Nebulized tobramycin: Prevention of pneumonias in patients with severe cerebral palsy

Plioplys, Audrius V.; Kasnicka, Irene

doi:10.3233/prm-2011-0168

Cited by 21 publications

(24 citation statements)

References 9 publications

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“…The clinical importance of our findings is supported by a small study indicating that the use of preventive aerolized antibiotics reduce the frequency of pneumonia in P. aeruginosa colonized patients with cerebral palsy, who—similar to patients with NMD—do not suffer from primary lung disease. The use of aerolized antibiotics to prevent ventilator associated pneumonia has been shown to reduce the risk for ventilator associated pneumonia without influencing the overall mortality .…”

Section: Discussionsupporting

confidence: 63%

“…Chronic retention of airway secretions might change the lung microbiome even in patients with NMD without primary lung disease. Case reports and small case series indicate that patients without primary lung disease but impaired clearance of airway secretions might suffer from colonization/infection with potential pathogenic bacteria like Pseudomonas aeruginosa and effective control of the colonization/infection might reduce pulmonary morbidity …”

Section: Introductionmentioning

confidence: 99%

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Upper airway microbial colonization in patients with neuromuscular disorders

et al. 2016

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Background and objective: Inherited neuromuscular disorders (NMD) inevitably result in severe lung volume restriction and cough insufficiency associated with high morbidity and mortality. The aim of this retrospective study was to evaluate whether the airways of patients with NMD are colonized with potential pathogenic microorganisms that might contribute to the pulmonary morbidity in NMD. Methods: In this cross-sectional study, cough swabs were obtained and cultured for microbiological analyses from 77 patients with NMD and different degrees of lung volume restriction and cough insufficiency. Upper airway microbial colonization was compared to lung function parameters and cough peak flow values. Results: Upper airway microbial colonization with potential pathogenic pathogens was identified in 39/77 (51%) of the subjects. Upper airway microbial colonization was associated with lower forced vital capacity (% pred.) 26.6 ± 19.7 versus 41.8 ± 20.4, P < 0.001 and cough peak flow (l/min) 125 ± 55 versus 207 ± 100, P < 0.001. In the subgroup colonized with potential pathogenic Gram-negative bacteria or Staphylococcus aureus forced vital capacity and cough peak flow remained significantly lower compared with subjects without upper airway colonization (FVC (% pred.): 22.6 ± 16.5 vs 37.9 ± 21.5, P = 0.003; CPF (l/min): 123 ± 60 vs 179 ± 93, P = 0.013). Conclusion: Severe respiratory compromise in patients with NMD is associated with upper airway microbial airway colonization, which might contribute to respiratory morbidity/insufficiency.

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Section: Discussionsupporting

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Upper airway microbial colonization in patients with neuromuscular disorders

et al. 2016

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“…Due to poor health care or incomplete treatment, pediatric pneumonia often recurs, which can result in numerous severe complications and a poor prognosis, thereby affecting the child's development, even leading to mortality (4,5). Although the prevalence of pediatric mortality has been reduced due to recent surgical and medical advances, pediatric pneumonia remains at a high risk of recurrence and hospitalization (6,7). Therefore, it is essential to investigate the underlying pathogenesis and to identify effective therapeutic targets for the treatment of pediatric pneumonia.…”

Section: Introductionmentioning

confidence: 99%

MicroRNA‑20a promotes inflammation via the nuclear factor‑κB signaling pathway in pediatric pneumonia

Liu

Guo

2017

Mol Med Report

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Pneumonia is a common respiratory disease worldwide, which is preventable and treatable; however, it is recognized as a leading cause of mortality in children. The present study aimed to investigate the role and mechanism of microRNA (miR)‑20a in inflammation in pediatric pneumonia. Clinical serum samples were collected from children with pneumonia and healthy children. Initially, the serum expression levels of miR‑20a were detected by reverse transcription‑quantitative polymerase chain reaction. Subsequently, A549 cells were randomly divided into four groups: Control group; lipopolysaccharide (LPS; 1 µg/ml) group; LPS + miR‑20a group; and LPS + miR‑20a + pyrrolidine dithiocarbamate (PDTC; 100 mmol/l) group. The concentrations of interleukin‑6 (IL‑6), tumor necrosis factor (TNF)‑α and C‑reactive protein (CRP) in clinical serum samples and A549 cells were determined by ELISA. In addition, the protein expression levels of inhibitor of nuclear factor (NF)‑κB α (IκBα) and phosphorylated (p)‑NF‑κB were measured by western blotting. The results demonstrated that miR‑20a was upregulated in children with pneumonia and in lung cells with LPS‑induced inflammatory injury (P<0.01). In addition, compared with the LPS group, cells in the LPS + miR‑20a group exhibited increased expression levels of IL‑6, TNF‑α and CRP (P<0.05). Overexpression of miR‑20a also resulted in upregulation of the expression levels of IκBα and p‑NF‑κB compared with in the LPS group (P<0.05). Furthermore, treatment with the NF‑κB inhibitor PDTC inhibited the expression of inflammatory factors compared with in the LPS + miR‑20a group (P<0.05). In conclusion, the present study indicated that miR‑20a is upregulated in pediatric pneumonia, and overexpression of miR‑20a may promote inflammation through activation of the NF‑κB signaling pathway.

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“…Recently, two small case series suggested a benefit of nebulized antibiotics in tracheotomized patients with neurological impairment and frequent respiratory exacerbations 17,18 .…”

Section: Discussionmentioning

confidence: 99%

“…Duration of nebulized antibiotics in tracheotomised children varied from 2 weeks to 12 months in published studies and optimum dose was not clear 10,11,17,18 . Since there are no specific guidelines regarding the duration and the dose of nebulized antibiotics in tracheotomised children, we discontinued nebulized antibiotics in patients who had clinical recovery and when the colony count was lower than 10 5 CFU/L.…”

Section: Discussionmentioning

confidence: 99%

The effects of nebulized antibiotics in children with tracheostomy

Atağ¹,

Ünal²,

Arslan³

et al. 2020

Preprint

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Introduction Children with tracheostomy have an increased risk of bacterial colonization and infections of the lower respiratory tracts. This study aimed to investigate the effects of nebulized antibiotics on the bacterial load, the need for oral antibiotic courses, the number of hospitalizations, and the length of stay in the intensive care unit in children with tracheostomy. Methods Children with tracheostomy and persistent bacterial colonization who were started on nebulized antibiotic therapy after a lower respiratory tract infection were included to the study. Nebulized gentamicin or colistin were used according to the results of tracheal aspirate cultures. Demographic and clinic characteristics were recorded from one year before until 12 months after initiating nebulized antibiotic treatment. Results Nebulized antibiotic treatment was initiated in 22 patients. Inhaled gentamicin was administered to 14 patients (63.6%) and colistin to 8 patients (36.4%). The median duration of treatment was 3 months (2-5 months). Following nebulized antibiotic treatment, median number of hospitalizations decreased from 2 (1-3.5) to 1 (0-1.5) (p=0.04). The median length of stay in the intensive care unit reduced significantly from 89.5 days (43-82.5) to 25 days (7.75-62.75) after starting nebulized antibiotics (p = 0.028). Following nebulized antibiotic treatment colony count also decreased (105 CFU/ml (105-106) vs. 6x104 CFU/ml (104-105); p=0.003). Conclusions Nebulize antibiotics are a reasonable treatment option for lower respiratory tract infections for tracheotomized children with persistent colonization. Further studies are needed to determine the main indications and the optimal duration and doses of the long-term nebulized antibiotic treatment in these patients.

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Nebulized tobramycin: Prevention of pneumonias in patients with severe cerebral palsy

Cited by 21 publications

References 9 publications

Upper airway microbial colonization in patients with neuromuscular disorders

Upper airway microbial colonization in patients with neuromuscular disorders

MicroRNA‑20a promotes inflammation via the nuclear factor‑κB signaling pathway in pediatric pneumonia

The effects of nebulized antibiotics in children with tracheostomy

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