Bacterial Infections and Treatment in Respiratory Health

Q: Bacterial Infections and Treatment in Respiratory Health

Hello： It is common for normal nasal cavities and respiratory tracts to coexist with commensal bacteria, so the presence of bacteria in cultures does not necessarily indicate an infection or disease. <br>However, based on your description, this condition may involve sinusitis and

Bacterial and pleural infiltration..?

Hello Doctor, I would like to ask a few questions...
I developed yellow, foul-smelling nasal discharge due to a cold, and after seeing a doctor, it did not improve.
It progressed to an upper and lower respiratory tract infection, with sinusitis and initially foul-smelling post-nasal drip.
An ENT specialist prescribed amoxicillin, which did not worsen my condition but also did not improve it.
Instead, it turned into a lower respiratory tract infection with a lot of yellow, foul-smelling sputum.
I then consulted a pulmonologist, who prescribed Augmentin, which also did not worsen or significantly improve my condition.
Due to frequent colds leading to lower respiratory tract infections, I underwent an aerobic culture, which ultimately identified moderate Staphylococcus aureus, one strain.
The doctor then switched me to ciprofloxacin.
I later received a report with the following information: 1.
The report indicates...
penicillin-G R>=0.5, gentamicin S<=0.5, tigecycline S<=0.12, ciprofloxacin S<=0.5, linezolid S=2.
I found that S indicates susceptibility and R indicates resistance, but I am unsure about the significance of the values following S and R.
2.
The gram stain showed gpb+, gnb+, gpc+, gnc+, wbc>25/lpf, rbc+, epicell<10/lpf, fungus-.
Does this indicate the presence of various bacteria? 3.
The pulmonologist performed a chest X-ray (on 2017/5/17) and noted some pulmonary infiltrates in the lower lung fields.
Last year, I had a low-dose CT scan of the lungs (on 2016/11/?), which also showed pulmonary infiltrates in the same location.
I am unsure what this means, as the doctor did not provide further explanation and did not ask me to return for a follow-up (stating that completing the 7-day course of ciprofloxacin should suffice).
Therefore, I would like to inquire about this.
4.
Since I frequently experience upper respiratory infections that lead to lower respiratory infections (due to chronic post-nasal drip), sometimes the upper respiratory symptoms seem to resolve, but the lower respiratory infection persists.
Does this mean that I need to fully resolve the upper respiratory infection, such as sinusitis, in order to cure the lower respiratory infection? Thank you...

Niming, 40~49 year old female. Ask Date: 2017/05/24

Dr. Yang Wenda reply Pulmonology

Hello: It is common for normal nasal cavities and respiratory tracts to coexist with commensal bacteria, so the presence of bacteria in cultures does not necessarily indicate an infection or disease.
However, based on your description, this condition may involve sinusitis and a mild pulmonary infection (with X-ray showing small areas of infiltration).
Since the antibiotic chosen by the physician is broad-spectrum, if there is no fever or worsening cough after completing seven days of treatment, you likely do not need to continue taking antibiotics.
However, symptoms such as productive cough and nasal discharge may persist for 1-3 weeks, and you can manage these with symptomatic medications.
The mention of WBC in the sputum, as well as the antimicrobial concentration and sensitivity (S) or resistance (R), are more specialized topics for your physician's reference in selecting medications, so I will not elaborate further on that.
I recommend ensuring adequate hydration and rest!

Reply Date: 2017/05/24

More Info

Understanding bacterial infections and their treatment in respiratory health is crucial, especially for individuals experiencing recurrent respiratory issues. Based on your detailed history, it appears that you have been dealing with a complex interplay of upper and lower respiratory tract infections, which may be exacerbated by underlying conditions such as allergies or anatomical variations in your nasal passages.

1. Understanding Antibiotic Sensitivity Report: The report you received indicates the susceptibility of Staphylococcus aureus to various antibiotics. The "S" stands for "sensitive," meaning the bacteria are likely to be inhibited by the antibiotic at standard doses, while "R" stands for "resistant," indicating that the bacteria are not effectively treated by that antibiotic. The numbers following "S" or "R" represent the minimum inhibitory concentration (MIC), which is the lowest concentration of the antibiotic that prevents bacterial growth. For example, a result of "penicillin-G R >= 0.5" means that the bacteria require a concentration of penicillin greater than or equal to 0.5 µg/mL to inhibit growth, indicating resistance. In contrast, "Ciprofloxacin S <= 0.5" suggests that ciprofloxacin is effective at concentrations less than or equal to 0.5 µg/mL.

2. Gram Stain Results: The results you provided from the Gram stain indicate the presence of various types of bacteria. The notation "gpb+" indicates Gram-positive bacilli, while "gnb+" indicates Gram-negative bacilli. The presence of "wbc > 25/lpf" suggests a significant inflammatory response, likely due to infection. The presence of red blood cells (rbc+) and epithelial cells (epicell < 10/lpf) can indicate irritation or inflammation in the respiratory tract. The absence of fungi suggests that a fungal infection is unlikely. Overall, these results suggest a polymicrobial infection, which is common in respiratory infections.

3. Pulmonary Infiltrates: The chest X-ray and low-dose CT findings of pulmonary infiltrates could indicate an ongoing infection or inflammation in the lungs. Infiltrates can be due to pneumonia, bronchitis, or other lung conditions. Given your history of recurrent infections, it is essential to follow up on these findings with your healthcare provider. Persistent infiltrates may require further evaluation, including repeat imaging or even bronchoscopy, to rule out other underlying conditions such as bronchiectasis or chronic obstructive pulmonary disease (COPD).

4. Connection Between Upper and Lower Respiratory Infections: Your observation about the relationship between upper respiratory infections (like sinusitis) and lower respiratory infections (like bronchitis) is valid. Conditions such as postnasal drip can lead to irritation and infection in the lower airways. Treating the upper respiratory infection effectively is crucial to preventing the spread of infection to the lower respiratory tract. This may involve addressing any underlying allergies, using nasal corticosteroids, or considering other interventions to improve sinus drainage.

In conclusion, it is essential to work closely with both your ENT specialist and pulmonologist to develop a comprehensive treatment plan. This may include targeted antibiotic therapy based on culture results, management of underlying conditions (like allergies), and possibly further diagnostic testing to evaluate the extent of lung involvement. Regular follow-up is crucial to monitor your symptoms and adjust treatment as necessary. If you continue to experience symptoms or have concerns about your condition, do not hesitate to seek further evaluation or a second opinion. Your health and well-being are paramount, and addressing these recurrent infections is key to improving your quality of life.

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