Abstract An accurate diagnosis is critical to reducing mortality in people with lower respiratory tract infections (LRTIs). Current microbiological culture is time-consuming, and nucleic acid amplification-based molecular technologies cannot distinguish between colonization and infection. Previously, we described developing a sampling system for effectively capturing biomolecules from human breath. We identified a new class of proteoform markers of protease activation, termed proteolytic products of infection, for detecting LRTIs in people with mechanical ventilation. Here, we further developed an in vitro assay by designing a specific substrate sensor for human neutrophil elastase (HNE) to detect LRTIs in breath samples. In the proof-of-concept study, we then applied this in vitro assay to breath samples collected from intubated patients and healthy volunteers. The findings revealed that the LRTI group demonstrated a significant mean differential, showing a 9.8-fold elevation in measured HNE activity compared with the non-LRTI group and a 9.2-fold compared with healthy volunteers. The in vitro assay's diagnostic potential was assessed by constructing a receiver operating characteristic curve, resulting in an area under the curve of 0.987. Using an optimal threshold for HNE at 0.2 pM, the sensitivity was determined to be 1.0 and the specificity to be 0.867. Further correlation analysis revealed a strong positive relationship between the measured HNE activity and the protein concentration in the breath samples. Our results demonstrate that this breath-based in vitro assay provides high diagnostic performance for LRTIs, suggesting that the technology may be useful in the near term for the accurate diagnosis of LRTIs.
Objective: We aimed to assess the effects of amoxicillin treatment in adult patients presenting to primary care with a lower respiratory tract infection (LRTI) who were infected with a potential bacterial, viral, or mixed bacterial/viral infection. Methods: This multicentre randomized controlled trial focused on adults with LRTI not suspected for pneumonia. Patients were randomized to receive either antibiotic (amoxicillin 1 g) or placebo three times daily for 7 consecutive days using computer-generated random numbers (follow-up 28 days). In this secondary analysis of the trial, symptom duration (primary outcome), symptom severity (scored 0-6), and illness deterioration (reconsultation with new or worsening symptoms, or hospital admission) were analysed in pre-specified subgroups using regression models. Subgroups of interest were patients with a (strictly) bacterial, (strictly) viral, or combined infection, and patients with elevated values of procalcitonin, C-reactive protein, or blood urea nitrogen. Results: 2058 patients (amoxicillin n = 1036; placebo n = 1022) were randomized. Treatment did not affect symptom duration (n = 1793). Patients from whom a bacterial pathogen only was isolated (n = 207) benefited from amoxicillin in that symptom severity (n = 804) was reduced by 0.26 points (95% CI -0.48 to -0.03). The odds of illness deterioration (n = 2024) was 0.24 (95% CI 0.11 to 0.53) times lower from treatment with amoxicillin when both a bacterial and a viral pathogen were isolated (combined infection; n = 198). Conclusions: Amoxicillin may reduce the risk of illness deterioration in patients with a combined bacterial and viral infection. We found no clinically meaningful benefit from amoxicillin treatment in other subgroups. (C) 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved. ; The authors have no conflicts of interest to declare. GRACE was funded by the European Community's Sixth Framework Programme (grant agreement 518226). Work in the UK was also supported by the National Institute for Health Research, in Barcelona by 2009 SGR 911 Ciber de Enfermedades Respiratorias (Ciberes CB06/06/0028), and in Belgium by the Research Foundationd-Flanders (FWO; G.0274.08N). Financial support from the Methusalem financing program of the Flemish Government is also gratefully acknowledged. NH acknowledges support from the University of Antwerp scientific chair in evidence-based vaccinology, financed in 2009-2017 by a gift from Pfizer and GSK. This publication has been financially supported through the European Science Foundation, in the framework of the Research Networking Program TRACE (www.esf.org/trace). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Background: Prescribing of antibiotics for common infections varies widely, and there is no medical explanation. Systematic reviews have highlighted factors that may influence antibiotic prescribing and that this is a complex process. It is unclear how factors interact and how the primary care organization affects diagnostic procedures and antibiotic prescribing. Therefore, we sought to explore and understand interactions between factors influencing antibiotic prescribing for respiratory tract infections in primary care. Methods: Our mixed methods design was guided by the Triangulation Design Model according to Creswell. Quantitative and qualitative data were collected in parallel. Quantitative data were collected by prescription statistics, questionnaires to patients, and general practitioners audit registrations. Qualitative data were collected through observations and semi-structured interviews. Results: From the analysis of the data from the different sources an overall theme emerged: A common practice in the primary health care centre is crucial for low antibiotic prescribing in line with guidelines. Several factors contribute to a common practice, such as promoting management and leadership, internalized guidelines including inter-professional discussions, the general practitioners diagnostic process, nurse triage, and patient expectation. These factors were closely related and influenced each other. The results showed that knowledge must be internalized and guidelines need to be normative for the group as well as for every individual. Conclusions: Low prescribing is associated with adapted and transformed guidelines within all staff, not only general practitioners. Nurses triage and self-care advice played an important role. Encouragement from the management level stimulated inter-professional discussions about antibiotic prescribing. Informal opinion moulders talking about antibiotic prescribing was supported by the managers. Finally, continuous professional development activities were encouraged for up-to-date knowledge. ; Funding Agencies|Public Health Agency of Sweden
ObjectiveTo estimate the association between household tenure and the odds of hospital admission for acute lower respiratory tract infections (LRTI) in children under age 2 years.
MethodsWe developed a birth cohort of all singleton children born in Scotland 2010-2012, using linked birth registration records and maternal Census 2011 data. Further linkage to hospital admission records provided information on acute LRTI (pneumonia, bronchitis, bronchiolitis, influenza, unspecified LRTI) admissions in children aged less than 2 years. Using logistic regression models, we estimated the association between housing tenure at birth (owned, social rented, private rented/lives rent free) with odds of hospital admission for LRTI before and after adjustment for parental occupational class (household reference), family type and highest qualification level.
ResultsFrom the cohort of all 174,279 births in 2010-2012, 84.1% linked to a maternal census record. Children whose parents were married or had a UK-born mother were more likely to link to a Census record. In the final linked cohort of 141,336 children, 7,486 (5.3%) were admitted to hospital for one or more LRTI during the 2 years of follow up. We found an association between housing tenure and LRTI admissions, with children residing in social rented, compared to owned housing having higher odds of an LRTI admission, OR: 1.40 (1.32-1.47); and children living in private rented/rent free housing, compared to owned, OR: 1.18 (1.11-1.26). After adjustment for household socioeconomic circumstances, these estimates attenuated to OR: 1.18 (1.11-1.27) and OR: 1.10 (1.03-1.18) respectively.
ConclusionAfter accounting for household socioeconomic circumstances, children living in social and private tenured accommodation, compared to children living in owned accommodation were more likely to be hospitalised for an acute LRTI during the first 2 years of life. Further research to understand the contribution specific housing circumstances make to inequalities in LRTI hospitalisations early in life is needed.
Lung cancer is the first killer among all the known malignancies. Late detection of this malignancy is a major contributor to advanced-stage diagnosis and poor outcomes. Pulmonary microbiota has been recently reported as one of lung cancer risk hallmarks that is still to be fully understood. This study aimed to explore the potential role of microbiome in predicting lung carcinogenesis. Microbiome Library Construction of the 16SrRNA variable region (V3–V4) was conducted by gene amplicon sequencing using the Illumina sequencing platform. Microbiome data was analysed using Version QIIME2-202006 software for species annotations. The sequences were denoised by the DADA2 plugin implemented in QIIMETM2. The bacterial amplicon sequence variants (ASVs) were then identified. The results of 16SrRNA sequencing and gene library bioinformatic analysis indicated that Haemophilus, Prevotella, and Streptococcus were on the top of abundant genera. The species Haemophilus influenza has also been identified among the top 12 bacterial species in malignant and non-malignant lung samples. Microbiome-based identification of the human airway microbiota may provide effective predictive biomarkers for lung carcinogenesis.
Objectives: Lower respiratory infections (LRTIs) are the leading reason of death infectious diseases in the world and the fifth leading cause of death in general. The study aimed to identify the general characteristics of LRTI, the causative bacteria and the results of sensitivity to antibiotics. Subjects and methods: A multicentre prospective study was performed at 3 University hospitals. The study included 555 clinical diagnostic cases as LRTI cases, 328 male and 227 female, aged 3 to 69 years. Clinical and demographic data were collected in the standard questionnaire, and samples included sputum or bronchial lavage (BAL) staining and culture. Samples were cultured in 3 different bacterial media, blood agar and LJ slope, chocolate agar with Co2; cultures were then examined for possible bacterial pathogens of LRTI. Possible bacterial pathogens were isolated and identified by standard laboratory techniques, and microbial sensitivity testing was carried out by disc diffusion method. Results: LRTI was recorded among all age groups and with less frequency in children less than 16 years of age. A large number of LRTI (36.2%) was not diagnosed, most in CAP (52.4%), followed by HAP (33.9%) while unidentified cases were lower in AECOPD (22.8%). CAP isolates are K. pneumoniae (26.2%), S. pyogens (12.3%), and S. pneumoniae (9%); in HAP are MSSA (24%), E. Coli (12.9%), MRAS (11.1%), K. pneumoniae (10.5%) and P. aeruginosa (7%); and in AECOPD are M. catarrhalis (47.2%), K. pneumoniae (17.2%), H. influnzae (10.7%) and P. aeruginosa (2%). In Gram-positive bacteria, high resistance to ampicillin/sulbactam (100%) and amoxicillin/clavulanate (100%) was recorded, while moderate resistance to amikacin, vancomycin, cefepime and moxifloxacin was recorded. In Gram-negative bacteria, a high resistance to 3rd g Cephalosporin's (68.5%) was recorded, while a moderate sensitivity to the other antibiotics tested was recorded. Conclusion: There is a high rate of undiagnosed LRTI in Yemen and this highlights the need for health authorities to develop strategies to diagnose most of the causes of LRTI, including Mycoplasma, Chlamydia, and viral causes. No antibiotics are completely effective in treating LRTI in our area and antibiotic sensitivity should be performed in all cases. Peer Review History: Received 22 March 2020; Revised 4 May; Accepted 9 May, Available online 15 May 2020 Academic Editor: Dr. Asia Selman Abdullah,Al-Razi university, Department of Pharmacy, Yemen, asia_abdullah65@yahoo.com UJPR follows the most transparent and toughest 'Advanced OPEN peer review' system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is 'to improve the quality of a candidate manuscript'. Our reviewers check the 'strength and weakness of a manuscript honestly'. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 8.0/10 Reviewer(s) detail: Dr. Michael Otakhor Erhunmwunse, St. Philomena Catholic Hospital, Nigeria, dedoctor4life@gmail.com Dr. Amany Mohamed Alboghdadly, Princess Nourah bint abdulrahman university, Riyadh, amalbgadley@pnu.edu.sa Similar Articles: BIOFILM FORMATION AND ANTIBIOTIC SUSCEPTIBILITY OF UROPATHOGENS IN PATIENTS WITH CATHETER ASSOCIATED URINARY TRACT INFECTIONS IN IBB CITY -YEMEN PREVALENCE, ANTIMICROBIAL SUSCEPTIBILITY PATTERN AND RISK FACTORS OF MRSA ISOLATED FROM CLINICAL SPECIMENS AMONG MILITARY PATIENTS AT 48 MEDICAL COMPOUND IN SANA'A CITY-YEMEN
The purpose of this study was to investigate the sickness rate of students with acute respiratory infections of the upper respiratory tract. To achieve this purpose was analyzed the dynamics of the annual incidence of acute respiratory infections of the upper respiratory tract infections among residents of Minsk and cadets of the Military Academy of the Republic of Belarus in the period from 2002 to 2012. Studied were rate of morbidity and duration of hospitalization among the cadets with different values of the fat component of the body, evaluated were their adaptive capabilities. It was detected that the incidence rates of cadets with acute respiratory infections of the upper respiratory tract are not significantly different from the annual averages for the city of Minsk and related to the overall epidemiological situation in the Republic of Belarus. A significant influence on them has the nutritional state that affects the adaptive capabilities of organism
Background: Lower respiratory tract infection is a common cause of morbidity and mortality worldwide. A crosssectional study was carried out with an objective to study the antibiogram of Gram-negative isolates of patients with lower respiratory tract infection visiting Kathmandu Model Hospital.Methods: A total of 274 specimens including sputum, endotracheal aspirates, suction tips were cultured as per standard microbiological technique. Antibiotic susceptibility and detection of Extended-spectrum beta- lactamases (ESBLs) were performed following Clinical Laboratory Standard Institute (CLSI 2014) guidelines.Results: Respiratory pathogens were recovered from 24.6% (n=65) cases. Klebsiella pneumoniae (40%) was the commonest isolates. The highest prevalence of multidrug-resistance (69.23%) was observed in Acinetobacter calcoaceticus baumannii complex. Extended-spectrum beta- lactamases were detected in Escherichia coli (n=4), Klebsiella pneumoniae (n=4) and Acinetobacter calcoaceticus baumannii complex (n=1).Conclusions: High prevalence of multidrug-resistance and extended- spectrum beta- lactamase producers were observed in respiratory isolates. For effective management of lower respiratory tract infections, an ultimate and detailed microbiological diagnosis and susceptibility testing is required.
Objectives Poor housing conditions have been associated with increased risks of respiratory infections. This review aims to determine whether modifying the physical environment of the home has benefits in reducing respiratory infections.
Content
We performed a systematic review and meta-analysis of the effectiveness of home environmental interventions for preventing respiratory tract infections. Ten electronic databases were searched to identify randomized controlled trials published from inception to July 31, 2020. Random-effects meta-analyses were used to assess the study outcomes. Our search identified 14 eligible studies across 12 countries, which comprised 87,428 households in total. The type of interventions on home environment included kitchen appliance and design, water supply and sanitation, house insulation, and home heating. Meta-analysis indicated a potential benefit of home environmental interventions in preventing overall respiratory tract infections (Absolute RR=0.89, 95% CI=0.78–1.01, p=0.07; Pooled adjusted RR=0.72, 95% CI=0.63–0.84, p<0.0001). Subgroup analyses depicted that home environmental interventions had no significant impact on lower respiratory tract infections, pneumonia, and severe pneumonia. A protective effect against respiratory infections was observed in high income country setting (RR=0.82, 95% CI=0.78–0.87, p<0.00001).
Summary and outlook
Home environmental interventions have the potential to reduce morbidity of respiratory tract infections. The lack of significant impact from stand-alone housing interventions suggests that multicomponent interventions should be implemented in tandem with high-quality health systems.
Respiratory disease symptoms in children are aggravated by frequent changes in meteorological conditions. The net effective temperature (NET) integrates temperature, relative humidity, and wind speed as a cooling indicator. This study aims to assess the effect of daily changes in meteorological factors and corresponding NET data on children's hospitalizations for different ages, genders and subtypes of respiratory infections in Baotou, China. Distributed lag non-linear models were constructed to simultaneously assess the exposure–response associations between daily admission counts of children with respiratory diseases and daily NET and other meteorological factors, as well as their lag dependencies. As air pollution significantly affects the respiratory tract, it was considered as confounding factor. In general, the cumulative meteorological factors had greater effects on lower respiratory tract infections than upper respiratory tract infections (RR: temperature [5.21 vs. 2.33], wind speed [4.89 vs. 3.12], and humidity [1.77 vs. 0.97]). The effects of cumulative meteorological factors on female children were greater than those on male children (RR: temperature [2.14 vs. 1.82], wind speed [5.46 vs. 1.90], and humidity [1.60 vs. 1.55]). Temperature and wind speed showed an influence on 4–7-year-old children, but these factors had no influence on other age groups; humidity only showed an influence on the 0–3-year-old group. The NET value had a large effect on lower respiratory infections, in the 4–7-year-old group and female children. In conclusion, a complex non-linear relationship exists between climate variability and children's respiratory diseases. The results of the study can be used to support the development of important meteorological information tools for early warnings of respiratory disease events in children. Concurrently, the NET values can be used for comprehensive assessments of climate change in the future, which will help the government and health authorities better minimize the impacts of ...
AbstractThe introduction of Tier 3 light-duty vehicles with reduced emissions began in New York State (NYS) in 2017, with required compliance by 2025. We hypothesized that improved air quality during the early implementation of Tier 3 (2017–2019) would result in reduced rates of hospitalizations and emergency department (ED) visits for respiratory infection associated with increased PM2.5 compared to 2014–2016 (pre-Tier 3). Using data on adult patients hospitalized or having an ED visit for influenza, upper respiratory infection, culture-negative pneumonia, or respiratory bacterial infection, living within 15 miles of six air quality monitoring sites in NY, and a case-crossover design and conditional logistic regression, we estimated the rates of respiratory infection hospitalizations and ED visits associated with increased ambient PM2.5 concentrations in the previous 0–6 days and each week thereafter up to 1 month. Interquartile range (IQR) increases in PM2.5 in the previous 6 days were associated with 4.6% (95% CI: − 0.5, 10.1) and 11.9% (95% CI = 6.1, 18.0) increased rates of influenza hospitalizations in 2014–2016 and 2017–2019, respectively. This pattern of larger relative rates in 2017–2019 observed at all lag times was only present in males hospitalized for influenza but not other infections or in females. The rates of respiratory infection visits associated with increased PM2.5 were generally not reduced in this early Tier 3 implementation period compared to 2014–2016. Limited fleet penetration of Tier 3 vehicles and differences in particle deposition, infection type, and sex by period may all have contributed to this lack of improvement.
Abstract The purpose was to study respiratory infections in a cold environment among young Finnish men. The seasonal variation in the occurrence of respiratory tract infections is well-known, but the impact of cold exposure is obscure. The burden of respiratory tract infections is especially apparent during military service, but the possible risk factors for infections are not. A total of 892 young military conscripts, 224 men with physician-diagnosed asthma, from the intake groups of July 2004 and January 2005 in Kainuu Brigade, were recruited for the study. In Kajaani area, the average daily temperature is above 10°C only from June to August and all conscripts serve during the cold season, too. The previous history of respiratory tract symptoms, infections, smoking habits and cold sensations were obtained with a questionnaire. Blood samples were taken for determination of the markers of inflammation and infection and peak expiratory flow, height and weight were measured. Data on respiratory tract infections requiring a physician consultation and results of a 12-min running test were collected. The temperature data was obtained from the nearest meteorological station located ca. 15 km from the garrison. At the beginning of the service, asthmatic men reported to have experienced more respiratory tract symptoms and were in poorer physical condition according to the 12-min running test compared to non-asthmatic men. However, 48% of men with asthma were without medication. After the 180–362 -day service, both men with and without asthma had enhanced their physical fitness as determined with the 12-min running test. At the same time, the levels of high sensitive C-reactive protein as a marker of low-grade inflammation, decreased. Infection episodes requiring physician consultation were more common among men with, rather than without, asthma. Chlamydia pneumoniae infections were mostly mild upper respiratory tract infections, common cold and sinusitis, and were as common in asthmatic as in non-asthmatic men. However, prolonged Chlamydia pneumoniae infections were more common among asthmatic men. Obesity and previous respiratory tract infections were independent risk factors for frequent infections among men with 180-day service. There was a typical seasonal variation in respiratory tract infections among conscripts: most infections occurred in the wintertime. The men with 180-day service had most infections during the first three months of the service, both in the July and January intake groups. Temperature was significantly associated with the occurrence of respiratory infection episodes. The most common temperature for the onset of an episode was in the outdoor temperature range of 0°C to –5°C. Respiratory tract infections were preceded by linearly decreasing outdoor temperature, the coldest day being the day before physician consultation.
Abstract Human bocavirus 1 (HBoV1) is a parvovirus recently found to be a possible aetiologic agent of acute respiratory disease in children. We conducted the first clinical and molecular study on this virus in Latvia (LV) and Lithuania (LT). The aim of the study was to determine the occurrence of HBoV1 in respiratory tract samples taken from hospitalised children with acute respiratory tract infections in LV and LT. In total 186 children with age one to 50 months, and who fulfilled criteria of acute respiratory tract infection, including lower respiratory tract infections, with or without fever, were included in this study. A nasopharyngeal aspirate was obtained from each patient on admission. DNA was isolated and polimerase chain reaction (PCR) performed targeting the HBoV1 NS1sequence. HBoV1 positive samples were sequenced and phylogenetic analysis was performed. HBoV1 sequence was detected in 42 (32%) of 130 LV and in 8 (14%) of 56 LT samples. In LV the majority of patients with HBoV1 infection were observed in February while in LT in October. The phylogenetic tree for HBoV1 indicated that isolates of HBoV1 cluster closely and include almost all of the isolates in this study. HBoV1 is common in Latvia and Lithuania and might be a significant pathogen that contributes to acute respiratory tract infections in children.
In: Finch , R G , Blasi , F B , Verheij , T J , Goossens , H , Coenen , S , Loens , K , Rohde , G , Saenz , H & Akova , M 2012 , ' GRACE and the development of an education and training curriculum ' , Clinical Microbiology and Infection , vol. 18 , no. 9 , pp. E308-E313 . https://doi.org/10.1111/j.1469-0691.2012.03909.x
Antimicrobial resistance is a serious threat and compromises the management of infectious disease. This has particular significance in relation to infections of the respiratory tract, which are the lead cause of antibiotic prescribing. Education is fundamental to the correct use of antibiotics. A novel open access curriculum has been developed in the context of a European Union funded research project Genomics to combat Resistance against Antibiotics in Community-acquired lower respiratory tract infections in Europe (GRACE http://www.grace-lrti.org). The curriculum was developed in modular format and populated with clinical and scientific topics relevant to community-acquired lower respiratory tract infections. This curriculum informed the content of a series of postgraduate courses and workshops and permitted the creation of an open access e-Learning portal. A total of 153 presentations matching the topics within the curriculum together with slide material and handouts and 104 webcasts are available through the GRACE e-Learning portal, which is fully searchable using a 'mindmap' to navigate the contents. Metrics of access provided a means for assessing usage. The GRACE project has permitted the development of a unique on-line open access curriculum that comprehensively addresses the issues relevant to community-acquired lower respiratory tract infections and has provided a resource not only for personal learning, but also to support independent teaching activities such as lectures, workshops, seminars and course work.
Clin Microbiol Infect 2012; 18: E308E313 Abstract Antimicrobial resistance is a serious threat and compromises the management of infectious disease. This has particular significance in relation to infections of the respiratory tract, which are the lead cause of antibiotic prescribing. Education is fundamental to the correct use of antibiotics. A novel open access curriculum has been developed in the context of a European Union funded research project Genomics to combat Resistance against Antibiotics in Community-acquired lower respiratory tract infections in Europe (GRACE http://www.grace-lrti.org). The curriculum was developed in modular format and populated with clinical and scientific topics relevant to community-acquired lower respiratory tract infections. This curriculum informed the content of a series of postgraduate courses and workshops and permitted the creation of an open access e-Learning portal. A total of 153 presentations matching the topics within the curriculum together with slide material and handouts and 104 webcasts are available through the GRACE e-Learning portal, which is fully searchable using a mindmap to navigate the contents. Metrics of access provided a means for assessing usage. The GRACE project has permitted the development of a unique on-line open access curriculum that comprehensively addresses the issues relevant to community-acquired lower respiratory tract infections and has provided a resource not only for personal learning, but also to support independent teaching activities such as lectures, workshops, seminars and course work.
