Alterations
to the respiratory microbiome have been identified as a predisposing factor of
interstitial lung diseases (ILD). In a new study, researchers studied the
influence of bacterial virulence on clinical outcomes patients hospitalized
with ILD patients. The authors found that the use of immunosuppressive
medications or antifibrotics had no influence on the outcomes including
development of resistant pathogens in patients.
Researchers
conducted a retrospective analysis of 472 patients with ILD who were
admitted to a large tertiary care academic center from Jan. 1st, 2010, to Dec.
31st, 2016. Patient data were extracted from electronic records using ICD-9 and
ICD-10 billing codes for various ILD. The majority of the patients had either
pulmonary fibrosis or sarcoidosis.
One
hundred and seventy respiratory cultures were collected in this population. The
majority of the respiratory isolates were gram-negative pathogens (39 percent
Pseudomonas and 18 percent other gram-negative organisms); 27 percent were
methicillin-resistant staphylococcus aureus (MRSA). Patients infected with
gram-negative organisms (other than Pseudomonas) and MRSA had the highest
30-day mortality (39 percent and 32 percent respectively) compared with lower
mortality for those infected with Pseudomonas and other gram positive organisms
(7 percent and 14 percent respectively). Patients infected with gram-negative
organisms other than Pseudomonas also had higher rates of vasopressin
administration compared with those infected with other organisms. Rates of ICU
admission also differed according to organism that was cultured. These
associations persisted even after adjustment for the other variables including
type of ILD, age, gender, comorbid conditions and smoking history. There was no
association between the use of immunosuppressant medications or antifibrotics
and the development of resistant pathogens.
See:
Posted by Dr. Tim Sandle,
Pharmaceutical Microbiology