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PubMed1989

Prognostic factors for lower respiratory tract infections after brain-tumor surgery.

Nosocomial infection of the lower respiratory tract is a frequent and serious complication after major operations. A 32% incidence of lower respiratory tract infections was found after brain-tumor surgery in 289 patients, with a 21% incidence of pneumonia. In 186 of these patients (Group A), five factors were identified which were associated with an increased risk of postoperative lower respiratory tract infection. These were: age, tumor type, cardiac insufficiency, preoperative disturbances of consciousness, and preoperative corticosteroid treatment. Based on these factors, a risk score was developed which correlated well with the incidence of infection in this group of patients. In a second group of patients (Group B), the derived risk score was applied and was found to possess a high degree of validity. As long as patients were intubated postoperatively, their freedom from infection decreased exponentially, with a half-life of 3.5 days.

Brain Neoplasms↗
PubMed1985

[Clinical study of aztreonam on respiratory tract infections caused by gram-negative pathogens].

Aztreonam (E-0734, AZT) was administered to pneumonia and chronic respiratory tract infections. The results were as follows: AZT was administered to 29 patients. Twenty-six cases were evaluable and 3 cases were excluded from evaluation of efficacy because 1 was Gram-positive infection, 2 were unclear symptom of infection. Pneumonia was 4 cases. Chronic respiratory tract infections were 22 cases. Clinical efficacy was judged as follows; excellent in 7 cases, good in 10 cases, fair in 5 cases and poor in 4 cases, then the efficacy rate was 65.4%. Efficacy rate in pneumonia, acute aggravation of diffuse panbronchiolitis and bronchiectasis with infection was 50%, 67% and 83%, respectively. Bacteriological response was judged on 21 cases with eradication rate was 66.7%. Bacteriological response classified by pathogen was as follows: All 6 isolates of H. influenzae, 2 in 6 isolates of P. aeruginosa, 4 in 5 isolates of H. parainfluenzae and all 3 isolates of K. pneumoniae were cleared. Total eradicated rate was 74.1%. Eruption was observed in 1 case as side effect. Abnormal laboratory findings were observed in 4 cases. Elevation of GOT and GPT was in 3 cases. Increase of eosinophil and basophil was in 1 case. AZT was considered to be a useful antibiotic for the treatment of respiratory tract infections, especially chronic respiratory tract infections, caused by Gram-negative pathogens.

Adult↗
PubMed2002

Clinical efficacy of cefpodoxime in respiratory tract infection.

Acute otitis media (AOM), sinusitis and tonsillopharyngitis are respiratory tract infections frequently encountered by primary-care physicians. Increasing bacterial resistance, particularly in Streptococcus pneumoniae, which is one of the most important respiratory tract bacteria implicated in community-acquired respiratory tract infections, has led to concern about the current options for empirical antibiotic treatment and has prompted a search for effective alternative treatments. Data from in vitro studies show that cefpodoxime has good activity against the main respiratory tract pathogens, S. pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pyogenes. Clinical studies confirm the efficacy of cefpodoxime in AOM, sinusitis and tonsillopharyngitis. As with all broad-spectrum antibiotics, there is the risk of promotion of bacterial resistance associated with overuse. However, if used with care, cefpodoxime can be considered as an alternative for empirical treatment of bacterial respiratory tract infections encountered in general practice, particularly where penicillins and macrolides have reduced efficacy against the main bacterial pathogens.

Adult↗
PubMed1986

[Treatment of respiratory tract infections with imipenem/cilastatin in critical patients with respiratory insufficiency].

In an open prospective study the efficacy and tolerance of imipenem/cilastatin was investigated in 24 critically ill patients on mechanical ventilation with nosocomial respiratory tract infection. Nine patients had previously received antibiotic therapy, eight of them with various other beta-lactam antibiotics which had failed. Imipenem was given in a dose of 1-3 g/24 h over 5-37 (mean 11) days. Seven patients were additionally treated with aminoglycosides, one patient with erythromycin. Pseudomonas aeruginosa (n = 14), Staphylococcus aureus (n = 4), Haemophilus influenzae (n = 4) and Escherichia coli (n = 3) were the potential pathogens most frequently isolated from tracheo-bronchial secretions. All of the isolates were susceptible to imipenem. 91% of the infections without and 77% with involvement of P. aeruginosa were successfully treated. Two patients who had not responded to previous treatment succumbed to the consequences of progressive respiratory distress syndrome. All of the gram-positive and 85% of the gram-negative pathogens (Pseudomonas not included) were eliminated in the course of therapy. By contrast, 64% of the isolates of P. aeruginosa persisted; half of these became imipenem-resistant. Nine patients showed adverse reactions including one case of pseudomembranous colitis or laboratory abnormalities which were all reversible. Imipenem/cilastatin proved highly effective and was relatively well tolerated; it is suitable as a single agent for the initial treatment of nosocomial respiratory tract infections in ventilated patients, although only with limitations in cases of infection due to P. aeruginosa.

Adolescent↗
PubMed2004

Communicating about expected course and re-consultation for respiratory tract infections in children: an exploratory study.

Acute respiratory tract infection is the commonest reason for children consulting, and about one-fifth re-consult for the same illness episode. Fifty-nine audiotape recordings from nine general practitioners (GPs) consulting with children with acute respiratory tract infections were examined. Prognosis was mentioned in only 22 consultations, with GPs predicting a brief course in 11, a possibly longer than expected course in six, and with predicted duration not made explicit in five. Carers were invited to re-consult if they were 'unhappy' with the child's condition in 11 consultations, and specific triggers to re-consult were provided in 15. A patient information leaflet was given out only once. Providing carers with an evidence-based account of the likely clinical course and communicating specific triggers to re-consult may help them manage more of these illness episodes without re-consulting.

Acute Disease↗
PubMed1995

Viral etiology and epidemiology of acute lower respiratory tract infections in Korean children.

Viral etiologic agents of acute lower respiratory tract infections were studied from November, 1990, through April, 1994, in Korean children. From 712 children who visited or were admitted to Seoul National University Children's Hospital because of acute lower respiratory tract infections, 804 nasal aspirates were collected; viral agents were detected by virus isolation and virus antigen was detected by indirect immunofluorescent staining. One or more viral agents were identified in 369 (45.9%) cases; of which 3.3% were mixed infections. The pathogens identified were respiratory syncytial virus (27.2%), parainfluenza virus type 3 (7.8%), influenza A virus (3.9%), adenovirus (3.9%), parainfluenza virus type 1 (1.7%), influenza B virus (1.4%), parainfluenza virus type 2 (0.5%), measles virus (0.1%) and others (0.9%). The clinical patterns of viral lower respiratory tract included pneumonia (56.6%), bronchiolitis (35.2%), croup (6.5%) and tracheo-bronchitis (1.6%). Infections with respiratory syncytial virus, parainfluenza virus types 1 and 3 and influenza A and B virus occurred in epidemics, whereas adenovirus was isolated sporadically throughout the study period. The data expand our understanding of the epidemiology of acute viral lower respiratory tract infections in Korean children and may be helpful to the clinicians and researchers interested in the control of viral respiratory tract infections.

Acute Disease↗
PubMed1988

Mycoplasma pneumoniae and other pathogens in the aetiology of lower respiratory tract infections among Japanese children.

The causes of lower respiratory tract infections in 1544 children attending a Japanese hospital over a period of 7 years were investigated. Both cultivation and two serological techniques were used to detect Mycoplasma pneumoniae whereas viral involvement was investigated only by serology. Pathogens were identified in 52% of 1175 patients with pneumonia and 36% of 369 patients without pneumonia. Mycoplasma pneumoniae infection was specifically diagnosed in 414 (26.8%) of the 1544 patients. Respiratory syncytial virus (RSV) was dominant in children up to 2 years of age. By the age of 3 years, M. pneumoniae was equalling it in incidence and became the main pathogen in older groups. It is suggested that M. pneumoniae may be more important in the 3-6 years age group than hitherto suspected. These observations may influence the choice of antibiotics for treating lower respiratory tract infections in childhood.

Adenovirus Infections, Human↗
PubMed1999

Respiratory tract infections due to direct and reflux aspiration in children with severe neurodisability.

Lower respiratory tract infections in children with severe neurodisability are usually caused by aspiration of stomach contents from gastroesophageal reflux (GOR) or direct aspiration (DA) of food due to oral and pharyngeal motor problems. To determine the contributions and interactions of GOR and DA, oesophageal 24-hour pH monitoring and feeding videofluoroscopy were performed in 34 children (age range 7 months to 16 years, mean 7 years) who had severe physical and learning disabilities and who were slow feeders. Subjects were divided into three groups according to the frequency of their respiratory tract infections. Subjects in group 1 had no respiratory tract infections (N=10); five had GOR and none had DA. Subjects in group 2 had minor respiratory tract infections but had not received more than one course of antibiotics for this in the previous year (N=8); two had GOR alone, four had DA alone, and two had neither. All subjects in group 3 had recurrent respiratory tract infections (N=16); one had GOR alone, seven had DA alone, and eight had both GOR and DA. This study suggests that oral and pharyngeal motor problems are the major cause of respiratory tract infection in children with severe neurodisability. These problems lead to DA and, if GOR is present, to the aspiration of stomach contents. Those children with both DA and GOR are more likely to have severe respiratory tract infections which may lead to gastrostomy feeding (together with fundoplication). GOR without sufficient oral and pharyngeal motor problems to cause DA is less likely to cause respiratory tract infection in children with severe neurodisability.

Adolescent↗
PubMed2006

[Role of rhinovirus in respiratory tract infections in hospitalized children].

BACKGROUND: Rhinovirus is a recognized cause of common cold and has been shown to cause asthma exacerbations in adults and children. The burden of rhinovirus infections in hospitalized children has not been described in Spain. OBJECTIVE: To describe confirmed rhinovirus infections in children hospitalized for respiratory tract infection in a secondary public hospital. PATIENTS AND METHODS: We performed a prospective descriptive study in children admitted to hospital with fever or respiratory tract infection and with a positive isolation of rhinovirus in nasopharyngeal washings between September 2004 and July 2005. Virological diagnosis was made with direct immunofluorescent assay and/or reverse transcription-polymerase chain reaction in specimens obtained from nasopharyngeal washings. The clinical characteristics of the patients were analyzed. RESULTS: There were 76 children with rhinovirus infection, representing 25 % of admissions in 304 children with fever or respiratory tract infection. Rhinovirus was the second most frequent viral agent identified after respiratory syncytial virus (RSV) (29.9 % of admissions). Fifty-four children (71.1 %) were under 2 years of age. The most frequent clinical diagnoses were recurrent wheezing in 60.5 %, bronchiolitis in 23.7 %, pneumonia in 7.9 %, and upper respiratory tract infection in 5.3 %. Fever > 38 degrees C was present in 57.9 % of the patients and radiologic infiltrate was found in 23.7 %. Oxygen saturation less than 95 % was found in 43.4 % of the patients. Of 22 children aged more than 2 years, a diagnosis of asthmatic crisis was made in 21. CONCLUSIONS: Rhinoviruses were frequently identified in hospitalized children with respiratory tract disease and were the second most common viruses after RSV. In our series, it was the most frequent cause of recurrent wheezing in hospitalized children and the second most common cause in infants.

Adolescent↗
PubMedDate not supplied

[Results of ciprofloxacin therapy in urinary and respiratory tract infections].

Ciprofloxacin was administered to 218 patients with various urinary and respiratory tracts infections, including 142 patients with urinary tract infections and 76 patients with respiratory tract infections. Bacteriological tests and routine laboratory tests were performed thrice (before, during and after therapy) in all patients. Ciprofloxacin was administered orally in daily dose of 500 mg for 10 days. Daily dose was increased to 1000 mg in 23 patients with severe respiratory tract infections. Satisfactory results (recovery or regression of the symptoms of exacerbated chronic disease) were achieved in 185 patients (84.9%) and no effect in 10 patients (4.6%). Significant improvement or transient improvement were noted in 23 patients (10.5%).

Adult↗
PubMed1983

Ceftazidime in the treatment of lower respiratory tract infection.

Forty patients with acute lower respiratory tract infection requiring hospital admission were treated with ceftazidime. One patient developed acute dyspnoea after the first dose of the drug which was considered to be drug related and treatment was discontinued. All remaining patients were clinically assessed as being either cured or improved. In all cases that were bacteriologically assessable the pathogens were eradicated. One patient developed erythema multiforme after the end of ceftazidime treatment; this was considered to be possibly drug related.

Adolescent↗
PubMed2002

Resistant pathogens in respiratory tract infections in older people.

Bronchitis, bronchiectasis, and pneumonia are the most common respiratory tract infections observed in older people and are the leading causes of morbidity and mortality associated with infection. Accurate diagnosis of respiratory tract infections in older people is problematic because of the lack of clear symptoms and signs that are usually seen in younger patients. In addition, the increasing prevalence of bacterial resistance to antibiotic therapy highlights the importance of appropriate therapy. The following review examines the issues associated with the accurate diagnosis of respiratory tract infections, optimal therapy for older patients, and the mechanisms of emerging bacterial resistance to antibiotic therapy.

Aged↗
PubMedDate not supplied

Epidemiology of acute respiratory tract infections among young children in Kenya.

The epidemiology of acute respiratory tract infection (ARI) was investigated in a rural community 80 km north of Nairobi, Kenya. This research was conducted prospectively on 250 families with 470 children less than 5 years of age who were contacted every 8 days during the 3-year study. The yearly incidence of respiratory tract infections decreased from 5.2 to 3.4 during the study; less than 5% of these infections involved the lower respiratory tract. The incidence was inversely related to age, and the illnesses were generally mild and brief in length. Fifteen children died during the study period. The precise causes of death are unknown, but respiratory infections possibly played a role in most cases. This study emphasizes the importance of determining the risk factors responsible for unusually severe morbidity and high mortality in children with ARI in developing countries.

Acute Disease↗
PubMed1990

[Analysis of immunoglobulin G subclasses in chronic respiratory tract infections].

To analyze the immunological aspects of chronic respiratory tract infections, immunoglobulin G (IgG) subclass patterns were investigated in 20 patients with diffuse panbronchiolitis (DPB) and 20 patients with cystic bronchiectasis (CBE). All IgG subclasses were increased in both diseases in comparison to the normal group. Increased levels of IgG1 and IgG2 were recognized more dominantly in DPB, whereas IgG4 level was elevated in CBE. Furthermore, analysis of the ratio of IgG subclass to total IgG showed increase of IgG1 and decrease of IgG2 in both diseases, and increase of IgG4 only in CBE. On the other hand, the increase of IgG1 correlated with infection by P. aeruginosa while increase of IgG4 was recognized in the group of non-P. aeruginosa infections. These results indicate that increased IgG1 and IgG2 levels are common characteristic phenomena in chronic respiratory tract infections such as DPB and CBE, reflecting the pathophysiological aspects based on respiratory tract defense mechanisms against microorganisms, and demonstrated that differences of IgG subclass patterns are observed among DPB and CBE, and also according to causative agents.

Adult↗
PubMed1990

[IgG subclasses in healthy children and in children with frequent respiratory tract infections].

A group of 130 children presenting with frequent respiratory tract infections was examined for serum levels of IgG-subclasses IgG1, IgG2, IgG3 and IgG4 using radial immunodiffusion according to Mancini. Additionally a control group of 175 children not prone to infections was investigated. Both, low and high levels compared to controls were observed for IgG3 and IgG4. 11.5% of the children with frequent airway infections had IgG3 values below 2 SD below the mean for age compared to 2.8% in the control group (p less than 0.01). Likewise a low IgG4 level was observed more frequently in children prone to airway infections (9.8% versus 2.8% in control; p less than 0.05). IgG4 was undetectable (level less than 3.4 mg/dl) in 5 of the 175 control children. Despite an accumulation of low or undetectable IgG3 or IgG4 levels in children with frequent respiratory tract infections, no correlation between low IgG subclass-levels and the degree of the individual disease could be detected. Based on this lack of a simple causal relationship between frequent respiratory tract infections and the finding of low or undetectable IgG-subclass levels, an immunoglobulin replacement therapy has to be considered with reserve.

Adolescent↗
PubMed1987

Upper respiratory tract infections in children: antibiotic treatment.

Upper respiratory tract infections, particularly pharyngitis and acute otitis media (AOM) are the commonest diseases in children. Although viruses are the main causative agents, bacteria may play an important role. With regard to antibiotic therapy, clinicians must solve two problems: differentiation between viral and bacterial aetiology and choice of the optimal drug for each bacterial disease. In patients with pharyngitis the identification of group A haemolytic streptococci as the causative agent may be very difficult if only clinical and haematological data are considered. Throat culture is time consuming and difficult to perform in ambulatory practice; the recent techniques for rapid detection of streptococcal antigens are a possible answer to this problem. In bacterial pharyngitis a single injection of benzathine penicillin is considered to be first choice. However local pain and the significant increase of the relative risk of allergic problems in comparison with the decrease of incidence of rheumatic fever may shift therapeutic preference towards macrolides. The recently marketed ones, especially miocamycin, seem to offer easier administration, fewer side-effects and better efficacy. With regard to AOM, the differentiation between bacterial and viral disease is less important because over 70% of cases are of bacterial origin. Besides, an exact aetiological diagnosis is possible only by tympanocentesis, an invasive method. In Italy amoxicillin is still the drug of choice: a twice-daily regimen has been demonstrated to be as effective as the traditional thrice-daily schedule.

Anti-Bacterial Agents↗
PubMed1980

Seasonal pattern in childhood viral lower respiratory tract infections in Melbourne.

Respiratory syncytial virus and parainfluenza viruses are the major pathogens in acute lower respiratory infection in infants and younger children. They show distinct seasonal patterns. An annual epidemic of respiratory syncytial virus infection is seen in Melbourne and this coincides with the coldest months of the year. Parainfluenza virus Type 1, the most frequent cause of laryngotracheobronchitis, occurs as an autumn epidemic every second year. Parainfluenza virus Types 2 and 3 are present most years and do not show a clear seasonal pattern.

Acute Disease↗