2016


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2016/№4

Comparative microbiological composition of sputum and biopsy samples from major bronchi of patients with pneumonia associated with decompensated chronic heart failure

Simbirtseva A.S.1, Arutyunov G.P.1, Dzhandarova D.T.2, Shvydkaya M.G.2, Orlov S.Yu.1, Grishina A.V.3, Korsunskaya M.I.1, Bylova N.A.1
1 – State Budgetary Educational Institution of Higher Professional Education, "N.I. Pirogov Russian National Research Medical University " of the RF Ministry of Health Care, Ostrovityanova 1, Moscow 117997
2 – Federal State Budgetary Institution, "Dmitry Rogachev Federal Science and Clinical Center of Children's Hematology, Oncology and Immunology " of the RF Ministry of Health Care, Samory Mashela 1, Moscow 117198
3 – State Budgetary Health Care Institution "Municipal Hospital #4 of the Moscow Health Care Department", Pavlovskaya 25, Moscow 115093

Keywords: microflora, sputum, pneumonia, prognosis, CHF

DOI: 10.18087/rhfj.2016.4.2268

Background. Pneumonia considerably contributes to the adverse prognosis for patients with CHF. Pneumonia suffered during the period of decompensated CHF influences the rate of subsequent hospitalizations and fatal outcomes. Monitoring of flora that has induced pneumonia is an important task. In the vast majority of cases, the monitoring is performed by analyzing the sputum flora. Studying the crypt compartment of bronchial tree and its role in outcomes of decompensated CHF and pneumonia is of particular interest. Aim. To compare data from sputum and biopsy culture samples obtained from patients with decompensated CHF and community-acquired pneumonia during bronchoscopy of the major bronchi. Materials and methods. The study included 51 patients admitted for decompensated CHF and confirmed pneumonia. Sputum and urine samples were collected for culture; bronchoscopy with differential brush biopsy of large air-way epithelium and further microbiological study of biopsy samples were performed. Results. Two groups were formed based on results of sputum and bronchial biopsy culture. In group A (28 patients), the microflora of bronchial samples was represented by Str. pneumonia and was consistent with the result of sputum culture. In group B (23 patients), results of sputum and bronchial biopsy culture did not coincide. Mixed infection was detected in 47.8% of bronchial samples from group B patients. Significantly different parameters in these two groups included the number of hospitalizations for the previous year; lean body weight (LBW) deficit; Δ creatinine; lymphocyte count, and CURB index (p≤0.01). Phenotypes combining LBW deficit >5%, rapidly progressing impairment of kidney function, frequent hospitalizations during the previous year, and relative lymphocyte count <20% were more frequently observed in group B. The in-hospital mortality was 25% in group A and 34.8% in group B. The death rate for one year following the given hospitalization was 39.3% in group A and 73.9% in group B (p ≤0.01). Conclusion. Patients admitted for decompensated CHF and pneumonia with the most severe phenotype (frequent hospitalizations + LBW deficit > 5–10% + ∆ creatinine >0.3mg/dl + relative lymphocyte count <20%) more likely had dissimilar flora in bronchial biopsy and sputum. With dissimilar sputum and bronchial biopsy flora, the clinical picture corresponded to severe pneumonia, and the risks of both in-hospital fatality and death within one year were increased 1.4 and 1.9 times, respectively.
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Simbirtseva A.S., Arutyunov G.P., Dzhandarova D.T., Shvydkaya M.G., Orlov S.Yu., Grishina A.V. et al. Comparative microbiological composition of sputum and biopsy samples from major bronchi of patients with pneumonia associated with decompensated chronic heart failureRussian Heart Failure Journal. 2016;17 (4):250–258

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