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Background Non-cystic fibrosis bronchiectasis (BE) is a chronic structural lung condition that facilitates chronic colonization by different microorganisms and courses with recurrent respiratory infections and frequent exacerbations. One of the main pathogens involved in BE is Pseudomonas aeruginosa. Objectives To determine the molecular mechanisms of resistance and the molecular epidemiology of P. aeruginosa strains isolated from patients with BE. Methods A total of 43 strains of P. aeruginosa were isolated from the sputum of BE patients. Susceptibility to the following antimicrobials was analysed: ciprofloxacin, meropenem, imipenem, amikacin, tobramycin, aztreonam, piperacillin/tazobactam, ceftazidime, ceftazidime/avibactam, ceftolozane/tazobactam, cefepime and colistin. The resistance mechanisms present in each strain were assessed by PCR, sequencing and quantitative RT–PCR. Molecular epidemiology was determined by MLST. Phylogenetic analysis was carried out using the eBURST algorithm. Results High levels of resistance to ciprofloxacin (44.19%) were found. Mutations in the gyrA, gyrB, parC and parE genes were detected in ciprofloxacin-resistant P. aeruginosa strains. The number of mutated QRDR genes was related to increased MIC. Different β-lactamases were detected: blaOXA50, blaGES-2, blaIMI-2 and blaGIM-1. The aac(3)-Ia, aac(3)-Ic, aac(6″)-Ib and ant(2″)-Ia genes were associated with aminoglycoside-resistant strains. The gene expression analysis showed overproduction of the MexAB-OprM efflux system (46.5%) over the other efflux system. The most frequently detected clones were ST619, ST676, ST532 and ST109. Conclusions Resistance to first-line antimicrobials recommended in BE guidelines could threaten the treatment of BE and the eradication of P. aeruginosa, contributing to chronic infection.

Background: Low physical activity and high sedentary behaviour in patients with bronchiectasis are associated with hospitalisation over one year. However, the factors associated with longitudinal changes in physical activity and sedentary behaviour have not been explored. We aimed to identify clinical and sociodemographic characteristics related to a change in physical activity and sedentary behaviour in patients with bronchiectasis after one year. Methods: This was a prospective observational study during which physical activity measurements were recorded using a SenseWear Armband for one week at baseline and at one year. At each assessment point, patients were classified as active or inactive (measured as steps per day) and as sedentary or not sedentary (measured as sedentary time). Results: 53 patients with bronchiectasis were analysed, and after one year, 18 (34%) had worse activity and sedentary levels. Specifically, 10 patients became inactive and sedentary. Multivariable analysis showed that the number of exacerbations during the follow-up period was the only outcome independently associated with change to higher inactivity and sedentary behaviour (odds ratio (OR), 2.19, 95% CI, 1.12 to 4.28). Conclusions: The number of exacerbations in patients with bronchiectasis was associated with changes in physical activity and sedentary behaviour. Exacerbation prevention may appear as a key factor in relation to physical activity and sedentary behaviour in patients with bronchiectasis.

The evaluation of sediment quality is a relevant topic that involves the analysis of various parameters that are altered by natural or anthropogenic causes. Therefore, the Grey Clustering method provides an alternative to evaluate sediment quality. In the present study, the sediment quality of the Chontayacu river watershed was evaluated considering the results of the monitoring of twenty-three points carried out in the early evaluations by the Environmental Impact Evaluation Agency (OEFA by its Spanish acronym). These twenty-three points were separated into three blocks considering the monitoring points upstream of the Uchiza town center and the Chontayacu Alto and Chontayacu Bajo hydroelectric plants. Seven parameters were analyzed: As, Cd, Cr, Cu, Pb, Hg and Zn, which were compared with Canadian sediment quality standards for the protection of aquatic life. The results of the assessment showed that all points in the Chontayacu River were classified as having unlikely adverse biological effects from heavy metals. However, a quality ranking was established between the points of each block where it was found that points P3, P4 and P17 correspond to the lowest values for the high CH, low CH and CP Uchiza blocks respectively. Finally, the results obtained will provide integrated information for decision making by the competent authorities in Peru, as well as indicate the level of sediment contamination that should be taken into account for the proposal of hydroelectric projects that influence sediment transport and entrainment.

There are controversies about the use of corticosteroids in severe community-acquired pneumonia (CAP). Despite several meta-analyses have shown reduce mortality, last ATS/IDSA guideline for CAP suggested against using corticosteroids in severe CAP. In 2015 a RCTs shown that corticosteroids reduce the rate of treatment failures in patients with severe CAP and high inflammatory response measured by values of C-reactive protein higher than 15 mg/dl. In this study we aimed to evaluate the applicability of this protocol in a real-life setting. We describe a prospective cohort of patients with severe CAP admitted to ICU, who received corticosteroids by CAP and CRP >15mg/dl. Patients with Influenza infection or those with high risk of corticosteroids side effects were excluded. From April of 2015 to December of 2019, we collected data from 100 patients. All patients received methylprednisolone 0.5 mg/kg BID. The median age (1st-3rd quartile) was 69.5 years (59-78), median APACHE II at admission was 15 points (10-20), 80% of patients presented PSI class IV-V, 54% septic shock and 32% required invasive mechanical ventilation. The most common pathogen isolated was Streptococcus pneumoniae in 34%. Mortality at 28 and 90-day mortality were 9 and 11% respectively. For patients with septic shock 28-day mortality was 15% (n:8) and for those patients who required invasive mechanical ventilation 28-day mortality was 16% (n:5). For those patients with both septic shock and invasive mechanical ventilation 28-day mortality was 20% (n:5). Conclusions: We observed a low mortality for patients with severe CAP, include in those patients with septic shock, invasive mechanical ventilation or both.

Background In adult patients with bronchiectasis (BE) the identification of the underlying aetiology may be difficult. In a new patient with BE the performance of a panel of tests is recommended, even though this practice may be expensive and the level of evidence supporting is low. We aimed to identify a panel of variables able to predict the aetiological diagnosis of BE. Methods Our prospective study derived from our real-life experience on the management of adult stable BE outpatients. We recorded variables concerning clinical, radiological, microbiological and laboratory features. We identified five groups of aetiological diagnosis of BE (idiopathic, post-infective, COPD, asthma and non-common diseases [immunodeficiency or other rare conditions]). Multivariate models were used to identify predictors of each aetiological diagnosis. The suitability of performing a specific test for the diagnosis was also considered. Results We enrolled 354 patients with a new diagnosis of BE. Patients with different aetiological causes differed significantly with regard to age, sex, smoking habit, comorbidities, dyspnoea perception, airflow obstruction and severity scores. Various predictors were assessed, including sex, previous respiratory infections, diffuse localization of BE, risk scores, and laboratory variables (sodium and eosinophils). The levels of autoantibodies or immunoglobulins were reserved for the diagnosis of non-common disease. Conclusion Our research confirms that some predictors are specific for the aetiological diagnosis of BE. The possibility of integrating this information may represent a useful tool for the diagnosis. The execution of certain specific tests should be reserved for patients with a non-common disease.

Introduction: Exacerbations of non-cystic fibrosis bronchiectasis (BE) are associated with increased systemic inflammation. Studies support an important role for neutrophils and cell-mediated immunity in the pathophysiology of BE, but the role of other inflammatory cells is less clear. Aims and Objectives: The aims of our study were: to describe changes in markers of inflammation during an exacerbation of BE and in a stable state; to investigate their relationship with clinical outcomes. Methods: A prospective bicentric observational study was performed in adult exacerbated BE patients*. Blood samples were taken for measurement of inflammatory markers at days 1 and 5 of the exacerbation and at day 30 after the exacerbation (stable state). Results: We measured the systemic levels of markers of 261 exacerbated BE patients (115 males, 72 [63; 78] years) (Table 1). Twenty-three (8.8%) patients died during the 1-year follow up and they showed significant different markers levels at days 5 and 30 (Table 2). Conclusions: CRP, WBC, neutrophils and NLR are measurable markers of inflammation that could be useful to predict the mortality in BE. *Hill AT et al. Eur. Respir. J (2017)

Background: Bronchiectasis exacerbations are often treated with prolonged antibiotic use, even though there is limited evidence for this approach. We therefore aimed to investigate the baseline clinical and microbiological findings associated with long courses of antibiotic treatment in exacerbated bronchiectasis patients. Methods: This was a bi-centric prospective observational study of bronchiectasis exacerbated adults. We compared groups receiving short (&le, 14 days) and long (15&ndash, 21 days) courses of antibiotic treatment. Results: We enrolled 191 patients (mean age 72 (63, 79) years, 108 (56.5%) females), of whom 132 (69%) and 59 (31%) received short and long courses of antibiotics, respectively. Multivariable logistic regression of the baseline variables showed that long-term oxygen therapy (LTOT), moderate&ndash, severe exacerbations, and microbiological isolation of Pseudomonas aeruginosa were associated with long courses of antibiotic therapy. When we excluded patients with a diagnosis of community-acquired pneumonia (n = 49), in the model we found that an etiology of P. aeruginosa remained as factor associated with longer antibiotic treatment, with a moderate and a severe FACED score and the presence of arrhythmia as comorbidity at baseline. Conclusions: Decisions about the duration of antibiotic therapy should be guided by clinical and microbiological assessments of patients with infective exacerbations.