scholarly journals Lack of impact of selective digestive decontamination on Pseudomonas aeruginosa ventilator-associated pneumonia: benchmarking the evidence base

2011 ◽  
Vol 66 (6) ◽  
pp. 1365-1373 ◽  
Author(s):  
James C. Hurley
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Evidence Base ◽  
Selective Digestive Decontamination ◽  
Ventilator Associated Pneumonia

scholarly journals The Perfidious Effect of Topical Placebo: Calibration of Staphylococcus aureus Ventilator-Associated Pneumonia Incidence within Selective Digestive Decontamination Studies versus the Broader Evidence Base

2013 ◽  
Vol 57 (9) ◽  
pp. 4524-4531 ◽  
Author(s):  
James C. Hurley
Keyword(s):  
Staphylococcus Aureus ◽  
Observational Studies ◽  
Estimating Equation ◽  
Evidence Base ◽  
Selective Digestive Decontamination ◽  
Generalized Estimating Equation ◽  
Ventilator Associated Pneumonia ◽  
Control Groups ◽  
Content Type ◽  
The Mean

ABSTRACTAmong various methods for preventing ventilator-associated pneumonia (VAP), the evidence base for selective digestive decontamination (SDD) appears most compelling. However, the extent ofStaphylococcus aureusemergence with SDD use remains uncertain. Groups from 37 observational studies and component (control and intervention) groups from 58 studies of SDD and other methods of VAP prevention were sourced exclusively from 10 systematic reviews.S. aureusas a proportion of VAP isolates (S. aureusisolate proportion [S. aureusIP]) among component groups was calibrated versus that among observational groups (the benchmark). The influence of topical placebo used for blinding purposes and other group-level factors was estimated using generalized estimating equation methods (GEE). The meanS. aureusIP is 22% (95% confidence interval [CI], 19 to 25) for 37 observational groups versus 32% (24 to 41) and 20% (15 to 25) for 22 control groups from the SDD evidence base which did versus did not receive topical placebo, respectively. In GEE models including all 148 observational and component groups, membership of a control (P= 0.03) or intervention (P< 0.001) group of an SDD study that used topical placebo was associated with higherS. aureusIP, whereas, in contrast, membership of these groups was without effect onPseudomonas aeruginosa. Topical placebo is implicated as a vehicle for selective cross-infection withS. aureuswithin the specific context of the SDD evidence base. This effect of topical placebo is perfidious; it could contribute to the higher VAP incidence and inflate the apparent “effectiveness” of SDD. The SDD evidence base requires reappraisal.

scholarly journals Rapid genetic and phenotypic changes in Pseudomonas aeruginosa clinical strains during ventilator-associated pneumonia

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Elise Persyn ◽  
Mohamed Sassi ◽  
Marc Aubry ◽  
Martin Broly ◽  
Sandie Delanou ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Ventilator Associated Pneumonia ◽  
Clinical Strains ◽  
Phenotypic Changes

scholarly journals The rapid in vivo evolution of Pseudomonas aeruginosa in ventilator-associated pneumonia patients leads to attenuated virulence

Open Biology ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. 170029 ◽  
Author(s):  
Ke Wang ◽  
Yi-qiang Chen ◽  
May M. Salido ◽  
Gurjeet S. Kohli ◽  
Jin-liang Kong ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Opportunistic Pathogen ◽  
Ventilator Associated Pneumonia ◽  
Loss Of Function ◽  
Short Term ◽  
Airway Infections ◽  
Evolutionary Trajectories ◽  
Human Airways ◽  
Late Stages

Pseudomonas aeruginosa is an opportunistic pathogen that causes severe airway infections in humans. These infections are usually difficult to treat and associated with high mortality rates. While colonizing the human airways, P. aeruginosa could accumulate genetic mutations that often lead to its better adaptability to the host environment. Understanding these evolutionary traits may provide important clues for the development of effective therapies to treat P. aeruginosa infections. In this study, 25 P. aeruginosa isolates were longitudinally sampled from the airways of four ventilator-associated pneumonia (VAP) patients. Pacbio and Illumina sequencing were used to analyse the in vivo evolutionary trajectories of these isolates. Our analysis showed that positive selection dominantly shaped P. aeruginosa genomes during VAP infections and led to three convergent evolution events, including loss-of-function mutations of lasR and mpl , and a pyoverdine-deficient phenotype. Specifically, lasR encodes one of the major transcriptional regulators in quorum sensing, whereas mpl encodes an enzyme responsible for recycling cell wall peptidoglycan. We also found that P. aeruginosa isolated at late stages of VAP infections produce less elastase and are less virulent in vivo than their earlier isolated counterparts, suggesting the short-term in vivo evolution of P. aeruginosa leads to attenuated virulence.

scholarly journals MODERN APPROACHES TO TREATMENT OF PSEUDOMONAS AERUGINOSA VENTILATOR-ASSOCIATED PNEUMONIA (LITERATURE REVIEW)

2019 ◽  
Vol 72 (5) ◽  
pp. 892-896
Author(s):  
Olha A. Poda ◽  
Tetyana O. Kryuchko ◽  
Inna N. Nesina ◽  
Olha Ya. Tkachenko ◽  
Nataliia V. Kuzmenko
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Causative Agent ◽  
Optimal Dose ◽  
Correct Choice ◽  
Antibacterial Drug ◽  
Controversial Issues ◽  
Ventilator Associated Pneumonia ◽  
Scientific Investigations ◽  
Multiresistant Strains ◽  
Hospital Acquired

Introduction: Nowadays anti-microbial therapy of ventilator-associated pneumonia caused by is one of the most topical issue as a consequence of widespread multiresistant strains of causative agent and their biological peculiarity of actively formation of resistance to new antibacterial drugs. The aim is to describe modern approaches to therapy of ventilator-associated pneumonia causative agent of which is presented by Pseudomonas aureginosa . Materials and methods: An analysis and summing up of results of scientific investigations described in medical publications concerning the issues of therapy of ventilatorassociated pneumonia caused by Pseudomonas aureginosa was done. Conclusions: Despite the development of modern approaches to anti-microbial therapy of ventilator-associated pneumonia caused by Pseudomonas aeruginosa, which are also concerned with such controversial issues as correct choice of antibacterial drug, its optimal dose, and duration of this therapy, the problem of treatment of hospital-acquired infections of respiratory airways caused by Pseudomonas aeruginosa has been discussable yet and requires the further study.

scholarly journals Association of Increased Circulating Acetic Acid With Poor Survival in Pseudomonas aeruginosa Ventilator-Associated Pneumonia Patients

2021 ◽  
Vol 11 ◽  
Author(s):  
Xiaoling Qi ◽  
Li Zhang ◽  
Jing Xu ◽  
Zheying Tao ◽  
Xiaoli Wang ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Acetic Acid ◽  
Short Chain Fatty Acids ◽  
Mass Spectrometry Analysis ◽  
Gas Chromatography Mass Spectrometry ◽  
Ventilator Associated Pneumonia ◽  
Fermentation Products ◽  
Spectrometry Analysis ◽  
Beneficial Effects ◽  
Microbial Dysbiosis

BackgroundWe previously found that microbial disruption in Pseudomonas aeruginosa ventilator-associated pneumonia (PA-VAP) patients are long-lasting. Long-term microbial dysbiosis may lead to changes in metabolites. Short-chain fatty acids (SCFAs) are microbial fermentation products and show beneficial effects in patients with pneumonia. In this study, we aimed to explore the association between circulating SCFA levels and clinical outcomes in patients with PA-VAP.MethodsIn this study, we analyzed SCFAs in the serum of 49 patients with PA-VAP by gas chromatography-mass spectrometry analysis. Twenty of these patients died, and 29 survived. The correlation between serum SCFAs and patient survival and immune parameters was analyzed.ResultsWe developed a partial least squares discriminant analysis (PLS-DA) model to examine differential SCFAs in 49 patients with PA-VAP. Among the seven SCFAs, only acetic acid was increased in non-survivors (P = 0.031, VIP &gt; 1). Furthermore, high levels of acetic acid (&gt;1.96ug/ml) showed increased 90-day mortality compared to low levels of acetic acid (&lt;1.96ug/ml) in Kaplan-Meier survival analyses (P = 0.027). Increased acetic acid also correlated with reduced circulating lymphocyte and monocyte counts.ConclusionOur study showed that increased circulating acetic acid is associated with 90-day mortality in PA-VAP patients. The decrease in lymphocytes and monocytes might be affected by acetic acid and involved in the poor prognosis.

scholarly journals Pseudomonas aeruginosa ventilator associated pneumonia: improved outcomes with earlier follow-up

Health ◽  
2010 ◽  
Vol 02 (02) ◽  
pp. 82-89
Author(s):  
Elpis Giantsou ◽  
Nikolaos Liratzopoulos ◽  
Eleni Efraimidou ◽  
Konstantinos I. Manolas ◽  
J. Duncan Young
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Ventilator Associated Pneumonia ◽  
Improved Outcomes

Antimicrobial-resistant Pseudomonas aeruginosa and Acinetobacter baumannii From Patients With Hospital-acquired or Ventilator-associated Pneumonia in Vietnam

2016 ◽  
Vol 38 (9) ◽  
pp. 2098-2105 ◽  
Author(s):  
Douglas J. Biedenbach ◽  
Phan Trong Giao ◽  
Pham Hung Van ◽  
Nguyen Su Minh Tuyet ◽  
Tran Thi Thanh Nga ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Acinetobacter Baumannii ◽  
Ventilator Associated Pneumonia ◽  
Hospital Acquired

Anti-virulence Bispecific Monoclonal Antibody Mediated Protection Against Pseudomonas aeruginosa Ventilator-Associated Pneumonia in a Rabbit Model

2021 ◽  
Author(s):  
Fábio Aguiar-Alves ◽  
Hoan N. Le ◽  
Vuvi G. Tran ◽  
Emmanuelle Gras ◽  
Trang Vu ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Rabbit Model ◽  
Arterial Oxygen ◽  
Rank Test ◽  
Ventilator Associated Pneumonia ◽  
Exact Test ◽  
Cytokines And Chemokines ◽  
Potential Clinical Utility ◽  
Human Igg1 ◽  
Type 3

Ventilator-associated pneumonia is an important clinical manifestation of the nosocomial pathogen Pseudomonas aeruginosa . We characterized the correlates of protection of MEDI3902, a bispecific human IgG1 mAb that targets the P. aeruginosa type-3-secretion PcrV protein and the Psl exopolysaccharide, in a rabbit model of ventilator-associated pneumonia using lung-protective, low-tidal volume mechanical ventilation. Rabbits infused with MEDI3902 prophylactically were protected, whereas those pretreated with irrelevant isotype-control IgG (c-IgG) succumbed between 12 and 44 hours post infection [100% (8/8) vs. 0% (8/8) survival, P <0.01 by log-rank test]. Lungs from rabbits pretreated with c-IgG, but not those with MEDI3902, had bilateral, multifocal areas of marked necrosis, hemorrhage, neutrophilic inflammatory infiltrate, diffuse fibrinous edema in alveolar spaces. All rabbits pretreated with c-IgG developed worsening bacteremia that peaked at the time of death, whereas only 38% (3/8) rabbits pretreated with MEDI3902 developed such high-grade bacteremia (two-sided Fisher’s exact test, P =0.026). Biomarkers associated with acute respiratory distress syndrome were evaluated longitudinally in blood samples collected every 2-4 hours to assess systemic pathophysiological changes in rabbits pretreated with MEDI3902 or c-IgG. Biomarkers were sharply increased or decreased in rabbits pretreated with c-IgG, but not those pretreated with MEDI3902, including ratio of arterial oxygen partial pressure to fractional inspired oxygen PaO 2 /FiO 2 <300, hypercapnia or hypocapnia, severe lactic acidosis, leukopenia and neutropenia. Cytokines and chemokines associated with ARDS were significantly downregulated in lungs from rabbits pretreated with MEDI3902 compared with c-IgG. These results suggest that MEDI3902 prophylaxis could have potential clinical utility for decreasing severity of P. aeruginosa ventilator-associated pneumonia.

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