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Gonska T, Keenan K, Au J, Dupuis A, Chilvers MA, Burgess C, Bjornson C, Fairservice L, Brusky J, Kherani T, Jober A, Kosteniuk L, Price A, Itterman J, Morgan L, Mateos-Corral D, Hughes D, Donnelly C, Smith MJ, Iqbal S, Arpin J, Reisman J, Hammel J, van Wylick R, Derynck M, Henderson N, Solomon M, Ratjen F. Outcomes of Cystic Fibrosis Screening-Positive Infants With Inconclusive Diagnosis at School Age. Pediatrics 2021; 148:183433. [PMID: 34814176 DOI: 10.1542/peds.2021-051740] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Cystic fibrosis (CF) screen-positive infants with an inconclusive diagnosis (CFSPID) are infants in whom sweat testing and genetic analysis does not resolve a CF diagnosis. Lack of knowledge about the health outcome of these children who require clinical follow-up challenges effective consultation. Early predictive biomarkers to delineate the CF risk would allow a more targeted approach to these children. METHODS Prospective, longitudinal, multicenter, Canada-wide cohort study of CF positive-screened newborns with 1 to 2 cystic fibrosis transmembrane conductance regulator gene variants, of which at least 1 is not known to be CF-causing and/or a sweat chloride between 30 and 59 mmol/L. These were monitored for conversion to a CF diagnosis, pulmonary, and nutritional outcomes. RESULTS The mean observation period was 7.7 (95% confidence interval 7.1 to 8.4) years. A CF diagnosis was established for 24 of the 115 children with CFSPID (21%) either because of reinterpretation of the cystic fibrosis transmembrane conductance regulator genotype or because of increase in sweat chloride concentration ≥60 mmol/L. An initial sweat chloride of ≥40 mmol/l predicted conversion to CF on the basis of sweat testing. The 91 remaining children with CFSPID were pancreatic sufficient and showed normal growth until school age. Pulmonary function as well as lung clearance index in a subgroup of children with CFSPID were similar to that of healthy controls. CONCLUSIONS Children with CFSPID have good nutritional and pulmonary outcomes at school age, but rates of reclassifying the diagnosis are high. The initial sweat chloride test can be used as a biomarker to predict the risk for CF in CFSPID.
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Affiliation(s)
- Tanja Gonska
- Divisions of Gastroenterology, Hepatology.,Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Katherine Keenan
- Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jacky Au
- Respiratory Medicine, Department of Pediatrics
| | - Annie Dupuis
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mark A Chilvers
- Division of Respiratory Medicine, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Caroline Burgess
- Division of Respiratory Medicine, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Candice Bjornson
- Section of Respiratory Medicine, Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Lori Fairservice
- Section of Respiratory Medicine, Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Janna Brusky
- Department of Pediatric, Jim Pattison Children's Hospital, Saskatoon, Saskatchewan, Canada
| | - Tamizan Kherani
- Division of Respiratory Medicine, Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Amanda Jober
- Division of Respiratory Medicine, Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Lorna Kosteniuk
- Department of Pediatric, Jim Pattison Children's Hospital, Saskatoon, Saskatchewan, Canada
| | - April Price
- Division of Respiratory Medicine, Department of Pediatrics, London Health Sciences Centre, London, Ontario, Canada
| | - Jennifer Itterman
- Division of Respiratory Medicine, Department of Pediatrics, London Health Sciences Centre, London, Ontario, Canada
| | - Lenna Morgan
- Department of Pediatrics, Windsor Regional Hospital, Windsor, Ontario, Canada
| | - Dimas Mateos-Corral
- Division of Respiratory Medicine, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Daniel Hughes
- Division of Respiratory Medicine, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christine Donnelly
- Division of Respiratory Medicine, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mary Jane Smith
- Department of Paediatrics, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Shaikh Iqbal
- Department of Pediatrics, Children's Hospital of Winnipeg, Winnipeg, Manitoba, Canada
| | - Jocelyn Arpin
- Department of Pediatrics, Children's Hospital of Winnipeg, Winnipeg, Manitoba, Canada
| | - Joe Reisman
- Division of Respiratory Medicine, Department of Pediatrics, Children Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Joanne Hammel
- Division of Respiratory Medicine, Department of Pediatrics, Children Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Michael Derynck
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
| | - Natalie Henderson
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
| | | | - Felix Ratjen
- Respiratory Medicine, Department of Pediatrics.,Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
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Meikle CKS, Creeden JF, McCullumsmith C, Worth RG. SSRIs: Applications in inflammatory lung disease and implications for COVID-19. Neuropsychopharmacol Rep 2021; 41:325-335. [PMID: 34254465 PMCID: PMC8411309 DOI: 10.1002/npr2.12194] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/17/2021] [Accepted: 07/02/2021] [Indexed: 12/15/2022] Open
Abstract
Selective serotonin reuptake inhibitors (SSRIs) have anti-inflammatory properties that may have clinical utility in treating severe pulmonary manifestations of COVID-19. SSRIs exert anti-inflammatory effects at three mechanistic levels: (a) inhibition of proinflammatory transcription factor activity, including NF-κB and STAT3; (b) downregulation of lung tissue damage and proinflammatory cell recruitment via inhibition of cytokines, including IL-6, IL-8, TNF-α, and IL-1β; and (c) direct suppression inflammatory cells, including T cells, macrophages, and platelets. These pathways are implicated in the pathogenesis of COVID-19. In this review, we will compare the pathogenesis of lung inflammation in pulmonary diseases including COVID-19, ARDS, and chronic obstructive pulmonary disease (COPD), describe the anti-inflammatory properties of SSRIs, and discuss the applications of SSRIS in treating COVID-19-associated inflammatory lung disease.
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Affiliation(s)
- Claire Kyung Sun Meikle
- Department of Medical Microbiology and Immunology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Justin Fortune Creeden
- Department of Neurosciences, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.,Department of Psychiatry, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Cheryl McCullumsmith
- Department of Psychiatry, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Randall G Worth
- Department of Medical Microbiology and Immunology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
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Chen P, Huang Z, Chen L, Zhuang S, Lin H, Xie J, Zheng K. The relationships between LncRNA NNT-AS1, CRP, PCT and their interactions and the refractory mycoplasma pneumoniae pneumonia in children. Sci Rep 2021; 11:2059. [PMID: 33479472 PMCID: PMC7820231 DOI: 10.1038/s41598-021-81853-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/11/2021] [Indexed: 11/17/2022] Open
Abstract
To investigate the relationships between LncRNA NNT-AS1, CRP, PCT and their interactions and the refractory mycoplasma pneumoniae pneumonia (RMPP) in children. Serum levels of LncRNA NNT-AS1 of RMPP and non-RMPP (NRMPP) patients were detected by real-time PCR, and were analyzed together with serum c-reactive protein (CRP) and procalcitonin (PCT). Correlations between LncRNA NNT-AS1 and CRP and PCT were analyzed by Pearson correlation test. The ROC curve was used to analyze the potential of LncRNA NNT-AS1, CRP and PCT as biomarkers for predicting RMPP. Logistic regression crossover model and the Excel compiled by Andersson et al. were used to analyze the interactions among the biomarkers. We found that LncRNA NNT-AS1, CRP and PCT were all highly expressed in patients with RMPP. LncRNA NNT-AS1 could positively correlate with the expressions of CRP and PCT, and jointly promote the occurrence of RMPP. The combined diagnosis of LncRNA NNT-AS1, CRP and PCT could predict the occurrence of RMPP.
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Affiliation(s)
- Ping Chen
- Fujian Children's Hospital, Fujian, China. .,Fujian Maternity and Child Health Hospital, Fujian, China.
| | - Zheng Huang
- Fujian Center for Disease Control and Prevention, Fujian, China
| | - Lumin Chen
- Fujian Maternity and Child Health Hospital, Fujian, China.
| | - Shihao Zhuang
- Fujian Children's Hospital, Fujian, China.,Fujian Maternity and Child Health Hospital, Fujian, China
| | - Hongli Lin
- Fujian Maternity and Child Health Hospital, Fujian, China
| | - Jianfeng Xie
- Fujian Center for Disease Control and Prevention, Fujian, China
| | - Kuicheng Zheng
- Fujian Center for Disease Control and Prevention, Fujian, China
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Vasconcellos ÂG, Clarêncio J, Andrade D, Cardoso MRA, Barral A, Nascimento-Carvalho CM. Systemic cytokines and chemokines on admission of children hospitalized with community-acquired pneumonia. Cytokine 2017; 107:1-8. [PMID: 29158121 DOI: 10.1016/j.cyto.2017.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/03/2017] [Accepted: 11/07/2017] [Indexed: 11/29/2022]
Abstract
Community-acquired pneumonia (CAP) is the main cause of death in children under-5 years worldwide and Streptococcus pneumoniae is the most common bacterial agent. However, it is difficult to identify pneumococcal infection among children with CAP. We aimed to assess association between any cytokine/chemokine and pneumococcal infection in childhood CAP. Furthermore, we evaluated the diagnostic value of cytokine/chemokine for pneumococcal infection. This prospective study was conducted at an Emergency Room, in Salvador, Brazil. Children <5-years-old hospitalized with CAP in a 21-month period were evaluated. On admission, clinical and radiological data were collected along with biological samples to investigate 20 etiological agents and determine serum cytokines (interleukin (IL)-8, IL-6, IL-10, IL-1β, IL-12, TNF-α, IL-2, IL-4, IL-5, γ-interferon), and chemokines (CCL2, CCL5, CXCL9, CXCL10) concentration. From 166 patients with etiology detected, pneumococcal infection was detected in 38 (22.9%) cases among which the median IL-6(pg/ml) was 31.2 (IQR: 12.4-54.1). The other 128 cases had other causative agents detected (Haemophilus influenzae, Moraxella catarrhalis, atypical bacteria and viruses) with the median IL-6 concentration being 9.0 (IQR: 4.1-22.0; p < 0.001). The area under the ROC curve for IL-6 to predict pneumococcal CAP was 0.74 (95%CI: 0.65-0.83; p < 0.001). By multivariate analysis, with pneumococcal CAP as dependent variable, IL-6 was an independent predictor for pneumococcal infection (OR = 5.56; 95%CI: 2.42-12.75, cut-off point = 12.5 pg/ml; p = 0.0001). The negative predictive value of IL-6 under 12.5 pg/ml for pneumococcal infection was 90% (95%CI: 82-95%). Independently significant difference was not found for any other cytokines/chemokines. Serum IL-6 concentration on admission is independently associated with pneumococcal infection among children under-5 years hospitalized with CAP.
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Affiliation(s)
- Ângela G Vasconcellos
- Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Brazil.
| | - Jorge Clarêncio
- Centro de Pesquisa Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.
| | - Daniela Andrade
- Centro de Pesquisa Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.
| | | | - Aldina Barral
- Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Brazil; Centro de Pesquisa Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.
| | - Cristiana M Nascimento-Carvalho
- Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Brazil; Department of Pediatrics, Federal University of Bahia School of Medicine, Salvador, Brazil.
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Uwaezuoke SN, Ayuk AC. Prognostic scores and biomarkers for pediatric community-acquired pneumonia: how far have we come? PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2017; 8:9-18. [PMID: 29388605 PMCID: PMC5774590 DOI: 10.2147/phmt.s126001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article aimed to review the current prognostic and diagnostic tools used for community-acquired pneumonia (CAP) and highlight those potentially applicable in children with CAP. Several scoring systems have been developed to predict CAP mortality risk and serve as guides for admission into the intensive care unit. Over the years, clinicians have adopted these tools for improving site-of-care decisions because of high mortality rates in the extremes of age. The major scoring systems designed for geriatric patients include the Pneumonia Severity Index and the confusion, uremia, respiratory rate, blood pressure, age >65 years (CURB-65) rule, as well as better predictors of intensive care unit admission, such as the systolic blood pressure, multilobar chest radiography involvement, albumin level, respiratory rate, tachycardia, confusion, oxygenation and arterial pH (SMART-COP) score, the Infectious Diseases Society of America/American Thoracic Society guidelines, the criteria developed by España et al as well as the systolic blood pressure, oxygenation, age and respiratory rate (SOAR) criteria. Only the modified predisposition, insult, response and organ dysfunction (PIRO) score has so far been applied to children with CAP. Because none of the tools is without its limitations, there has been a paradigm shift to incorporate biomarkers because they are reliable diagnostic tools and good predictors of disease severity and outcome, irrespective of age group. Despite the initial preponderance of reports on their utility in geriatric CAP, much progress has now been made in demonstrating their usefulness in pediatric CAP.
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Affiliation(s)
| | - Adaeze C Ayuk
- Pediatric Pulmonology Firm, Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
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Assessment of Cytokine and Chemokine Signatures as Potential Biomarkers of Childhood Community-acquired Pneumonia Severity: A Nested Cohort Study in India. Pediatr Infect Dis J 2017; 36:102-108. [PMID: 27956727 DOI: 10.1097/inf.0000000000001364] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Pediatric community-acquired pneumonia (CAP) is a leading cause of childhood mortality in developing countries. In resource-poor settings, pneumonia diagnosis is commonly made clinically, based on World Health Organization guidelines, where breathing difficulty or cough and age-adjusted tachypnea suffice to establish diagnosis. Also, the severity of CAP is generally based on clinical features and existing biomarkers do not reliably correlate to either clinical severity or outcome. Here, we asked whether systemic immune and inflammatory mediators could act as biomarkers predicting CAP severity or outcome. METHODS Serum from a subset of a CAP cohort (n = 196), enrolled in India, classified according to World Health Organization criteria as having pneumonia or severe pneumonia, was used for simultaneous measurement of 21 systemic cytokines and chemokines. RESULTS We found significantly higher IL-6, IL-8, IL-13, IFN-γ and lower CCL22 concentrations in patients with severe compared with mild CAP (P values: 0.019, 0.036, 0.006, 0.016 and 0.003, respectively). Based on higher MIP-1α, IL-8, IL-17 or lower CCL22 response pattern at the time of enrolment, children with fatal outcome showed markedly different pattern of inflammatory response compared with children classified with the same disease severity, but with nonfatal outcome (P values: 0.043, 0.017, 0.008 and 0.020, respectively). CONCLUSIONS Our results suggest a relation between an elevated mixed cytokine response and CAP severity on one hand, and a bias toward uncontrolled neutrophilic inflammation in subjects with fatal outcome on the other. Collectively our findings contribute to increased knowledge on new biomarkers that can potentially predict severity and outcome of childhood CAP in the future.
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Abstract
Chronic obstructive pulmonary disease (COPD) is one of the main causes of human mortalities globally after heart disease and stroke. There is increasing evidence of an aetiological association between COPD and pneumonia, the leading infectious cause of death globally in children under 5 years. In this review, we discuss the known risk factors of COPD that are also shared with pneumonia including smoking, air pollution, age and immune suppression. We review how lung pathology linked to a previous history of pneumonia may heighten susceptibility to the development of COPD in later life. Furthermore, we examine how specific aspects of COPD immunology could contribute to the manifestation of pneumonia. Based on the available evidence, a convergent relationship is becoming apparent with respect to the pathogenesis of COPD and pneumonia. This has implications for the management of both diseases, and the development of new interventions.
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Affiliation(s)
- Sanjay S Gautam
- a Breathe Well Centre, School of Medicine, University of Tasmania , Hobart , Australia
| | - Ronan F O'Toole
- a Breathe Well Centre, School of Medicine, University of Tasmania , Hobart , Australia
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Guo L, Liu F, Lu MP, Zheng Q, Chen ZM. Increased T cell activation in BALF from children with Mycoplasma pneumoniae pneumonia. Pediatr Pulmonol 2015; 50:814-9. [PMID: 25157471 DOI: 10.1002/ppul.23095] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 05/07/2014] [Accepted: 05/27/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND OBJECTIVE The mechanisms of Mycoplasma pneumoniae induced lung inflammation are not clearly understood yet. This study investigated whether activated T cells in the airway contributed to the pulmonary inflammation in patients with severe Mycoplasma pneumoniae pneumonia (MPP). METHODS BALF were collected in all 45 patients with MPP (MPP, n = 45), including mild (Mild, n = 20) and severe (Severe, n = 25) group. BALF in 20 of all 25 severe cases with MPP at the recovery stage (Rec-severe, n = 20) were collected again. The control group consisted of 20 patients with airway foreign body aspiration (Con., n = 20). CD3+ T cells, CD69+, HLA-DR+, CD25+ on CD3+ T cells in BALF were determined by flow cytometry. Levels of IL-6, IL-10 in BALF were determined by ELISA, and percentage of neutrophils was counted. RESULTS A significant increased percentage of neutrophils and levels of IL-6 and IL-10, decreased percentage of CD3+ T cells, increased expressions of CD69+, HLA-DR+ or CD25+ on CD3+ T cells were observed in children with MPP compared with the control group (P < 0.05 or 0.01). Compared to mild group, the percentage of neutrophils, CD3+ CD25+, IL-6, and IL-10 were increased in children with severe MPP (P < 0.01 or 0.05). Compared to acute stage, an increased percentage of CD3+ T cells, decreased percentage of neutrophils and IL-6 level, and expressions of CD3+ CD69+ or CD3+ CD25+ were observed at the recovery stage in children with severe MPP (P < 0.01 or 0.05). CONCLUSIONS Increased activation of T cell in BALF may play an important role in the inflammatory response of acute and severe MPP. IL-6 may predict the severity and prognosis and provide a better assessment for patient care. However, the underlying mechanism awaits further detailed investigations.
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Affiliation(s)
- Li Guo
- Department of Rheumatology Immunology & Allergy, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Fang Liu
- Department of Respiratory, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.,Taizhou Nursing School, 100 Chennan Huaxi Rd, Linhai, 317000, Zhejiang, China
| | - Mei-Ping Lu
- Department of Rheumatology Immunology & Allergy, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.,Department of Respiratory, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Qi Zheng
- Department of Rheumatology Immunology & Allergy, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Zhi-Min Chen
- Department of Respiratory, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
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Gilani Z, Kwong YD, Levine OS, Deloria-Knoll M, Scott JAG, O'Brien KL, Feikin DR. A literature review and survey of childhood pneumonia etiology studies: 2000-2010. Clin Infect Dis 2012; 54 Suppl 2:S102-8. [PMID: 22403223 PMCID: PMC3693495 DOI: 10.1093/cid/cir1053] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 12/20/2011] [Indexed: 01/20/2023] Open
Abstract
The Pneumonia Etiology Research for Child Health (PERCH) project is the largest multicountry etiology study of childhood pneumonia since the Board on Science and Technology in International Development studies of the 1980s. However, it is not the only recent or ongoing pneumonia etiology study, and even with seven sites, it cannot capture all epidemiologic settings in the developing world. Funding providers, researchers and policymakers rely on the best available evidence to strategically plan programs, new research directions and interventions. We aimed to describe the current landscape of recent pneumonia etiology studies in children under 5 years of age in the developed and developing world, as ascertained by a literature review of relevant studies with data since the year 2000 and a survey of researchers in the field of childhood pneumonia. We collected information on the study population, study design, case definitions, laboratory samples and methods and identified pathogens. A literature review identified 88 studies with child pneumonia etiology results. As of June 2010, our survey of researchers identified an additional 65 ongoing and recently completed child pneumonia etiology studies. This demonstrates the broad existing context into which the PERCH study must be placed. However, the landscape analysis also reveals a multiplicity of case definitions, levels of clinician involvement, facility types, specimen collection, and laboratory techniques. It reinforces the need for the standardization of methods and analyses for present and future pneumonia etiology studies in order to optimize their cumulative potential to accurately describe the microbial causes of childhood pneumonia.
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Affiliation(s)
- Zunera Gilani
- Department of Epidemiology, Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Macrolide and clindamycin resistance in Streptococcus milleri group isolates from the airways of cystic fibrosis patients. Antimicrob Agents Chemother 2010; 54:2823-9. [PMID: 20404127 DOI: 10.1128/aac.01845-09] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Organisms belonging to the Streptococcus milleri group (SMG) are known for their role in pyogenic infections but have recently been implicated as etiological agents of pulmonary exacerbation in adult patients with cystic fibrosis (CF). The prolonged exposure of CF patients to antibiotics prompted us to investigate the susceptibility profiles of 118 SMG isolates from the airways of CF patients to 12 antibiotics compared to 43 SMG isolates from patients with invasive infections. We found that approximately 60% of all isolates failed to grow using the standard medium for disc diffusion, Mueller-Hinton blood agar (MHBA), so we explored the usefulness of brain heart infusion (BHI) agar for susceptibility testing. Zone-of-inhibition comparisons between BHI and MHBA showed strong correlations for six antibiotics, and interpretations were similar for both medium types. For ceftriaxone and cefepime, both groups of isolates were highly susceptible. Tetracycline resistance levels were comparable between the two groups (22% in CF isolates and 17.4% in invasive isolates). However, more than half of the CF isolates were not susceptible to azithromycin, erythromycin, and clindamycin, compared to 11%, 13%, and 6.5% of invasive isolates, respectively. There were 5-fold and 8-fold increased risks of azithromycin and clindamycin resistance, respectively, for the isolates from the airways of CF patients relative to the invasive isolates. Macrolide resistance was strongly linked to chronic azithromycin therapy in CF patients. This study shows that BHI agar is a suitable alternative for antimicrobial susceptibility testing for the SMG and that SMG isolates from the airways of CF patients are more resistant to macrolides and clindamycin than strains isolated from patients with invasive infections.
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