutze et al, 2004;Zabel et al, 2004;Crivaro et al, 2009;Sánchez-Carrillo et al, 2009;Naze et al, 2010) were reviewed using 18 ORION criteria (Stone et al, 2007).…”

Section: Resultsmentioning

confidence: 99%

Pseudomonas aeruginosa outbreaks in the neonatal intensive care unit – a systematic review of risk factors and environmental sources

Jefferies

Cooper

Yam

et al. 2012

Journal of Medical Microbiology

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Pseudomonas aeruginosa is a Gram-negative bacterium commonly occurring in soil and water. It is an opportunistic pathogen and an important cause of healthcare-associated infections, particularly among infants in neonatal intensive care units (NICUs). Several reports regarding outbreaks of P. aeruginosa in NICUs have been published. MEDLINE and EMBASE databases were searched using the MeSH terms [Pseudomonas aeruginosa], [Outbreak OR Infection OR bacteraemia, OR sepsis OR disease] and [Neonat* OR baby OR babies OR newborn*]. Fifteen studies describing a total of 414 infants colonized or infected with P. aeruginosa were reviewed. The mean percentage of infections occurring in the populations that had been colonized by the organism (calculated as n infected /n infected +n colonized ) was 22 %. Environmental sampling was performed in 14 studies, nine of which detected P. aeruginosa. The risk factors identified were antimicrobial drug use and the number of days of antimicrobial therapy prescribed before positive blood culture, exposure to particular healthcare workers (HCW), transfusion of blood products, and intravenous delivery of nutrients/electrolytes. Exposure to umbilical venous catheters was associated with bloodstream infections. Increasing age and use of artificial fingernails were risk factors for colonization of hands of HCWs. Low birth weight pre-term infants were at greater risk of mortality from P. aeruginosa infection than older infants. BackgroundPseudomonas aeruginosa is a Gram-negative bacterium commonly occurring in soil and water. It is an opportunistic pathogen, causing disease in vulnerable individuals, such as the immunocompromised, those where host defences have been breached, such as burns patients, and infants in whom the immune system is not yet developed. Most commonly, P. aeruginosa infections occur in the urinary tract, in burn wounds and as chronic lung infections in cystic-fibrosis patients. However, the organism is also an important cause of healthcare-associated infections, particularly among infants in neonatal intensive care units (NICUs) (Jarvis et al., 1987) owing to their underdeveloped immune system and the fact that such infants are often intubated, catheterized with intravascular catheters/devices in-situ, and/or receiving parenteral nutrition, which may increase risk of infection (Gaynes et al., 2005). Unfortunately, such infections in neonates can be fatal, as was the case in a recent UK outbreak in which four babies died (Wise, 2012). The ubiquitous nature of P. aeruginosa in the environment makes the sources of such outbreaks difficult to identify.Several outbreaks of P. aeruginosa colonization and infection in NICUs have been published. Simon et al. (2008) published a systematic review of confirmed outbreaks in both neonatal and paediatric patients that were identified using the PubMed database and the web-based register for nosocomial outbreaks. That review did not search for reports of outbreaks listed in the Embase database and so may have been biased by the omission ...

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“…While the importance of oropharyngeal flora in seeding the lungs has been heavily studied in ICU settings [19, 20, 21], the role of oropharyngeal-lung flora exchange in otherwise healthy children with isolated swallowing dysfunction is unknown. Furthermore, studies investigating the relationships between microbial communities across the aerodigestive tract have not examined how microbes exchange between the stomach and lungs, and how this exchange relates to clinical factors such as aspiration and gastroesophageal reflux.…”

Section: Introductionmentioning

confidence: 99%

Aerodigestive sampling reveals altered microbial exchange between lung, oropharyngeal, and gastric microbiomes in children with impaired swallow function

et al. 2019

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Background Children with oropharyngeal dysphagia have impaired airway protection mechanisms and are at higher risk for pneumonia and other pulmonary complications. Aspiration of gastric contents is often implicated as a cause for these pulmonary complications, despite being supported by little evidence. The goal of this study is to determine the relative contribution of oropharyngeal and gastric microbial communities to perturbations in the lung microbiome of children with and without oropharyngeal dysphagia and aspiration. Methods We conducted a prospective cohort study of 220 patients consecutively recruited from a tertiary aerodigestive center undergoing simultaneous esophagogastroduodenoscopy and flexible bronchoscopy. Bronchoalveolar lavage, gastric and oropharyngeal samples were collected from all recruited patients and 16S sequencing was performed. A subset of 104 patients also underwent video fluoroscopic swallow studies to assess swallow function and were categorized as aspiration/no aspiration. To ensure the validity of the results, we compared the microbiome of these aerodigestive patients to the microbiome of pediatric patients recruited to a longitudinal cohort study of children with suspected GERD; patients recruited to this study had oropharyngeal, gastric and/or stool samples available. The relationships between microbial communities across the aerodigestive tract were described by analyzing within- and between-patient beta diversities and identifying taxa which are exchanged between aerodigestive sites within patients. These relationships were then compared in patients with and without aspiration to evaluate the effect of aspiration on the aerodigestive microbiome. Results Within all patients, lung, oropharyngeal and gastric microbiomes overlap. The degree of similarity is the lowest between the oropharynx and lungs (median Jensen-Shannon distance (JSD) = 0.90), and as high between the stomach and lungs as between the oropharynx and stomach (median JSD = 0.56 for both; p = 0.6). Unlike the oropharyngeal microbiome, lung and gastric communities are highly variable across people and driven primarily by person rather than body site. In patients with aspiration, the lung microbiome more closely resembles oropharyngeal rather than gastric communities and there is greater prevalence of microbial exchange between the lung and oropharynx than between gastric and lung sites (p = 0.04 and 4x10 −5 , respectively). Conclusions The gastric and lung microbiomes display significant overlap in patients with intact airway protective mechanisms while the lung and oropharynx remain distinct. In patients with impaired swallow function and aspiration, the lung microbiome shifts towards oropharyngeal rather than gastric communities. This finding may explain why antireflux surgeries fail to show benefit in pediatric pulmonary outcomes.

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Prospective study of colonization and infection because of Pseudomonas aeruginosa in mechanically ventilated patients at a neonatal intensive care unit in China

Cited by 8 publications

References 18 publications

The Association between Positive Tracheal Aspirate Cultures and Adverse Pulmonary Outcomes in Preterm Infants with Severe Bronchopulmonary Dysplasia

The Association between Positive Tracheal Aspirate Cultures and Adverse Pulmonary Outcomes in Preterm Infants with Severe Bronchopulmonary Dysplasia

Pseudomonas aeruginosa outbreaks in the neonatal intensive care unit – a systematic review of risk factors and environmental sources

Aerodigestive sampling reveals altered microbial exchange between lung, oropharyngeal, and gastric microbiomes in children with impaired swallow function

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