You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.
 

Table 1.  

Variables Overall, n = 497 Acinetobacter baumannii isolated p value Hazard ratio (95% CI)
Yes, n = 159 No, n = 338
Median age, y (IQR) 60.1 (49–73) 61 (50–74) 59.6 (49–73) 0.444 1.004 (0.994–1.013)
Sex, no. (%)          
   F 160 (32.2) 44 (27.7) 116 (34.3) Referent  
   M 337 (67.8) 115 (72.3) 222 (65.7) 0.139 0.769 (0.544–1.089)
Mean Charlson comorbidity index, (SD) 4.26 (2.12) 4.40 (2.14) 4.20 (2.11) 0.293 1.038 (0.968–1.113)
Underlying conditions, no. (%)          
   Cardiovascular diseases 200 (40.2) 79 (49.7) 121 (358) 0.003 1.596 (1.169–2.178)
   Chronic renal insufficiency 179 (36.0) 71 (44.7) 108 (32.0) 0.011 1.504 (1.200–2.056)
   COPD and asthma 176 (35.4) 71 (44.7) 105 (31.1) 0.005 1.570 (1.148–2.146)
   Type 2 diabetes mellitus 116 (23.3) 46 (28.9) 70 (20.7) 0.057 1.395 (0.990–1.965)
   Solid tumor 100 (20.1) 36 (22.6) 64 (18.9) 0.363 1.188 (0.820–1.723)
   Hematologic malignancy 31 (6.2) 8 (5.0) 23 (6.8) 0.497 0.781 (0.384–1.591)
   Past inhaled steroids use for chronic conditions 47 (9.5) 17 (10.7) 30 (8.9) 0.450 1.214 (0.734–2.007)
   Current or former smoker 187 (37.6) 74 (46.5) 113 (33.4) 0.005 1.565 (1.146–2.138)
   Postoperative admission 142 (28.6) 38 (23.9) 104 (30.8) 0.134 0.757 (0.526–1.090)
Treatment, no. (%)          
   No aerosol inhalation 137 (27.6) 33 (20.8) 104 (30.8) Referent  
   Glucocorticoid aerosol inhalation 262 (52.7) 107 (67.3) 155 (45.9) 0.002 1.860 (1.264–2.738)
   Aerosol inhalation without glucocorticoid 98 (19.7) 19 (11.9) 79 (23.4) 0.337 0.760 (0.433–1.332)
   Broad-spectrum antimicrobial drugs, ≥7 d 417 (83.9) 157 (98.7) 260 (76.9) <0.001 9.539 (4.595–18.795)
   Invasive mechanical ventilation, ≥5 d 221 (44.5) 112 (70.4) 109 (32.2) <0.001 3.452 (2.453–4.858)
   Urethral catheter placement, ≥3 d 493 (99.2) 158 (99.4) 335 (99.1) 0.875 1.171 (0.164–8.361)
   Vasopressor treatment, ≥3 d 75 (15.1) 42 (26.4) 33 (9.8) <0.001 2.634 (1.850–3.750)
   Renal dialysis, ≥3 d 84 (16.9) 34 (21.4) 50 (14.8) 0.063 1.432 (0.980–2.093)
APACHE II score, mean (SD) 18.18 (6.03) 18.98 (6.44) 17.80 (5.80) 0.053 1.026 (1.000–1.053)
Median length of ICU stay, d (IQR) 15 (7–23) 20 (10–28) 13 (6–20) 0.057 1.005 (1.000–1.010)

Table 1. Univariate analysis of risk factors for Acinetobacter baumannii among patients during invasive mechanical ventilation, China*

*APACHE II, Acute Physiology and Chronic Health Evaluation II; COPD, chronic obstructive pulmonary disease; ICU, intensive care unit; IQR, interquartile range.

Table 2.  

Variables p value Hazard ratio (95% CI)
Underlying conditions    
   Cardiovascular diseases 0.054 1.394 (0.994–1.955)
   Chronic renal insufficiency 0.730 0.937 (0.648–1.356)
   COPD and asthma 0.132 1.299 (0.924–1.825)
   Type 2 diabetes mellitus 0.325 1.197 (0.837–1.714)
   Current or former smoker 0.098 1.307 (0.951–1.797)
Treatment    
     No aerosol inhalation Referent  
     Glucocorticoid aerosol inhalation 0.038 1.528 (1.024–2.278)
     Aerosol inhalation without glucocorticoid 0.524 0.829 (0.467–1.475)
   Broad-spectrum antimicrobial drugs, ≥7 d 0.001 7.238 (2.758–15.788)
   Invasive mechanical ventilation, ≥5 d 0.001 2.381 (1.664–3.405)
   Vasopressor treatment, ≥3 d <0.001 2.060 (1.402–3.028)
   Renal dialysis, ≥3 d 0.841 1.046 (0.675–1.620)
APACHE II score 0.586 0.992 (0.965–1.020)

Table 2. Multivariate analysis of risk factors for Acinetobacter baumannii among patients during invasive mechanical ventilation, China*

*Results are from model 2; only variables with p<0.1 in univariate analysis were included. APACHE II, Acute Physiology and Chronic Health Evaluation II; COPD, chronic obstructive pulmonary disease.

Table 3.  

Variables p value Hazard ratio (95% CI)
Underlying conditions    
   Cardiovascular diseases 0.117 1.361 (0.926–2.001)
   Chronic renal insufficiency 0.800 1.052 (0.712–1.554)
   Type 2 diabetes mellitus 0.243 1.271 (0.850–1.899)
   Current or former smoker 0.051 1.442 (0.998–2.083)
Treatment    
     Glucocorticoid aerosol inhalation 0.032 1.489 (1.036–2.141)
   Broad-spectrum antimicrobial drugs, ≥7 d 0.004 6.315 (2.543–13.921)
   Invasive mechanical ventilation, ≥5 d <0.001 2.388 (1.614–3.534)
   Vasopressor treatment, ≥3 d 0.501 1.188 (0.719–1.963)
APACHE II score 0.363 1.014 (0.984–1.045)

Table 3. Multivariate analysis of risk factors for Acinetobacter baumannii among propensity-matched patient cohort during invasive mechanical ventilation, China*

*Only variables with p<0.1 in univariate analysis of the propensity-matched cohort were included. APACHE II, Acute Physiology and Chronic Health Evaluation II; COPD, chronic obstructive pulmonary disease.

CME / ABIM MOC

Acinetobacter baumannii Among Patients Receiving Glucocorticoid Aerosol Therapy During Invasive Mechanical Ventilation, China

  • Authors: Wenchao Zhang, MD, PhD; Mei Yin, MD, PhD; Wei Li, MD, PhD; Nana Xu, MD; Haining Lu, MD; Weidong Qin, MD, PhD; Hui Han, MD; Chen Li, MD; Dawei Wu, MD; Hao Wang, MD, PhD
  • CME / ABIM MOC Released: 11/17/2022
  • Valid for credit through: 11/17/2023
Start Activity

  • Credits Available

    Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 1.00 ABIM MOC points

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for primary care physicians, infectious disease specialists, critical care specialists, and other physicians who care for patients receiving invasive mechanical ventilation (IMV).

The goal of this activity is for learners to be better able to discuss how aerosol treatments may affect the risk for infection with Acinetobacter baumannii (AB).

Upon completion of this activity, participants will:

  1. Distinguish the percentage of patients receiving invasive mechanical ventilation (IMV) who had a positive culture for Acinetobacter baumannii (AB)
  2. Assess the role of aerosol inhalation in the isolation of AB in the current study
  3. Analyze risk factors for the isolation of AB in the current study
  4. Evaluate the effects of aerosol inhalation and AB on the risk for mortality among patients receiving IMV


Disclosures

Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.


Faculty

  • Wenchao Zhang, MD, PhD

    Qilu Hospital of Shandong University
    Jinan, China

  • Mei Yin, MD, PhD

    Qilu Hospital of Shandong University
    Jinan, China

  • Wei Li, MD, PhD

    Qilu Hospital of Shandong University
    Jinan, China

  • Nana Xu, MD

    Qilu Hospital of Shandong University
    Jinan, China

  • Haining Lu, MD

    Qingdao Branch Qilu Hospital of Shandong University Qingdao, China

  • Weidong Qin, MD, PhD

    Qilu Hospital of Shandong University
    Jinan, China

  • Hui Han, MD

    Qilu Hospital of Shandong University
    Jinan, China

  • Chen Li, MD

    Qilu Hospital of Shandong University
    Jinan, China

  • Dawei Wu, MD

    Qingdao Branch
    Qilu Hospital of Shandong University
    Qingdao, China

  • Hao Wang, MD, PhD

    Qilu Hospital of Shandong University
    Jinan, China

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California, Irvine School of Medicine

    Disclosures

    Charles P. Vega, MD, has the following relevant financial relationships:
    Consultant or advisor for: GlaxoSmithKline; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.

Editor

  • Amy J. Guinn, BA, MA

    Copyeditor 
    Emerging Infectious Diseases

Compliance Reviewer

  • Amanda Jett, PharmD, BCACP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Amanda Jett, PharmD, BCACP, has no relevant financial relationships.


Accreditation Statements



In support of improving patient care, this activity has been planned and implemented by Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

    For Physicians

  • Medscape, LLC designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read about the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or print it out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate, but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period, you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.

CME / ABIM MOC

Acinetobacter baumannii Among Patients Receiving Glucocorticoid Aerosol Therapy During Invasive Mechanical Ventilation, China

Authors: Wenchao Zhang, MD, PhD; Mei Yin, MD, PhD; Wei Li, MD, PhD; Nana Xu, MD; Haining Lu, MD; Weidong Qin, MD, PhD; Hui Han, MD; Chen Li, MD; Dawei Wu, MD; Hao Wang, MD, PhDFaculty and Disclosures

CME / ABIM MOC Released: 11/17/2022

Valid for credit through: 11/17/2023

processing....

References

  1. Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al.; EPIC II Group of Investigators. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302:2323–9.
  2. Vincent JL, Sakr Y, Singer M, Martin-Loeches I, Machado FR, Marshall JC, et al.; EPIC III Investigators. Prevalence and outcomes of infection among patients in intensive care units in 2017. JAMA. 2020;323:1478–87.
  3. Mea HJ, Yong PVC, Wong EH. An overview of Acinetobacter baumannii pathogenesis: Motility, adherence and biofilm formation. Microbiol Res. 2021;247:126722.
  4. Lynch JP III, Zhanel GG, Clark NM. Infections due to Acinetobacter baumannii in the ICU: treatment options. Semin Respir Crit Care Med. 2017;38:311–25.
  5. Shi J, Sun T, Cui Y, Wang C, Wang F, Zhou Y, et al. Multidrug resistant and extensively drug resistant Acinetobacter baumannii hospital infection associated with high mortality: a retrospective study in the pediatric intensive care unit. BMC Infect Dis. 2020;20:597.
  6. Sunenshine RH, Wright MO, Maragakis LL, Harris AD, Song X, Hebden J, et al. Multidrug-resistant Acinetobacter infection mortality rate and length of hospitalization. Emerg Infect Dis. 2007;13:97–103.
  7. Blanco N, Harris AD, Rock C, Johnson JK, Pineles L, Bonomo RA, et al.; the CDC Epicenters Program. Risk factors and outcomes associated with multidrug-resistant Acinetobacter baumannii upon intensive care unit admission. Antimicrob Agents Chemother. 2017;62:e01631–17.
  8. Zhang C, Mi J, Wang X, Lv S, Zhang Z, Nie Z, et al. Knowledge and current practices of ICU nurses regarding aerosol therapy for patients treated with invasive mechanical ventilation: A nationwide cross-sectional study. J Clin Nurs. 2021;30:3429–38.
  9. Zhang Z, Xu P, Fang Q, Ma P, Lin H, Fink JB, et al.; China Union of Respiratory Care (CURC). Practice pattern of aerosol therapy among patients undergoing mechanical ventilation in mainland China: A web-based survey involving 447 hospitals. PLoS One. 2019;14:e0221577.
  10. Lyu S, Li J, Wu M, He D, Fu T, Ni F, et al.; Respiratory Care Committee in Chinese Thoracic Society. The use of aerosolized medications in adult intensive care unit patients: A prospective, multicenter, observational, cohort Study. J Aerosol Med Pulm Drug Deliv. 2021;34:383–91.
  11. Lyu S, Li J, Yang L, Du X, Liu X, Chuan L, et al. The utilization of aerosol therapy in mechanical ventilation patients: a prospective multicenter observational cohort study and a review of the current evidence. Ann Transl Med. 2020;8:1071.
  12. Dhand R. Inhaled drug therapy 2016: the year in review. Respir Care. 2017;62:978–96.
  13. Ari A. Practical strategies for a safe and effective delivery of aerosolized medications to patients with COVID-19. Respir Med. 2020;167:105987.
  14. Singanayagam A, Glanville N, Cuthbertson L, Bartlett NW, Finney LJ, Turek E, et al. Inhaled corticosteroid suppression of cathelicidin drives dysbiosis and bacterial infection in chronic obstructive pulmonary disease. Sci Transl Med. 2019;11:eaav3879.
  15. Ernst P, Gonzalez AV, Brassard P, Suissa S. Inhaled corticosteroid use in chronic obstructive pulmonary disease and the risk of hospitalization for pneumonia. Am J Respir Crit Care Med. 2007;176:162–6.
  16. Sibila O, Soto-Gomez N, Restrepo MI. The risk and outcomes of pneumonia in patients on inhaled corticosteroids. Pulm Pharmacol Ther. 2015;32:130–6.
  17. Artigas A, Camprubí-Rimblas M, Tantinyà N, Bringué J, Guillamat-Prats R, Matthay MA. Inhalation therapies in acute respiratory distress syndrome. Ann Transl Med. 2017;5:293.
  18. van Rensen EL, Straathof KC, Veselic-Charvat MA, Zwinderman AH, Bel EH, Sterk PJ. Effect of inhaled steroids on airway hyperresponsiveness, sputum eosinophils, and exhaled nitric oxide levels in patients with asthma. Thorax. 1999;54:403–8.
  19. Horvath G, Wanner A. Inhaled corticosteroids: effects on the airway vasculature in bronchial asthma. Eur Respir J. 2006;27:172–87.
  20. Leading Industry Research Network. Analysis on market demand status and market development trend of budesonide inhalation preparations in China in 2020. 2020 Nov 23 [cited 2022 Jan 24]. http://www.leadingir.com/datacenter/view/5683.html
  21. Gales AC, Seifert H, Gur D, Castanheira M, Jones RN, Sader HS. Antimicrobial susceptibility of Acinetobacter calcoaceticus-Acinetobacter baumannii complex and Stenotrophomonas maltophilia clinical isolates: results from the SENTRY antimicrobial surveillance program (1997–2016). Open Forum Infect Dis. 2019;6(Suppl 1):S34–46.
  22. European Centre for Disease Prevention and Control. Surveillance of antimicrobial resistance in Europe 2018. Stockholm: The Centre; 2019.
  23. Hu F, Guo Y, Zhu D, Wang F, Jiang X, Xu Y, et al. CHINET surveillance of bacterial resistance in China: 2018 report. Chin J Infect Chemother. 2020;20:1–10.
  24. Wang F, Zhu D, Hu F, Jiang X, Hu Z, Li Q, et al. 2012 CHINET surveillance of bacterial resistance in China. Chin J Infect Chemother. 2013;13:321–30.
  25. Meng X, Fu J, Zheng Y, Qin W, Yang H, Cao D, et al. Ten-year changes in bloodstream infection with Acinetobacter baumannii complex in intensive care units in eastern China: a retrospective cohort study. Front Med (Lausanne). 2021;8:715213.
  26. Chung DR, Song JH, Kim SH, Thamlikitkul V, Huang SG, Wang H, et al.; Asian Network for Surveillance of Resistant Pathogens Study Group. High prevalence of multidrug-resistant nonfermenters in hospital-acquired pneumonia in Asia. Am J Respir Crit Care Med. 2011;184:1409–17.
  27. Xie J, Yang Y, Huang Y, Kang Y, Xu Y, Ma X, et al. The current epidemiological landscape of ventilator-associated pneumonia in the intensive care unit: a multicenter prospective observational study in China. Clin Infect Dis. 2018;67(suppl_2):S153–61.
  28. Hu FP, Guo Y, Zhu DM, Wang F, Jiang XF, Xu YC, et al. Resistance trends among clinical isolates in China reported from CHINET surveillance of bacterial resistance, 2005-2014. Clin Microbiol Infect. 2016;22(Suppl 1):S9–14.
  29. Hu F, Guo Y, Yang Y, Zheng Y, Wu S, Jiang X, et al.; China Antimicrobial Surveillance Network (CHINET) Study Group. Resistance reported from China antimicrobial surveillance network (CHINET) in 2018. Eur J Clin Microbiol Infect Dis. 2019;38:2275–81.
  30. Huang H, Chen B, Liu G, Ran J, Lian X, Huang X, et al. A multi-center study on the risk factors of infection caused by multi-drug resistant Acinetobacter baumannii. BMC Infect Dis. 2018;18:11.
  31. Bassetti M, Righi E, Vena A, Graziano E, Russo A, Peghin M. Risk stratification and treatment of ICU-acquired pneumonia caused by multidrug- resistant/extensively drug-resistant/pandrug-resistant bacteria. Curr Opin Crit Care. 2018;24:385–93.
  32. Freire MP, de Oliveira Garcia D, Garcia CP, Campagnari Bueno MF, Camargo CH, Kono Magri ASG, et al. Bloodstream infection caused by extensively drug-resistant Acinetobacter baumannii in cancer patients: high mortality associated with delayed treatment rather than with the degree of neutropenia. Clin Microbiol Infect. 2016;22:352–8.
  33. Yamada K, Yanagihara K, Araki N, Harada Y, Morinaga Y, Akamatsu N, et al. Clinical characteristics of tertiary hospital patients from whom Acinetobacter calcoaceticus-Acinetobacter baumannii complex strains were isolated. Intern Med. 2012;51:51–7.
  34. Jang TN, Lee SH, Huang CH, Lee CL, Chen WY. Risk factors and impact of nosocomial Acinetobacter baumannii bloodstream infections in the adult intensive care unit: a case-control study. J Hosp Infect. 2009;73:143–50.
  35. Mor A, Thomsen RW, Ulrichsen SP, Sørensen HT. Chronic heart failure and risk of hospitalization with pneumonia: a population-based study. Eur J Intern Med. 2013;24:349–53.
  36. Ehrmann S, Roche-Campo F, Sferrazza Papa GF, Isabey D, Brochard L, Apiou-Sbirlea G; REVA research network. Aerosol therapy during mechanical ventilation: an international survey. Intensive Care Med. 2013;39:1048–56.
  37. Hashemian SM, Mortaz E, Jamaati H, Bagheri L, Mohajerani SA, Garssen J, et al. Budesonide facilitates weaning from mechanical ventilation in difficult-to-wean very severe COPD patients: Association with inflammatory mediators and cells. J Crit Care. 2018;44:161–7.
  38. Ju YN, Yu KJ, Wang GN. Budesonide ameliorates lung injury induced by large volume ventilation. BMC Pulm Med. 2016;16:90.
  39. Yang M, Zhang Y, Chen H, Lin J, Zeng J, Xu Z. Inhaled corticosteroids and risk of upper respiratory tract infection in patients with asthma: a meta-analysis. Infection. 2019;47:377–85.
  40. Yang M, Chen H, Zhang Y, Du Y, Xu Y, Jiang P, et al. Long-term use of inhaled corticosteroids and risk of upper respiratory tract infection in chronic obstructive pulmonary disease: a meta-analysis. Inhal Toxicol. 2017;29:219–26.
  41. McKeever T, Harrison TW, Hubbard R, Shaw D. Inhaled corticosteroids and the risk of pneumonia in people with asthma: a case-control study. Chest. 2013;144:1788–94.
  42. Wang J, Li F, Tian Z. Role of microbiota on lung homeostasis and diseases. Sci China Life Sci. 2017;60:1407–15.
  43. Sze MA, Dimitriu PA, Hayashi S, Elliott WM, McDonough JE, Gosselink JV, et al. The lung tissue microbiome in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2012;185:1073–80.
  44. Hilty M, Burke C, Pedro H, Cardenas P, Bush A, Bossley C, et al. Disordered microbial communities in asthmatic airways. PLoS One. 2010;5:e8578.
  45. Laroumagne S, Lepage B, Hermant C, Plat G, Phelippeau M, Bigay-Game L, et al. Bronchial colonisation in patients with lung cancer: a prospective study. Eur Respir J. 2013;42:220–9.
  46. Dickson RP, Singer BH, Newstead MW, Falkowski NR, Erb-Downward JR, Standiford TJ, et al. Enrichment of the lung microbiome with gut bacteria in sepsis and the acute respiratory distress syndrome. Nat Microbiol. 2016;1:16113.
  47. Dickson RP, Erb-Downward JR, Huffnagle GB. Towards an ecology of the lung: new conceptual models of pulmonary microbiology and pneumonia pathogenesis. Lancet Respir Med. 2014;2:238–46.
  48. Lai Y, Gallo RL. AMPed up immunity: how antimicrobial peptides have multiple roles in immune defense. Trends Immunol. 2009;30:131–41.
  49. Ramsheh MY, Haldar K, Esteve-Codina A, Purser LF, Richardson M, Müller-Quernheim J, et al. Lung microbiome composition and bronchial epithelial gene expression in patients with COPD versus healthy individuals: a bacterial 16S rRNA gene sequencing and host transcriptomic analysis. Lancet Microbe. 2021;2:e300–10.
  50. Huang C, Yu Y, Du W, Liu Y, Dai R, Tang W, et al. Fungal and bacterial microbiome dysbiosis and imbalance of trans-kingdom network in asthma. Clin Transl Allergy. 2020;10:42.
« Return to: Acinetobacter baumannii Among Patients Receiving Glucocorticoid Aerosol Therapy During Invasive Mechanical Ventilation, China