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Background: Patients hospitalized in the intensive care unit (ICU) have a higher susceptibility to infections. Respiratory infections are the most common nosocomial infections. Rising antibiotic resistance due to indiscriminate use of antibiotics and poor adherence to standard precaution in healthcare facilities compounds the problem. The main aim of this study is to assess microbial patterns and antibiotic resistance from bronchoalveolar lavage specimens in severe pneumonia patients. Methods: This retrospective study was conducted in an Indonesian tertiary care hospital from January 2016-December 2020. Written and verbal informed consent was obtained prior to bronchoscopy procedures. Patients were enrolled if they had severe community-acquired pneumonia (CAP) according to American Thoracic Society (ATS)/Infectious Disease Society of America (IDSA) criteria, had high-risk hospital-acquired pneumonia (HAP), late-onset ventilator-associated pneumonia (VAP), or pneumonia caused by Coronavirus disease (COVID-19). Respiratory specimens via bronchoscopy were inoculated on general semi-sloid thioglycolate media. Testing for antibiotic susceptibility was done using the disk diffusion method. Results: Two hundred and one patients’ data were analyzed. The majority of patients were males (65,17%) and above 60 years of age. The most common type of pneumonia was CAP (39,3%). Neurologic/cerebrovascular disease was the most common comorbidity (35,32%). Acinetobacter baumannii was the most frequently isolated microorganism. Ampicillin/sulbactam and amikacin were found to yield lower microbial resistance. Conclusion: Combination of ampicillin/sulbactam and amikacin appeared effective as initial empirical therapy in severe pneumonia patients. Further studies are needed to evaluate the feasibility and effectiveness of this combined therapy.

Background: Understanding the bronchoalveolar-lavage fluid immunopathology biomarker interactions can help clinicians decipher the pathophysiology of severe pneumonia and get better management for early extubation.Objectives: The objectives were to assess bronchoalveolar lavage fluid biomarker interactions of severely affected lung and their association in determining the early extubation success.Methods: In this cross-sectional study, we consecutively evaluated 137 severe pneumonia patients. Patients who fulfilled inclusion criteria will undergo early bronchoscopy. The BALF was collected from the right and left lungs. Two Respirologist and Critical Illness consultants, plus one internist, determined the location for severely affected lung. Biomarker interactions in severely affected lung were analyzed. The primary outcome was the 19-days extubation.Results: Forty patients underwent bronchoscopy for BALF collection. The right lung was the predominant severely affected lung (28 patients). Eight patients survived and were successfully extubated within 19 days. There were significantly higher absolute CD4+ BALF cell counts (95% Confidence Interval = 9,24 – 49,50, p = 0,003) in the left lung and higher absolute CD4+ BALF cell counts (95% Confidence Interval = 9,00 – 29,75, p = 0,010) in the patients with extubation success and survived. Among all the patients with extubation success within 19 days, eight patients (100%) displayed the tendency of high CD4 levels (cutoff points median 16 cells/μL), low expression of alveolar macrophage function (cutoff points by ROC 756.5 MFI CD169), and low expression of IL-6 (cutoff points by ROC 369 pg/mg protein).Conclusion: In severely affected lung of severe pneumonia patients with early extubation success and survived, we found biomarker interactions marked by low alveolar macrophage function, low IL-6 levels, and high CD4 levels. Trial Registration: The study was registered at UMIN Clinical Trials Registry (UMIN-CTR) (registration number UMIN000046236), accessible at: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000049197

BackgroundUnderstanding the bronchoalveolar-lavage fluid immunopathology biomarker interactions can help clinicians decipher the pathophysiology of severe pneumonia and get better management for early extubation.ObjectivesThe objectives were to assess bronchoalveolar lavage fluid biomarker interactions of severely affected lung and their association in determining the early extubation success.MethodsIn this cross-sectional study, we consecutively evaluated 137 severe pneumonia patients. Patients who fulfilled inclusion criteria will undergo early bronchoscopy. The BALF was collected from the right and left lungs. Two Respirologist and Critical Illness consultants, plus one internist, determined the location for severely affected lung. Biomarker interactions in severely affected lung were analyzed. The primary outcome was the 19-days extubation.ResultsForty patients underwent bronchoscopy for BALF collection. The right lung was the predominant severely affected lung (28 patients). Eight patients survived and were successfully extubated within 19 days. There were significantly higher absolute CD4 + BALF cell counts (95% Confidence Interval = 9,24–49,50, p = 0,003) in the left lung and higher absolute CD4 + BALF cell counts (95% Confidence Interval = 9,00–29,75, p = 0,010) in the patients with extubation success and survived. Among all the patients with extubation success within 19 days, eight patients (100%) displayed the tendency of high CD4 levels (cutoff points median 16 cells/µL), low expression of alveolar macrophage function (cutoff points by ROC 756.5 MFI CD169), and low expression of IL-6 (cutoff points by ROC 369 pg/mg protein).ConclusionIn severely affected lung of severe pneumonia patients with early extubation success and survived, we found biomarker interactions marked by low alveolar macrophage function, low IL-6 levels, and high CD4 levels.Trial RegistrationThe study was registered at UMIN Clinical Trials Registry (UMIN-CTR) (registration number UMIN000046236), accessible at: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000049197