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A cohort study of the airway mycobiome in adult cystic fibrosis patients: differences in community structure of fungi compared to bacteria reveal predominance of transient fungal elements.

The respiratory mycobiome is an important but understudied component of the human microbiota. Like bacteria, fungi can cause severe lung diseases but infection rates are much lower.

This study compared the bacterial and fungal communities of sputum samples from a large cohort of 56 adult cystic fibrosis (CF) patients during non-exacerbation periods and under continuous antibiotic treatment.

Molecular fingerprinting based on single-strand conformation polymorphism (SSCP) analysis revealed fundamental differences between bacterial and fungal communities. Both groups of microorganisms were taxonomically classified by identification of gene sequences (16S rRNA and ITS) and prevalences of single taxa were determined for the entire cohort. Major bacterial pathogens were frequently observed, whereas fungi of known pathogenicity in CF were only detected at low frequencies. Fungal species richness increased without reaching a constant level (saturation), whereas bacterial richness showed saturation after 50 patients had been analysed. In contrast to bacteria, a large number of fungal species was observed together with high fluctuations over time and between patients. These findings demonstrated that the mycobiome was dominated by transient species. This strongly suggests that the main driving force is their presence in inhaled air rather than colonization.

Considering the high exposure of human airways to fungal spores, we concluded that fungi have low colonization abilities in CF and colonisation by pathogenic fungal species may be considered a rare event. A comprehensive understanding of the conditions promoting fungal colonization may offer the opportunity to prevent colonization and substantially reduce or even eliminate fungi-related disease progression in CF.

Management of Infections with Drug-Resistant Organisms in Critical Care

Infections with multidrug-resistant organisms (MDROs) are common in critically ill patients and are challenging to manage appropriately. Strategies that can be used in the treatment of MDRO infections in the intensive care unit (ICU) include combination therapy, adjunctive aerosolized therapy, and optimization of pharmacokinetics with higher doses or extended-infusion therapy as appropriate. Rapid diagnostic tests could assist in improving timely appropriate antimicrobial therapy for MDRO infections in the ICU. (Source: Clinics in Chest Medicine)

Novel Uses of Extracorporeal Membrane Oxygenation in Adults

Extracorporeal membrane oxygenation (ECMO) has been available for decades, with its use steadily expanding in the setting of advances in technology. The most common indications for venovenous and venoarterial ECMO remain severe hypoxemic respiratory failure and cardiogenic shock, respectively. Refinements in extracorporeal circuitry and cannulation strategies have led to novel indications for ECMO in cardiopulmonary failure, including pulmonary hypertension, extracorporeal cardiopulmonary resuscitation, and less severe forms of the acute respiratory distress syndrome. There is hope for the development of destination device therapy, which could have significant implications for acute and chronic management of severe respiratory and cardiac disease. (Source: Clinics in Chest Medicine)

First-ever possible treatments for MERS; two promising candidates

As the South Korean MERS outbreak continues, researchers have discovered and validated two therapeutics that show early promise in preventing and treating the disease, which can cause severe respiratory symptoms, and has a death rate of 40 percent. (Source: ScienceDaily Headlines)

Efficacy of an inhaled corticosteroid/long-acting {beta}2-agonist combination in symptomatic COPD patients in GOLD groups B and D

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011 recommendations stratified patients with chronic obstructive pulmonary disease (COPD) into four severity groups (A–D) [1]. However, the clinical trials on which these recommendations were based did not use this patient classification. Within group D, patients may be stratified into subgroups according to the criteria that determine their inclusion: either forced expiratory volume in 1 s (FEV1), frequency of exacerbations or both [2–4]. These D-subgroups display significantly different treatment outcomes [2]. The current report determined whether budesonide/formoterol prevented exacerbations more effectively than formoterol alone in symptomatic patients with COPD at high and low risk of exacerbations acc...

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