Pradeep Morar, MD; Zvoru Makura, MD; Andrew Jones, MD; Paul Baines, MD; Andrew Selby, MD; Julie Hughes, RGN; and Rick van Saene, MD

Size: px
Start display at page:

Download "Pradeep Morar, MD; Zvoru Makura, MD; Andrew Jones, MD; Paul Baines, MD; Andrew Selby, MD; Julie Hughes, RGN; and Rick van Saene, MD"

Transcription

1 Topical Antibiotics on Tracheostoma Prevents Exogenous Colonization and Infection of Lower Airways in Children* Pradeep Morar, MD; Zvoru Makura, MD; Andrew Jones, MD; Paul Baines, MD; Andrew Selby, MD; Julie Hughes, RGN; and Rick van Saene, MD Introduction: Patients requiring long-term ventilation are at high risk of lower airway infections, generally of endogenous development. Patients on long-term ventilation, in particular via a tracheostomy, may develop tracheobronchitis or pneumonia of exogenous pathogenesis, ie, caused by microorganisms not carried in the oropharynx. The frequency of exogenous colonization or infection has previously been reported to be as high as 33%. A prospective observational cohort study of 2 years was undertaken to evaluate the efficacy of topical antibiotics in the prevention of exogenous colonization or infection of the lower airways. The antibiotic combination of polymyxin E and tobramycin in a 2% paste was applied four times a day on the tracheostoma. Materials and methods: A total of 23 children (median age, 4.1 months; range, 0 to 215 months) were enrolled in the study from September 1, 1996, until August 30, Surveillance samples of the oropharynx were obtained before tracheostomy and thereafter twice weekly. Diagnostic samples of the lower airways were taken once weekly and on clinical indication. Results: Fourteen children (61%) had a total of 16 episodes of tracheal colonization or infection with 20 potentially pathogenic microorganisms. Only one child had tracheobronchitis with Streptococcus pneumoniae and Haemophilus influenzae during the 2-year study. Of the 16 colonization episodes, 12 (75%) were of primary endogenous pathogenesis, ie, caused by microorganisms present in the oropharynx at the time of tracheostomy. Community microorganisms including S pneumoniae, H influenzae, Moraxella (Branhamella) catarrhalis, and Staphylococcus aureus were the predominating bacteria. Three patients acquired nosocomial bacteria Pseudomonas aeruginosa and Hafnia alvei in the oropharynx, subsequently followed by secondary colonization of the lower airways. There was one failure of the prophylaxis: one patient (4%) had exogenous colonization with Pseudomonas pickettii. Conclusion: Topical antibiotics applied to the tracheostoma were found to be effective in reducing the exogenous route of colonization of the lower respiratory tract, compared with clinical experience and the literature. This promising technique requires further evaluation in randomized trials. (CHEST 2000; 117: ) Key words: antibiotics; children; colonization; infection; pathogenesis; prevention; tracheotomy Abbreviations: CRP C-reactive protein; MRSA methicillin-resistant Staphylococcus aureus; PICU pediatric ICU; PPM potentially pathogenic microorganism Patients who are unable to breathe spontaneously and therefore require ventilation are, in general, seriously ill and, therefore, immunocompromised. There is a general consensus that patients requiring long-term ventilation are at high risk of lower airway *From the Departments of Otolaryngology (Drs. Morar, Makura, and Jones), Paediatric Intensive Care (Drs. Baines and Selby), and Clinical Microbiology/Infection Control (Dr. van Saene and Ms. Hughes), Royal Liverpool Children s NHS Trust of Alder Hey, Liverpool, UK. Manuscript received June 9, 1999; revision accepted August 18, Correspondence to: Dr. Pradeep Morar, 5 Teal Close, Aughton, Lancashire, L39 5QQ; paddy@morarp.freeserve.co.uk infections. 1 Exogenous lower airway infections are distinguished from endogenous tracheobronchitis and pneumonia. 2 The seriously ill patient almost certainly develops a lower airway infection with a potentially pathogenic microorganism (PPM) carried in the oropharyngeal flora at the time when the systemic immunosuppression is at the lowest level, ie, the endogenous pathogenesis of infection. Surveillance samples of the oropharynx and diagnostic samples of the lower airways yield the same PPM in infections of endogenous development. However, patients requiring long-term ventilation, in particular via a tracheostomy, may develop tracheobronchitis CHEST / 117 / 2/ FEBRUARY,

2 or pneumonia of exogenous pathogenesis. Surveillance samples from the throat are negative for the PPM that are isolated from the diagnostic samples of the lower airway secretions. PPM causing exogenous tracheobronchitis or pneumonia almost always include typical hospital bacteria such as Pseudomonas, Serratia, and Acinetobacter spp and methicillinresistant Staphylococcus aureus (MRSA). 3 The external sources may be both inanimate and animate reservoirs. Ventilation equipment, nebulizers, and humidifiers have been implicated in exogenous infections, 4 whereas other long-stay patients are in general the animate source of PPM responsible for infections of exogenous pathogenesis. 5 The exogenous problem has been evaluated in one pediatric study, as far as we are aware. 6 The frequency of exogenous colonization or infection was found to be as high as 33%. A prospective interventional cohort study of 2 years was undertaken to evaluate the efficacy of topical antibiotics applied on the tracheostoma in the prevention of exogenous colonization or infection of the lower airways. The antibiotic combination, composed of polymyxin E and tobramycin in a 2% paste, was applied qid on the tracheostoma for a period of 2 weeks. Materials and Methods This study was undertaken during a 2-year period as a prospective interventional cohort study, from September 1, 1996, until August 30, Children requiring long-term mechanical ventilation, initially transtracheally and then via tracheostomy in the pediatric ICU (PICU), were consecutively enrolled in the trial. Patients Twenty-three patients, 16 male and 7 female, were enrolled in the study. Median age was 4.07 months (range, 0.03 days to 217 months), and the mean age was 37.8 months (SD 64.3 months) at the time of the tracheostomy (Table 1). Seventeen of the patients had a tracheostomy for airway obstruction. This included six supralaryngeal obstructions, five subglottic stenosis, two subglottic hemangiomata, two vocal cord palsies, one laryngeal papillomata, and one tracheomalacia. In none of these was the tracheostomy regarded as being permanent. Four of the patients had neurologic underlying disease, including two children with cerebral palsy and two with Guillain-Barré syndrome. The former two patients were regarded as having permanent tracheostomies. Only one patient had a tracheostomy performed for a primary respiratory problem, namely bronchopulmonary dysplasia. Finally, one patient had a tracheostomy performed as a precaution before a surgical correction of a kyphoscoliosis. Study Intervention To prevent the immediate transfer of PPM from the external source into the lower airways via the tracheotomy, 0.5 g of paste containing 2% polymyxin E and tobramycin was applied topically Table 1 Patient Demographics Variables Data Age at time of tracheotomy, mo Median (range) 4.07 ( ) Mean (SD) 37.8 (64.3) 95% confidence interval 2.7 to 41.5 Sex, No. Male 16 Female 7 Diagnosis, No. Neurologic disorder Cerebral palsy 2 Guillain-Barré 2 Pulmonary disorder Bronchopulmonary dysplasia 1 Airway obstruction Supralaryngeal obstruction 6 Subglottic stenosis 5 Subglottic hemangioma 2 Vocal cord palsy 2 Laryngeal papillomata 1 Tracheomalacia 1 Skeletal disorder Kyphoscoliosis 1 Term of tracheotomy Long-term 21 Short-term 2 to the tracheostomy site four times daily. The paste was applied for a fortnight to cover the postoperative period during which the patient is known to be at high risk of colonization or infection of the lower airways and tracheostomy site. Sampling Surveillance Samples: Surveillance samples of the oropharynx were obtained immediately before the placement of the tracheotomy, and twice weekly afterward during the application of the 2% paste with polymyxin E and tobramycin in the PICU. The reason for taking these samples is to detect the carrier state of the potential pathogens that allow us to distinguish the endogenous from the exogenous pathway. Diagnostic Samples: Diagnostic samples of lower airway secretions and tracheotomy site were taken once weekly and on clinical indication. In addition, tracheal aspirates and tracheotomy site exudates that were turbid were obtained in the study. Microbiological Methods 2 Surveillance Samples: Throat swabs were processed qualitatively and semiquantitatively using three solid media, ie, MacConkey, staphylococcal, and yeast agar, and enrichment broth to detect both overgrowth and low-grade carriage. Diagnostic Samples: Endotracheal aspirates and pus from the tracheostomy site were processed in a qualitative and quantitative way using standard microbiological methods. For all types of samples, macroscopically distinct colonies were isolated in pure culture. Standard methods for identification, typing, and sensitivity patterns were used for all microorganisms. Tracheotomy All tracheotomies were performed electively with the routine methods used by most authorities in children. 7 Immediate after- 514 Clinical Investigations in Critical Care

3 Figure 1. Classification of the 16 colonization or infection episodes in 14 children according to route of acquisition. PE primary endogenous; SE secondary endogenous; EX exogenous. care, including daily stoma care, suctioning, and change of tracheotomy tube were all conducted under strict protocols of hygiene and sterility. 8 Antibiotic Policy During the Study Systemic antibiotics were given only in case of infection. Infection was diagnosed on clinical signs of infection including fever of 38.5 C, leukocytosis 12, /L, and elevated C-reactive protein (CRP) 15 g/ml, combined with purulent tracheal aspirates yielding 10 6 cfu/ml. 3,6 All five requirements had to be fulfilled for the diagnosis of infection. Tracheobronchitis was distinguished from pneumonia by the absence of chest radiographic changes. Infection caused by aerobic Gram-positive bacteria was, in general, treated with a first-generation cephalosporin, whereas a third-generation cephalosporin was given in children who developed a lower airway infection caused by aerobic Gram-negative bacilli. Infection in general was treated with a 5-day course of antibiotics, followed by clinical reevaluation of the patient. Definitions 6 Carriage or the carrier state existed when the same bacterial strain was isolated from at least two consecutive throat samples, in any concentration, during a period of at least 1 week. Colonization of the lower airways was defined as the presence of a microorganism in the lower airways; the diagnostic sample yielded 10 6 cfu/ml of diagnostic sample. The concentration of leukocytes in the lower airway secretions was, in general, few ( ) or moderate ( ), on a semiquantitative scale of,, and (many). Infection of the lower airways was defined as a microbiologically proven diagnosis of systemic inflammation. The diagnostic sample obtained from the lower airways yielded 10 6 cfu/ml of sample, and there were many leukocytes in the lower airway secretions. Tracheobronchitis was defined as follows: 1. Purulent endotracheal aspirate (WBC, ). 2. Fever 38.5 C. 3. Leukocytosis (WBC 12, /L) or leukopenia (WBC 4, /L) cfu/ml of tracheal aspirate. 5. Elevated CRP 15 g/ml. Bronchopneumonia was defined as the same five criteria as above, combined with the presence of a new or progressive pulmonary infiltrate on chest radiograph for 48 h. Primary endogenous colonization or infection was defined as colonization or infection of the lower airways caused by a PPM isolated from the lower airway secretions and carried by the patient in the throat at the time of admission to the PICU or tracheotomy. Secondary endogenous colonization or infection was defined as colonization or infection of the lower airways caused by a PPM isolated from the tracheal aspirate and not carried in the throat at the time of admission to the PICU or tracheotomy, but appearing later. Exogenous colonization or infection was defined as colonization or infection of the lower airways caused by a PPM isolated from the tracheal aspirate and not previously carried by the child in the throat at any time. End points of the study evaluated during the 2 weeks of the intervention were as follows: 1. Percentage of patients colonized or infected. 2. Percentage of types of colonization or infection episodes. 3. Effect of topical antibiotics on the exogenous route. Results All children required mechanical ventilation after the tracheostomy. They were ventilated for a total of 671 days; the median was 2 days (range, 1 to 281 days, 95% confidence interval, 2 to 17), and the mean was 29.2 days (SD 64.5 days). CHEST / 117 / 2/ FEBRUARY,

4 Table 2 Microbial Distribution Among Colonization/ Infection Episodes* Organisms Primary Endogenous Colonization/Infection Secondary Endogenous Exogenous Community, PPM S pneumoniae 2 H influenzae 3 M catarrhalis 3 S aureus 5 1 Hospital, PPM E cloacae 1 H alvei 1 P aeruginosa 1 1 S maltophilia 1 P picketti 1 *More than one PPM was isolated from the tracheal secretions of three patients. Sterile lower respiratory tract in eight patients. Of the 23 children enrolled in the study, 14 (61%) developed colonization or infection of the lower airways during the 2 weeks of topical antibiotics. There were a total of 16 episodes of colonization or infection during the 2-week observation period. Only one child (4%) had tracheobronchitis. Figure 1 shows the distribution of the three types of lower airway colonization: 12 episodes in 11 patients were of primary endogenous pathogenesis; three episodes in three patients were of secondary endogenous pathogenesis, and one patient had one episode of exogenous colonization. Table 2 shows the microorganisms causing the three types of colonization or infection. There was only one infection of primary endogenous development, ie, a tracheobronchitis caused by Streptococcus pneumoniae and Haemophilus influenzae (Fig 2) and one failure of the topical prophylaxis, ie, exogenous colonization by Pseudomonas pickettii (Fig 3). This bacterium was sensitive to polymyxin E, but resistant to tobramycin in a concentration of 4 mg/l. After discontinuation of the study maneuver, an additional four children in whom the lower airways were sterile during the paste application each developed one episode of colonization (one exogenous episode caused by S aureus and three secondary endogenous colonization episodes with S aureus (2) and Enterobacter cloacae together with Candida albicans). Moreover, two children who Figure 2. Chart displaying type and semiquantitative growth densities of the microorganisms at the three sites being routinely monitored to determine route of acquisition in child A during the study. Endogenous colonization is always preceded by oropharyngeal carriage. If the bacteria are present, eg, S pneumoniae, H influenzae, or Moraxella catarrhalis, before the tracheotomy, that pathway is primary endogenous. In case the bacterium is acquired in the oropharynx after placement of the tracheotomy, the colonization or infection of lower airway is termed secondary endogenous, eg, Enterobacter cloacae. 516 Clinical Investigations in Critical Care

5 Figure 3. Chart displaying type and semiquantitative growth densities of the microorganisms at the three sites being routinely monitored to determine route of acquisition in child B during the study. Exogenous pathway of colonization caused by P pickettii is shown. It was only present in the lower airway, without previous carriage in the oropharynx. This child also had primary endogenous colonization with Hafnia alvei. had previous lower airway colonization during the topical paste developed a further three episodes: one primary endogenous episode caused by Pseudomonas aeruginosa, one secondary endogenous caused by Stenotrophomonas maltophilia, and one exogenous episode with S aureus. Overall, 78% of the children had 23 episodes of colonization or infection. A total of five children kept their lower airways sterile. Discussion This 2-year pilot study in 23 children with tracheostomy showed that the topical application of nonabsorbable antibiotics polymyxin E and tobramycin prevented exogenous colonization or infection of the lower airways in all but one patient during the 2 weeks of the intervention after the placement of the tracheostomy. Our previous historical baseline study 6 in 22 children showed six exogenous colonizations or infections in the 2 weeks after the placement of the tracheostomy. The literature shows that it is virtually impossible to keep the lower airway sterile in that particular subset of children who require long-term tracheostomy. 10 Most of these children who need a tracheostomy suffer severe underlying disabilities, eg, cerebral palsy or neurologic impairment. It is well known that the standard of hygiene is difficult to maintain in this population. Breaches of hygiene are responsible for the exogenous pathway of colonization or infection of the lower airways, ie, microorganisms are directly transferred from external sources via the tracheostomy or tube into the lower airway. Several factors contribute to the exogenous development of lower airway colonization or infection. These include the stoma, the tracheostomy tube, ventilation tubing, the low-grade inflammation or ulceration of the stomal lining, the higher ph of secretions in children with tracheostomy, and in particular, the regular interventions of suctioning and changing tubes. Almost all studies in children with tracheostomy use solely tracheal aspirates to evaluate colonization or infection of the lower airway. 10 However, this design does not allow the detection of an exogenous problem in a particular subset of patients. Both an oropharyngeal culture and tracheal aspirate have to be obtained as a pair of samples to distinguish the endogenous from the exogenous route of colonization or infection. Our data show that both samples are required to unravel the route of acquisition, because each requires a different infection control method. Oropharyngeal paste has been shown to control the endogenous route, 9 whereas topical paste on the tracheostoma aims to control the exogenous route. The topical application of polymyxin E and tobramycin is thought to act as a barrier to reduce the exogenous introduction of microorganisms into the lower airway. This method does not replace basic hygiene measures; it is, rather, an addition to it. We believe that the intervention of topical antibiotics on the tracheostoma is promising in the prevention of the exogenous route. Further randomized trials are needed. If randomized trials prove this technique to be effective, we believe that the paste CHEST / 117 / 2/ FEBRUARY,

6 should only be applied for the immediate posttracheostomy period, inasmuch as patients are at their highest risk during that time. References 1 Jarvis WR. Epidemiology of nosocomial infections in pediatric patients. Pediatr Infect Dis J 1987; 6: van Saene HKF, Damjanovic V, Murray AE, et al. How to classify infections in intensive care units: the carrier state, a criterion whose time has come? J Hosp Infect 1996; 33: Silvestri L, Monti Bragadin C, Milanese M, et al. Are most ICU infections really nosocomial? A prospective observational cohort study in mechanically ventilated patients. J Hosp Infect 1999; 42: Wiener J, Weinstein R. Infection control methods. In: Neidermann MS, Sarosi GA, Glasroth J, eds. Respiratory infections: a scientific basis for management. 1st ed. Philadelphia, PA: WB Saunders, Levin MH, Olson B, Nathan C, et al. Pseudomonas in the sinks in an intensive care unit: relation to patients. J Clin Pathol 1984; 37: Morar P, Singh V, Jones AS, et al. Impact of tracheotomy on colonization and infection of lower airways in children requiring long-term ventilation: a prospective observational cohort study. Chest 1998; 113: Rogers JH. Tracheostomy and decannulation. In: Kerr AG, ed. Scott-Brown s otolaryngology (vol 6). 6th ed. London: Butterworths, 1997; Ch 26 8 Tym GM. Home tracheostomy care. In: Kerr AG, ed. Scott- Brown s otolaryngology (vol 6). 6th ed. London: Butterworths, 1997; Ch 27 9 Stoutenbeek CP, van Saene HKF, Liberati A. Prevention of respiratory tract infections in intensive care by selective decontamination of the digestive tract. In: Niederman MS, Sarosi GA, Glassroth J, eds. Respiratory infections. 1st ed. Philadelphia, PA: WB Saunders, 1994; Brook I. Bacterial colonization, tracheobronchitis, and pneumonia following tracheostomy and long-term intubation in pediatric patients. Chest 1979; 76: Clinical Investigations in Critical Care

Description of Respiratory Microbiology of Children With Long-Term Tracheostomies

Description of Respiratory Microbiology of Children With Long-Term Tracheostomies Description of Respiratory Microbiology of Children With Long-Term Tracheostomies Rachael McCaleb PharmD, Robert H Warren MD, Denise Willis RRT-NPS, Holly D Maples PharmD, Shasha Bai PhD, and Catherine

More information

Pneumonia (PNEU) and Ventilator-Associated Pneumonia (VAP) Prevention. Basics of Infection Prevention 2-Day Mini-Course 2016

Pneumonia (PNEU) and Ventilator-Associated Pneumonia (VAP) Prevention. Basics of Infection Prevention 2-Day Mini-Course 2016 Pneumonia (PNEU) and Ventilator-Associated Pneumonia (VAP) Prevention Basics of Infection Prevention 2-Day Mini-Course 2016 Objectives Differentiate long term care categories of respiratory infections

More information

ANWICU knowledge

ANWICU knowledge ANWICU knowledge www.anwicu.org.uk This presenta=on is provided by ANWICU We are a collabora=ve associa=on of ICUs in the North West of England. Permission to provide this presenta=on has been granted

More information

CHEST VOLUME 117 / NUMBER 4 / APRIL, 2000 Supplement

CHEST VOLUME 117 / NUMBER 4 / APRIL, 2000 Supplement CHEST VOLUME 117 / NUMBER 4 / APRIL, 2000 Supplement Evidence-Based Assessment of Diagnostic Tests for Ventilator- Associated Pneumonia* Executive Summary Ronald F. Grossman, MD, FCCP; and Alan Fein, MD,

More information

PERCUTANEOUS DILATATIONAL TRACHEOSTOMY

PERCUTANEOUS DILATATIONAL TRACHEOSTOMY PERCUTANEOUS DILATATIONAL TRACHEOSTOMY GM KOKSAL *, NC SAYILGAN * AND H OZ ** Abstract Background: The aim of this study was to investigate the rate, timing, the incidence of complications of percutaneous

More information

Healthcare-associated infections acquired in intensive care units

Healthcare-associated infections acquired in intensive care units SURVEILLANCE REPORT Annual Epidemiological Report for 2015 Healthcare-associated infections acquired in intensive care units Key facts In 2015, 11 788 (8.3%) of patients staying in an intensive care unit

More information

Nosocomial Pneumonia. <5 Days: Non-Multidrug-Resistant Bacteria

Nosocomial Pneumonia. <5 Days: Non-Multidrug-Resistant Bacteria Nosocomial Pneumonia Meredith Deutscher, MD Troy Schaffernocker, MD Ohio State University Burden of Hospital-Acquired Pneumonia Second most common nosocomial infection in the U.S. 5-10 episodes per 1000

More information

VAP Prevention bundles

VAP Prevention bundles VAP Prevention bundles Dr. Shafiq A.Alimad MD Head of medical department at USTH YICID workshop, 15-12-2014 Care Bundles What are they & why use them? What are Care Bundles? Types of Care Bundles available

More information

THE MICROBIOLOGICAL PROFILE OF VENTILATOR ASSOCIATED PNEUMONIA.

THE MICROBIOLOGICAL PROFILE OF VENTILATOR ASSOCIATED PNEUMONIA. THE MICROBIOLOGICAL PROFILE OF VENTILATOR ASSOCIATED PNEUMONIA. Dr. Poonam C. Sharma, Dr. S. S. Raut, Dr. S. R. More, Dr. V. S. Rathod, Dr. V. M. Gujar. 1. Post Graduate Student, Department of Microbiology,

More information

HEALTHCARE-ASSOCIATED PNEUMONIA: EPIDEMIOLOGY, MICROBIOLOGY & PATHOPHYSIOLOGY

HEALTHCARE-ASSOCIATED PNEUMONIA: EPIDEMIOLOGY, MICROBIOLOGY & PATHOPHYSIOLOGY HEALTHCARE-ASSOCIATED PNEUMONIA: EPIDEMIOLOGY, MICROBIOLOGY & PATHOPHYSIOLOGY David Jay Weber, M.D., M.P.H. Professor of Medicine, Pediatrics, & Epidemiology Associate Chief Medical Officer, UNC Health

More information

Aerosolized Antibiotics in Mechanically Ventilated Patients

Aerosolized Antibiotics in Mechanically Ventilated Patients Aerosolized Antibiotics in Mechanically Ventilated Patients Gerald C Smaldone MD PhD Introduction Topical Delivery of Antibiotics to the Lung Tracheobronchitis Aerosolized Antibiotic Delivery in the Medical

More information

Babak Valizadeh, DCLS

Babak Valizadeh, DCLS Laboratory Diagnosis of Bacterial Infections of the Respiratory Tract Babak Valizadeh, DCLS 1391. 02. 05 2012. 04. 25 Babak_Valizadeh@hotmail.com Biological Safety Cabinet Process specimens in biological

More information

ISF criteria (International sepsis forum consensus conference of infection in the ICU) Secondary peritonitis

ISF criteria (International sepsis forum consensus conference of infection in the ICU) Secondary peritonitis Appendix with supplementary material. This appendix was part of the submitted manuscript and has been peer reviewed. It is posted as supplied by the authors. Supplementary Tables Table S1. Definitions

More information

The presence and sequence of endotracheal tube colonization in patients undergoing mechanical ventilation

The presence and sequence of endotracheal tube colonization in patients undergoing mechanical ventilation Eur Respir J 1999; 13: 546±551 Printed in UK ± all rights reserved Copyright #ERS Journals Ltd 1999 European Respiratory Journal ISSN 0903-1936 The presence and sequence of endotracheal tube colonization

More information

Hospital Acquired Pneumonias

Hospital Acquired Pneumonias Hospital Acquired Pneumonias Hospital Acquired Pneumonia ( HAP ) Hospital acquired pneumonia ( HAP ) is defined as an infection of the lung parenchyma developing during hospitalization and not present

More information

Hospital-acquired Pneumonia

Hospital-acquired Pneumonia Hospital-acquired Pneumonia Hospital-acquired pneumonia (HAP) Pneumonia that occurs at least 2 days after hospital admission. The second most common and the leading cause of death due to hospital-acquired

More information

HEALTHCARE-ASSOCIATED PNEUMONIA: DIAGNOSIS, TREATMENT & PREVENTION

HEALTHCARE-ASSOCIATED PNEUMONIA: DIAGNOSIS, TREATMENT & PREVENTION HEALTHCARE-ASSOCIATED PNEUMONIA: DIAGNOSIS, TREATMENT & PREVENTION David Jay Weber, M.D., M.P.H. Professor of Medicine, Pediatrics, & Epidemiology Associate Chief Medical Officer, UNC Health Care Medical

More information

The Bacteriology of Bronchiectasis in Australian Indigenous children

The Bacteriology of Bronchiectasis in Australian Indigenous children The Bacteriology of Bronchiectasis in Australian Indigenous children Kim Hare, Amanda Leach, Peter Morris, Heidi Smith-Vaughan, Anne Chang Presentation outline What is bronchiectasis? Our research at Menzies

More information

PNEUMONIA. I. Background 6 th most common cause of death in U.S. Most common cause of infection related mortality

PNEUMONIA. I. Background 6 th most common cause of death in U.S. Most common cause of infection related mortality Page 1 of 8 September 4, 2001 Donald P. Levine, M.D. University Health Center Suite 5C Office: 577-0348 dlevine@intmed.wayne.edu Assigned reading: pages 153-160; 553-563 PNEUMONIA the most widespread and

More information

All previously published papers and figures were reproduced with permission from the publisher.

All previously published papers and figures were reproduced with permission from the publisher. All previously published papers and figures were reproduced with permission from the publisher. Published by Karolinska Institutet. Printed by Larserics Digital Print AB. Petra Hyllienmark, 2013 ISBN ISBN

More information

From the labo to the ICU: Surveillance cultures in daily ICU practice. Pieter Depuydt MD PhD Dept. Intensive Care Ghent University Hospital

From the labo to the ICU: Surveillance cultures in daily ICU practice. Pieter Depuydt MD PhD Dept. Intensive Care Ghent University Hospital From the labo to the ICU: Surveillance cultures in daily ICU practice Pieter Depuydt MD PhD Dept. Intensive Care Ghent University Hospital Question 1: What is the current practice of surveillance cultures

More information

American College of Surgeons Critical Care Review Course 2012: Infection Control

American College of Surgeons Critical Care Review Course 2012: Infection Control American College of Surgeons Critical Care Review Course 2012: Infection Control Overview: I. Central line associated blood stream infection (CLABSI) II. Ventilator associated pneumonia (VAP) I. Central

More information

THE USE OF THE PENICILLINASE-RESISTANT

THE USE OF THE PENICILLINASE-RESISTANT Therapeutic problems THE USE OF THE PENICILLINASE-RESISTANT PENICILLIN IN THE PNEUMONIAS OF CHILDREN MARTHA D. Yow, MARY A. SOUTH AND CHARLES G. HESS From the Department of Pediatrics, Baylor University

More information

Influenza-Associated Pediatric Mortality Case Report Form Form Approved OMB No

Influenza-Associated Pediatric Mortality Case Report Form Form Approved OMB No Influenza-Associated Pediatric Mortality Case Report Form Form Approved OMB No. 0920-0004 STATE USE ONLY DO NOT SEND INFORMATION IN THIS SECTION TO CDC Last Name: First Name: County: Address: City: State,

More information

A study on common pathogens associated with nosocomial infections and their antibiotic sensitivity

A study on common pathogens associated with nosocomial infections and their antibiotic sensitivity International Journal of Contemporary Pediatrics Ahirrao VS et al. Int J Contemp Pediatr. 2017 Mar;4(2):365-369 http://www.ijpediatrics.com pissn 2349-3283 eissn 2349-3291 Original Research Article DOI:

More information

Influenza A (H1N1)pdm09 in Minnesota Epidemiology

Influenza A (H1N1)pdm09 in Minnesota Epidemiology Influenza A (H1N1)pdm09 in Minnesota Epidemiology Infectious Disease Epidemiology, Prevention and Control Division PO Box 64975 St. Paul, MN 55164-0975 Number of Influenza Hospitalizations by Influenza

More information

Usefulness of Gram staining of tracheal aspirates in initial therapy for ventilator-associated pneumonia in extremely preterm neonates

Usefulness of Gram staining of tracheal aspirates in initial therapy for ventilator-associated pneumonia in extremely preterm neonates (2010) 30, 270 274 r 2010 Nature Publishing Group All rights reserved. 0743-8346/10 $32 www.nature.com/jp ORIGINAL ARTICLE Usefulness of Gram staining of tracheal aspirates in initial therapy for ventilator-associated

More information

Ventilator Associated Pneumonia: New for 2008

Ventilator Associated Pneumonia: New for 2008 Ventilator Associated Pneumonia: New for 2008 Jeanine P. Wiener-Kronish, MD Henry Isaiah Dorr Professor of Research and Teaching in Anaesthetics and Anaesthesia Department of Anesthesia and Critical Care

More information

Diagnosis of Ventilator- Associated Pneumonia: Where are we now?

Diagnosis of Ventilator- Associated Pneumonia: Where are we now? Diagnosis of Ventilator- Associated Pneumonia: Where are we now? Gary French Guy s & St. Thomas Hospital & King s College, London BSAC Guideline 2008 Masterton R, Galloway A, French G, Street M, Armstrong

More information

Acceptability of Sputum Specimens

Acceptability of Sputum Specimens JOURNAL OF CLINICAL MICROBIOLOGY, Oct. 1982, p. 627-631 0095-1137/82/100627-05$02.00/0 Copyright C 1982, American Society for Microbiology Vol. 16, No. 4 Comparison of Six Different Criteria for Judging

More information

Lecture Notes. Chapter 16: Bacterial Pneumonia

Lecture Notes. Chapter 16: Bacterial Pneumonia Lecture Notes Chapter 16: Bacterial Pneumonia Objectives Explain the epidemiology Identify the common causes Explain the pathological changes in the lung Identify clinical features Explain the treatment

More information

Influenza-Associated Pediatric Deaths Case Report Form

Influenza-Associated Pediatric Deaths Case Report Form STATE USE ONLY DO NOT SEND INFORMATION IN THIS SECTION TO CDC Form approved OMB No. 0920-0007 Last Name: First Name: County: Address: City: State, Zip: Patient Demographics 1. State: 2. County: 3. State

More information

Enterobacter aerogenes

Enterobacter aerogenes Enterobacter aerogenes Piagnerelli M 1, Carlier E 1, Deplano A 3, Lejeune P 1, Govaerts D 2 1 Departments of Intensive Care and 2 Microbiology, A. Vésale Hospital. 6110 Montigny-le-Tilleul. 3 Department

More information

Community Acquired Pneumonia. Abdullah Alharbi, MD, FCCP

Community Acquired Pneumonia. Abdullah Alharbi, MD, FCCP Community Acquired Pneumonia Abdullah Alharbi, MD, FCCP A 68 y/ male presented to the ED with SOB and productive coughing for 2 days. Reports poor oral intake since onset due to nausea and intermittent

More information

GUIDE TO INFECTION CONTROL IN THE HOSPITAL. Carbapenem-resistant Enterobacteriaceae

GUIDE TO INFECTION CONTROL IN THE HOSPITAL. Carbapenem-resistant Enterobacteriaceae GUIDE TO INFECTION CONTROL IN THE HOSPITAL CHAPTER 47: Carbapenem-resistant Enterobacteriaceae Authors E-B Kruse, MD H. Wisplinghoff, MD Chapter Editor Michelle Doll, MD, MPH) Topic Outline Key Issue Known

More information

Chapter 22. Pulmonary Infections

Chapter 22. Pulmonary Infections Chapter 22 Pulmonary Infections Objectives State the incidence of pneumonia in the United States and its economic impact. Discuss the current classification scheme for pneumonia and be able to define hospital-acquired

More information

Routine endotracheal cultures for the prediction of sepsis in ventilated babies

Routine endotracheal cultures for the prediction of sepsis in ventilated babies Archives of Disease in Childhood, 1989, 64, 34-38 Routine endotracheal cultures for the prediction of sepsis in ventilated babies T A SLAGLE, E M BIFANO, J W WOLF, AND S J GROSS Department of Pediatrics,

More information

Selective decontamination of the digestive tract: an update of the evidence

Selective decontamination of the digestive tract: an update of the evidence Endorsed by proceedings in Intensive Care Cardiovascular Anesthesia review ArticlE HSR Proceedings in Intensive Care and Cardiovascular Anesthesia 2012; 4(1): 21-29 Selective decontamination of the digestive

More information

320 MBIO Microbial Diagnosis. Aljawharah F. Alabbad Noorah A. Alkubaisi 2017

320 MBIO Microbial Diagnosis. Aljawharah F. Alabbad Noorah A. Alkubaisi 2017 320 MBIO Microbial Diagnosis Aljawharah F. Alabbad Noorah A. Alkubaisi 2017 Pathogens of the Urinary tract The urinary system is composed of organs that regulate the chemical composition and volume of

More information

Critical Care Nursing Theory. Pneumonia. - Pneumonia is an acute infection of the pulmonary parenchyma

Critical Care Nursing Theory. Pneumonia. - Pneumonia is an acute infection of the pulmonary parenchyma - is an acute infection of the pulmonary parenchyma - is a common infection encountered by critical care nurses when it complicates the course of a serious illness or leads to acute respiratory distress.

More information

SURVEILLANCE BLOODSTREAM INFECTIONS IN BELGIAN HOPITALS ( SEP ) RESULTS ANNUAL REPORT data

SURVEILLANCE BLOODSTREAM INFECTIONS IN BELGIAN HOPITALS ( SEP ) RESULTS ANNUAL REPORT data SURVEILLANCE BLOODSTREAM INFECTIONS IN BELGIAN HOPITALS ( SEP ) RESULTS ANNUAL REPORT data 2000-2014 SEP Workgroup Meeting 24 June 2015 Dr. Naïma Hammami Dr. Marie-Laurence Lambert naima.hammami@wiv-isp.be

More information

Treatment of febrile neutropenia in patients with neoplasia

Treatment of febrile neutropenia in patients with neoplasia Treatment of febrile neutropenia in patients with neoplasia George Samonis MD, PhD Medical Oncologist Infectious Diseases Specialist Professor of Medicine The University of Crete, Heraklion,, Crete, Greece

More information

MICROBIOLOGICAL TESTING IN PICU

MICROBIOLOGICAL TESTING IN PICU MICROBIOLOGICAL TESTING IN PICU This is a guideline for the taking of microbiological samples in PICU to diagnose or exclude infection. The diagnosis of infection requires: Ruling out non-infectious causes

More information

Trial protocol - NIVAS Study

Trial protocol - NIVAS Study 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 Trial protocol - NIVAS Study METHODS Study oversight The Non-Invasive Ventilation after Abdominal Surgery

More information

BIP Endotracheal Tube

BIP Endotracheal Tube Bactiguard Infection Protection BIP Endotracheal Tube For prevention of healthcare associated infections Ventilator associated pneumonia Infections of the respiratory tract are serious and common healthcare

More information

Ventilator-Associated Pneumonia in Neonatal and Pediatric Intensive Care Unit Patients

Ventilator-Associated Pneumonia in Neonatal and Pediatric Intensive Care Unit Patients CLINICAL MICROBIOLOGY REVIEWS, July 2007, p. 409 425 Vol. 20, No. 3 0893-8512/07/$08.00 0 doi:10.1128/cmr.00041-06 Copyright 2007, American Society for Microbiology. All Rights Reserved. Ventilator-Associated

More information

PULMONARY EMERGENCIES

PULMONARY EMERGENCIES EMERGENCIES I. Pneumonia A. Bacterial Pneumonia (most common cause of a focal infiltrate) 1. Epidemiology a. Accounts for up to 10% of hospital admissions in the U.S. b. Most pneumonias are the result

More information

Ventilator Associated Pneumonia. ICU Fellowship Training Radboudumc

Ventilator Associated Pneumonia. ICU Fellowship Training Radboudumc Ventilator Associated Pneumonia ICU Fellowship Training Radboudumc Attributable mortality VAP Meta-analysis of individual patient data from randomized prevention studies Attributable mortality mainly results

More information

Methicillin-Resistant Staphylococcus aureus (MRSA) S urveillance Report 2008 Background Methods

Methicillin-Resistant Staphylococcus aureus (MRSA) S urveillance Report 2008 Background Methods Methicillin-Resistant Staphylococcus aureus (MRSA) Surveillance Report 2008 Oregon Active Bacterial Core Surveillance (ABCs) Office of Disease Prevention & Epidemiology Oregon Department of Human Services

More information

Preventing & Controlling the Spread of Infection

Preventing & Controlling the Spread of Infection Preventing & Controlling the Spread of Infection Contributors: Alice Pong M.D., Hospital Epidemiologist Chris Abe, R.N., Senior Director Ancillary and Support Services Objectives Review the magnitude of

More information

Upper...and Lower Respiratory Tract Infections

Upper...and Lower Respiratory Tract Infections Upper...and Lower Respiratory Tract Infections Robin Jump, MD, PhD Cleveland Geriatric Research Education and Clinical Center (GRECC) Louis Stokes Cleveland VA Medical Center Case Western Reserve University

More information

Nosocomial infections surveillance in RIPAS Hospital

Nosocomial infections surveillance in RIPAS Hospital Original Article Brunei Int Med J. 212; 8 (6): 32-333 Nosocomial infections surveillance in RIPAS Hospital Muppidi SATYAVANI, 1, 2 Junita MOMIN, ² and Samuel Kai San YAPP 2, 3 ¹ Department of Microbiology,

More information

Ventilator-associated pneumonia after pediatric cardiac surgery in southern Taiwan

Ventilator-associated pneumonia after pediatric cardiac surgery in southern Taiwan J Microbiol Immunol Infect. 2009;42:413-419 Ventilator-associated pneumonia after pediatric cardiac surgery in southern Taiwan Chia-Wan Tang 1, Po-Yen Liu 1, Yung-Feng Huang 1, Jun-Yen Pan 2, Susan Shin-Jung

More information

Culture of Throat, Sputum and Other Respiratory Specimens

Culture of Throat, Sputum and Other Respiratory Specimens Culture of Throat, Sputum and Other Respiratory Specimens Carol Spiegel, Ph.D., D(ABMM) Professor of Pathology and Laboratory Medicine at the UW School of Medicine and Public Health and Director of Clinical

More information

Guillain-Barré Syndrome

Guillain-Barré Syndrome Guillain-Barré Syndrome A Laboratory Perspective Laura Dunn Biomedical Scientist (Trainee Healthcare Scientist) Diagnosis of GBS GBS is generally diagnosed on clinical grounds Basic laboratory studies

More information

Research & Reviews of Pneumonia

Research & Reviews of Pneumonia Chapter 1 Pathophysiology of Hospital Acquired Pneumonia Priyam Batra * ; Purva Mathur 1 1 Department of Laboratory Medicine, AIIMS, Trauma Centre, New Delhi, India. *Correspondence to: Priyam Batra, Department

More information

Marcos I. Restrepo, MD, MSc, FCCP

Marcos I. Restrepo, MD, MSc, FCCP Thank you for viewing this presentation. We would like to remind you that this material is the property of the author. It is provided to you by the ERS for your personal use only, as submitted by the author.

More information

Bronchiectasis Domiciliary treatment. Prof. Adam Hill Royal Infirmary and University of Edinburgh

Bronchiectasis Domiciliary treatment. Prof. Adam Hill Royal Infirmary and University of Edinburgh Bronchiectasis Domiciliary treatment Prof. Adam Hill Royal Infirmary and University of Edinburgh Plan of talk Background of bronchiectasis Who requires IV antibiotics Domiciliary treatment Results to date.

More information

MRSA pneumonia mucus plug burden and the difficult airway

MRSA pneumonia mucus plug burden and the difficult airway Case report Crit Care Shock (2016) 19:54-58 MRSA pneumonia mucus plug burden and the difficult airway Ann Tsung, Brian T. Wessman An 80-year-old female with a past medical history of chronic obstructive

More information

A new selective blood agar medium for Streptococcus pyogenes and other haemolytic streptococci

A new selective blood agar medium for Streptococcus pyogenes and other haemolytic streptococci J. clin. Path. (1964), 17, 231 A new selective blood agar medium for Streptococcus pyogenes and other haemolytic streptococci E. J. L. LOWBURY, A. KIDSON, AND H. A. LILLY From the Medical Research Council

More information

Community Acquired & Nosocomial Pneumonias

Community Acquired & Nosocomial Pneumonias Community Acquired & Nosocomial Pneumonias IDSA/ATS 2007 & 2016 Guidelines José Luis González, MD Clinical Assistant Professor of Medicine Outline Intro - Definitions & Diagnosing CAP treatment VAP & HAP

More information

Abstract. Introduction

Abstract. Introduction ORIGINAL ARTICLE INFECTIOUS DISEASES Accuracy of American Thoracic Society/Infectious Diseases Society of America criteria in predicting infection or colonization with multidrug-resistant bacteria at intensive-care

More information

Discrepancies in the recovery of bacteria from multiple sinuses in acute and chronic sinusitis

Discrepancies in the recovery of bacteria from multiple sinuses in acute and chronic sinusitis Journal of Medical Microbiology (2004), 53, 879 885 DOI 10.1099/jmm.0.45655-0 Short Communication Correspondence Itzhak Brook ib6@georgetown.edu Received 1 March 2004 Accepted 18 May 2004 Discrepancies

More information

Work-up of Respiratory Specimens Now you can breathe easier

Work-up of Respiratory Specimens Now you can breathe easier 34 th Annual Meeting Southwestern Association of Clinical Microbiology Work-up of Respiratory Specimens Now you can breathe easier Yvette S. McCarter, PhD, D(ABMM) Director, Clinical Microbiology Laboratory

More information

Cross-colonisation with Pseudomonas aeruginosa of patients in an intensive care unit

Cross-colonisation with Pseudomonas aeruginosa of patients in an intensive care unit Thorax 1998;53:1053 1058 1053 Internal Medicine, University Hospital Maastricht, Maastricht, The DCJJBergmans S van der Geest R M Wilting P W de Leeuw Internal Medicine, University Hospital Utrecht, Utrecht,

More information

Skin reactivity to autologous bacteria isolated from respiratory tract of patients with obstructive pulmonary disease

Skin reactivity to autologous bacteria isolated from respiratory tract of patients with obstructive pulmonary disease Skin reactivity to autologous bacteria 149 Original Article Skin reactivity to autologous bacteria isolated from respiratory tract of patients with obstructive pulmonary disease J. Halasa 1, M. Halasa

More information

27/11/2012. Parainfuenza 1, 2 3 Rhinovirus Coronavirus Adenovirus Respiratory syncytial virus (RSV) Chlamydophila pneumoniae Mycoplasma pneumonite

27/11/2012. Parainfuenza 1, 2 3 Rhinovirus Coronavirus Adenovirus Respiratory syncytial virus (RSV) Chlamydophila pneumoniae Mycoplasma pneumonite 8 «Evidence-based Medicine-» 27/11/2012,,,, : :,,,,,,,, (30%-50%) () (5%-10%) (40%-50%) 20% Infuenza A B Parainfuenza 1, 2 3 Rhinovirus Coronavirus Adenovirus Respiratory syncytial virus (RSV) Chlamydophila

More information

RESPIRATORY TRACT INFECTIONS. CLS 212: Medical Microbiology

RESPIRATORY TRACT INFECTIONS. CLS 212: Medical Microbiology RESPIRATORY TRACT INFECTIONS CLS 212: Medical Microbiology Anatomy of the Respiratory System Respiratory Infections Respiratory tract can be divided into: Upper Respiratory Tract (URT): Sinuses Nasopharynx,.

More information

Antisepsis Bath and Oral.. Should We Change Practice? DR AZMIN HUDA ABDUL RAHIM

Antisepsis Bath and Oral.. Should We Change Practice? DR AZMIN HUDA ABDUL RAHIM Antisepsis Bath and Oral.. Should We Change Practice? DR AZMIN HUDA ABDUL RAHIM Chlorhexidine Exposure in ICU Chlorhexidine gluconate Long acting topical antiseptic In use since 1954 Water soluble Remains

More information

Infection Control. Student Orientation

Infection Control. Student Orientation Infection Control Student Orientation Basic, but important, Principles of Cross Transmission Presence of microorganisms on hands or in environment does not necessarily = cross transmission or infection

More information

POLICY FOR TREATMENT OF LOWER RESPIRATORY TRACT INFECTIONS

POLICY FOR TREATMENT OF LOWER RESPIRATORY TRACT INFECTIONS POLICY F TREATMENT OF LOWER RESPIRATY TRACT INFECTIONS Written by: Dr M Milupi, Consultant Microbiologist Date: June 2018 Approved by: The Drugs & Therapeutics Committee Date: July 2018 Implementation

More information

Respiratory Pathogen Panel TEM-PCR Test Code:

Respiratory Pathogen Panel TEM-PCR Test Code: Respiratory Pathogen Panel TEM-PCR Test Code: 220000 Tests in this Panel Enterovirus group Human bocavirus Human coronavirus (4 types) Human metapneumovirus Influenza A - Human influenza Influenza A -

More information

Surveillance of Healthcare Associated Infections in Scottish Intensive Care Units

Surveillance of Healthcare Associated Infections in Scottish Intensive Care Units Surveillance of Healthcare Associated Infections in Scottish Intensive Care Units Annual report of data from January 2010 to December 2010 Scottish Intensive Care Society Audit Group 1 Health Protection

More information

심사사례 성균관의대강북삼성병원감염내과 염준섭

심사사례 성균관의대강북삼성병원감염내과 염준섭 폐렴및호흡기질환의치료와 심사사례 성균관의대강북삼성병원감염내과 염준섭 서 론 미국 : 매년 560만명의환자발생 -- 20% 입원 사망률 - 외래에서치료가능한환자 : 1-5% - 입원치료가필요한환자 : 25% - 국내 ( 사망원인통계결과 ) : 2001년 ; 6.1명 /10만명, 1991년 ; 5.1명 /10만명 50-90% 가외래에서치료 30-40% 는원인을밝혀내지못함

More information

Mechanical Ventilation

Mechanical Ventilation GUIDE TO INFECTION CONTROL IN THE HOSPITAL CHAPTER 33: Mechanical Ventilation Authors C. Landelle, PharmD, PhD D. Pittet, MD, MS Chapter Editor Gonzalo Bearman, MD, MPH, FACP, FSHEA, FIDSA Topic Outline

More information

Selective decontamination of the digestive tract in elective gastrointestinal surgery Roos, Daphne

Selective decontamination of the digestive tract in elective gastrointestinal surgery Roos, Daphne UvA-DARE (Digital Academic Repository) Selective decontamination of the digestive tract in elective gastrointestinal surgery Roos, Daphne Link to publication Citation for published version (APA): Roos,

More information

Online Supplement for:

Online Supplement for: Online Supplement for: INFLUENCE OF COMBINED INTRAVENOUS AND TOPICAL ANTIBIOTIC PROPHYLAXIS ON THE INCIDENCE OF INFECTIONS, ORGAN DYSFUNCTIONS, AND MORTALITY IN CRITICALLY ILL SURGICAL PATIENTS A PROSPECTIVE,

More information

Ceftizoxime in the treatment of infections in patients with cancer

Ceftizoxime in the treatment of infections in patients with cancer Journal of Antimicrobial Chemotherapy (98), Suppl. C, 67-73 Ceftizoxime in the treatment of infections in patients with cancer V. Fainstein, R. Bolivar,. Elting, M. Valdivieso and G. P. Bodey Department

More information

Ventilator Associated Pneumonia. ICU Fellowship Training Radboudumc

Ventilator Associated Pneumonia. ICU Fellowship Training Radboudumc Ventilator Associated Pneumonia ICU Fellowship Training Radboudumc Attributable mortality VAP Meta-analysis of individual patient data from randomized prevention studies Attributable mortality mainly results

More information

Surveillance of Healthcare Associated Infections in Scottish Intensive Care Units

Surveillance of Healthcare Associated Infections in Scottish Intensive Care Units Surveillance of Healthcare Associated Infections in Scottish Intensive Care Units Annual report of data from January - December 2012 Scottish Intensive Care Society Audit Group Health Protection Scotland

More information

Unit II Problem 2 Pathology: Pneumonia

Unit II Problem 2 Pathology: Pneumonia Unit II Problem 2 Pathology: Pneumonia - Definition: pneumonia is the infection of lung parenchyma which occurs especially when normal defenses are impaired such as: Cough reflex. Damage of cilia in respiratory

More information

Disclosure. DIAGNOSIS AND TREATMENT OF RESPIRATORY CONDITIONS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT Rishi Agrawal, MD, MPH

Disclosure. DIAGNOSIS AND TREATMENT OF RESPIRATORY CONDITIONS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT Rishi Agrawal, MD, MPH DIAGNOSIS AND TREATMENT OF RESPIRATORY CONDITIONS IN CHILDREN WITH NEUROLOGICAL IMPAIRMENT Rishi Agrawal, MD, MPH Disclosure I have no relevant financial relationships with the manufacturers(s) of any

More information

Epidemiology of Infectious Complications of H1N1 Influenza Virus Infection

Epidemiology of Infectious Complications of H1N1 Influenza Virus Infection Epidemiology of Infectious Complications of H1N1 Influenza Virus Infection Lyn Finelli, DrPH, MS Lead, Influenza Surveillance and Outbreak Response Epidemiology and Prevention Branch Influenza Division

More information

pneumonia 2015;6:48 56

pneumonia 2015;6:48 56 pneumonia 2015 Aug 21;6:48 56 pneumonia Brief Report Anne B Chang a,b, Heidi Smith-Vaughan a,c, Theo P Sloots f, Patricia C Valery a, David Whiley f, Jemima Beissbarth a, Paul J Torzillo d,e a Menzies

More information

INTRODUCTION TO UPPER RESPIRATORY TRACT DISEASES

INTRODUCTION TO UPPER RESPIRATORY TRACT DISEASES Upper Respiratory Tract Infections Return to Syllabus INTRODUCTION TO UPPER RESPIRATORY TRACT DISEASES General Goal: To know the major mechanisms of defense in the URT, the major mechanisms invaders use

More information

Ventilator-associated pneumonia

Ventilator-associated pneumonia Respirology (2009) 14 (Suppl. 2) S51 S58 doi: 10.1111/j.1400-1843.2009.01577.x CHAPTER VIII Ventilator-associated pneumonia SUMMARY Ventilator-associated pneumonia is a pneumonia that develops initially

More information

Ventilator Associated

Ventilator Associated Ventilator Associated Pneumonia: Key and Controversial Issues Christopher P. Michetti, MD, FACS Inova Fairfax Hospital, Falls Church, VA Forrest Dell Moore, MD, FACS Banner Healthcare System, Phoenix,

More information

1.40 Prevention of Nosocomial Pneumonia

1.40 Prevention of Nosocomial Pneumonia 1.40 Prevention of Nosocomial Pneumonia Purpose Audience Policy Statement: The guideline is designed to reduce the incidence of pneumonia and other acute lower respiratory tract infections. All UTMB healthcare

More information

PNEUMONIA IN CHILDREN. IAP UG Teaching slides

PNEUMONIA IN CHILDREN. IAP UG Teaching slides PNEUMONIA IN CHILDREN 1 INTRODUCTION 156 million new episodes / yr. worldwide 151 million episodes developing world 95% in developing countries 19% of all deaths in children

More information

an inflammation of the bronchial tubes

an inflammation of the bronchial tubes BRONCHITIS DEFINITION Bronchitis is an inflammation of the bronchial tubes (or bronchi), which are the air passages that extend from the trachea into the small airways and alveoli. Triggers may be infectious

More information

Preventing Nosocomial Pneumonia

Preventing Nosocomial Pneumonia Prevention of Nosocomial Pneumonia Andreas F. Widmer, MD,MS,FIDSA,FSHEA Chair Infection Control University of Basel Hospitals & Clinics Basel, Switzerland Preventing Nosocomial Pneumonia Definition & Surveillance

More information

Herpes virus reactivation in the ICU. M. Ieven BVIKM

Herpes virus reactivation in the ICU. M. Ieven BVIKM Herpes virus reactivation in the ICU M. Ieven BVIKM 07.04.2011 Introduction: Viruses identified in critically ill ICU patients Viral diseases have recently been the subject of numerous investigations in

More information

Sequential microbiological monitoring of tracheal aspirates in intubated patients admitted to a pediatric intensive care unit

Sequential microbiological monitoring of tracheal aspirates in intubated patients admitted to a pediatric intensive care unit 0021-7557/05/81-01/29 Jornal de Pediatria Copyright 2005 by Sociedade Brasileira de Pediatria ORIGINAL ARTICLE Sequential microbiological monitoring of tracheal aspirates in intubated patients admitted

More information

PANELISTS. Controversial Issues In Common Interventions In ORL 4/10/2014

PANELISTS. Controversial Issues In Common Interventions In ORL 4/10/2014 Controversial Issues In Common Interventions In ORL Mohamed Hesham,MD Alexandria Faculty of Medicine PANELISTS Prof. Ahmed Eldaly Prof. Hamdy EL-Hakim Prof. Hossam Thabet Prof. Maged El-Shenawy Prof. Prince

More information

Neonatal Airway Disorders, Treatments, and Outcomes. Steven Goudy, MD Pediatric Otolaryngology Emory University Medical Center

Neonatal Airway Disorders, Treatments, and Outcomes. Steven Goudy, MD Pediatric Otolaryngology Emory University Medical Center Neonatal Airway Disorders, Treatments, and Outcomes Steven Goudy, MD Pediatric Otolaryngology Emory University Medical Center Disclosure I have nothing to disclose Neonatal and Pediatric Tracheostomy Tracheostomy

More information

ORIGINAL ARTICLE /j x

ORIGINAL ARTICLE /j x ORIGINAL ARTICLE 10.1111/j.1469-0691.2008.01949.x An outbreak of hospital-acquired Pseudomonas aeruginosa infection caused by contaminated bottled water in intensive care units T. Eckmanns 1, M. Oppert

More information

Bacterial colonization of distal airways in healthy subjects and chronic lung disease: a bronchoscopic study

Bacterial colonization of distal airways in healthy subjects and chronic lung disease: a bronchoscopic study Eur Respir J 1997; 10: 1137 1144 DOI: 10.1183/09031936.97.10051137 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1997 European Respiratory Journal ISSN 0903-1936 Bacterial colonization

More information

HOSPITAL INFECTION CONTROL

HOSPITAL INFECTION CONTROL HOSPITAL INFECTION CONTROL Objectives To be able to define hospital acquired infections discuss the sources and routes of transmission of infections in a hospital describe methods of prevention and control

More information

Normal Human Flora. (Human Microbiome) Dr.Sarmad M.H. Zeiny Baghdad College of Medicine

Normal Human Flora. (Human Microbiome) Dr.Sarmad M.H. Zeiny Baghdad College of Medicine Normal Human Flora (Human Microbiome) Dr.Sarmad M.H. Zeiny Baghdad College of Medicine 2014-2015 Objectives Describe important human normal flora. Demonstrate the epidemiology of human normal flora. Determine

More information