Home About us Articles Multimedia Search Instructions Login 
IF 2017: 1.596 (® Clarivate Analytics)
Total Cites: 7606
Q2 in Medicine, General & Internal
Follow Us
Follow Us
  • Users Online: 1709
  • Home
  • Print this page
  • Email this page

 Table of Contents  
Year : 2015  |  Volume : 128  |  Issue : 20  |  Page : 2792-2797

Distribution of Major Pathogens from Sputum and Bronchoalveolar Lavage Fluid in Patients with Noncystic Fibrosis Bronchiectasis: A Systematic Review

Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China

Date of Submission15-Apr-2015
Date of Web Publication15-Oct-2015

Correspondence Address:
Dr. Jin-Fu Xu
Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai 200433
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0366-6999.167360

Rights and Permissions

Objective: Noncystic fibrosis (non-CF) bronchiectasis remains as a common health problem in Asia. Pathogens' distribution in airways of patients with non-CF bronchiectasis is important for doctors to make right decision.
Data Sources: We performed this systematic review on the English language literatures from 1966 to July 2014, using various search terms included "pathogens" or "bacteria" or "microbiology" and "bronchiectasis" or "non-cystic fibrosis bronchiectasis" or "non-CF bronchiectasis" or "NCFB."
Study Selection: We included studies of patients with the confirmed non-CF bronchiectasis for which culture methods were required to sputum or bronchoalveolar lavage fluid (BALF). Weighted mean isolation rates for Haemophilus influenzae, Pseudomonas aeruginosa, Streptococcus pneumoniae, Stapylococcus aureus, Moxarella catarrhails were compared according to different methodology.
Results: The total mean bacterial culture positive rates were 63%. For studies using sputum samples, the mean positive culture rates were 74%. For studies using BALF alone or BALF and sputum, it was 48%. The distributions of main bacterial strains were 29% for H. influenzae, 28% for P. aeruginosa, 11% for S. pneumoniae, 12% for S. aureus, and 8% for M. catarrhails with methodology of sputum. Meanwhile, the bacterial distributions were 37% for H. influenzae, 8% for P. aeruginosa, 14% for S. pneumoniae, 5% for S. aureus, and 10% for M. catarrhails with methodology of BALF alone or BALF and sputum. Analysis of the effect of different methodology on the isolation rates revealed some statistically significant differences.
Conclusions: H. influenzae accounted for the highest percentage in different methodology. Our results suggested that the total positive culture rates and the proportion of P. aeruginosa from sputum and BALF specimens had significant differences, which can be used in further appropriate recommendations for the treatment of non-CF bronchiectasis.

Keywords: Bronchiectasis; Bronchoalveolar Lavage Fluid; Pathogens; Sputum

How to cite this article:
Miao XY, Ji XB, Lu HW, Yang JW, Xu JF. Distribution of Major Pathogens from Sputum and Bronchoalveolar Lavage Fluid in Patients with Noncystic Fibrosis Bronchiectasis: A Systematic Review. Chin Med J 2015;128:2792-7

How to cite this URL:
Miao XY, Ji XB, Lu HW, Yang JW, Xu JF. Distribution of Major Pathogens from Sputum and Bronchoalveolar Lavage Fluid in Patients with Noncystic Fibrosis Bronchiectasis: A Systematic Review. Chin Med J [serial online] 2015 [cited 2018 Nov 20];128:2792-7. Available from: http://www.cmj.org/text.asp?2015/128/20/2792/167360

  Introduction Top

Bronchiectasis is a heterogeneous and progressive respiratory disease. It is characterized by recurrent cough, sputum production, and recurrent respiratory infections. These patients had chronic colonization or infection of pathogens, the underlying pathological process can be understood as a vicious circle caused by chronic infection. [1],[2] The two main pathogens isolated have been reported as Haemophilus influenzae (mean of 42% and a range of 29-70%) and Pseudomonas aeruginosa (mean of 18% and range of 12-33%). [3] Most studies used sputum culture, mainly as a simple noninvasive and inexpensive procedure, although it may combine with oropharyngeal flora which comes from upper airways. On the contrary, bronchoalveolar lavage fluid (BALF) can avoid oropharyngeal flora and provide bacterial samples of lower airways. Therefore, BALF specimens are the golden standard for evaluating lower airway microorganisms and inflammation in adults as well as in young children who are unable to expectorate sputum. [4] Studies using BALF techniques have shown that H. influenzae and P. aeruginosa may be isolated from 60% to 90% of these patients. [5]

Some studies show that 40-67% of children with bronchiectasis have respiratory bacteria pathogens in their sputum with H. influenzae and Streptococcus pneumoniae as the most commonly bacteria. [6],[7] Stockley et al. achieved sputum of 12 adult bronchiectasis patients found that the most common infecting organisms isolated are H. influenzae and S. pneumoniae. [8] P. aeruginosa, particulaly, tends to be of more amount than H. influenzae. A study by Ho indicated that P. aeruginosa rank the first followed by H. influenza. [9]

Although there are some studies using varying culture methods under different conditions that have obtained the isolation rates of bacteria from the airway of noncystic fibrosis (non-CF) bronchiectasis, previous studies reported various confusing results on the rates of cultural bacteria. It is generally believed that H. influenzae account for the highest, but there was a trend toward more P. aeruginosa and less H. influenzae. And, there was no study making a systematic evaluation and calculation about the proportion of pathogenic bacteria caused by different culture samples. Therefore, the purpose of this study was to find out the real prevalence of pathogens isolated from patients with non-CF bronchiectasis and whether different culture samples would cause different results through a systematic review of the data provided by those enrolled studies.

  Methods Top

Selection of studies

A retrospective review of the English language literature was performed for inclusion using the following criteria: (1) With the aim of non-CF bronchiectasis patients, and the diagnosis of bronchiectasis was confirmed radiologically by high-resolution computed tomography; (2) The literatures from the period 1966 to 2014 that were restricted to English language literatures and human studies; (3) Articles contained the isolation rates of pathogens. The search included the following databases: PubMed, EMBASE, Web of Science, Cochrane Libray, and Controlled Trials metaRegister. The search terms included "pathogens" or "bacteria" or "microbiology" and "bronchiectasis" or "non-cystic fibrosis bronchiectasis" or "non-CF bronchiectasis" or "NCFB."

All studies with abstracts that either met the inclusion criteria or did not provide sufficient information were then reviewed for exclusion. Studies were excluded if: (1) Articles were not in the English language; (2) They involved CF bronchiectasis patients; (3) Using either other culture technique such as nasopharyngeal and deep nasal swab; (4) Data could not be extracted by the statistical methods. Also, the references of each article were reviewed for inclusion or exclusion.

Data extraction

Basic graphic information was obtained from each studies. Items included culture technique (either sputum or BALF alone or BALF and sputum), median age, sex percentages, the number of patients who had culture performed, the number of patients who had positive culture rates, the isolation rates of the interested pathogens (H. influenzae, P. aeruginosa, S. pneumoniae, Stapylococcus aureus, Moxarella catarrhails), studies locations, studies years, status, and forced expiratory volume in 1 s (FEV 1 ).

Statistical analysis

Studies analyses were conducted by STATA version 12.0 (STATA, College Station, Texas, USA). Culture rates of each specific pathogen were computed per article, such data were pooled and mean isolation rates were weighted according to the different samples. The nonparametric test was performed to determine the statistical differences of specific pathogens isolation rates and positive culture rates between the different samples.

  Results Top

The initial search had gained 2848 abstracts or articles. In all, 949 duplicates were removed, 1899 abstracts or articles were screened for eligibility. These articles were evaluated, and after a more full and deeply evaluation, 1856 articles were excluded [Figure 1]. At last, 30 articles were enrolled for final analysis [Table 1]. Among the 30 final articles, 19 articles reported the use of sputum for culture, 8 articles reported BALF results alone, and 4 studies reported BALF and sputum results. Among a total number of 3073 patients, 2358 patients had positive culture results (9 articles did not list the number of positive culture results). The weighted mean positive culture rates of 2358 non-CF bronchiectasis patients was 65% (95% confidence interval [CI]: 55-75%). For sputum samples, mean positive culture rates of 1905 patients was 75% (95% CI: 66-84%). Five hundred and twelve patients using BALF alone or BALF and sputum for culture was 48% (95% CI: 33-63%). Data comparing between the different method of positive culture rates results are shown in [Table 2].
Figure 1: Flow diagram of the process of selection of included studies. Flow chart depicts the selection process at each stage.

Click here to view
Table 1: Characteristics of and isolation rates in 30 studies of noncystic fibrosis

Click here to view
Table 2: Percentages of patients who had positive culture results

Click here to view

Thirty articles were weighted mean values for analyses of the isolation rates of the 5 major pathogens. Nineteen articles reported H. influenzae from sputum samples, the mean isolation rate was 29% (95% CI: 23-36%), 12 articles reported using BALF alone or BALF and sputum method and the mean isolation rate was 37% (95% CI: 29-44%). For P. aeruginosa, 19 articles using sputum method and mean isolation rate was 28% (95 : 21-34%), 9 articles using BALF alone or BALF and sputum method and mean isolation rate was 8% (95% CI: 5-11%) [Table 3]. For S. pneumonia, 14 articles reported mean isolation rate as 11% (95% CI: 7-14%) by sputum culture, 12 articles using BALF alone or BALF and sputum method was 14% (95% CI: 9-19%). Ten articles of mean isolation rate cultured from sputum for S. aureus was 12% (95% CI: 7-16%), 8 articles with BALF or BALF and sputum results was 5% (95% CI: 3-6%) [Table 3]. Thirteen articles reported mean isolation rate cultured from sputum for Moxarella catarrhalis was 8% (95% CI: 5-11%), 8 articles with BALF or BALF and sputum results was 10% (95% CI: 5-15%) [Table 3].
Table 3: Weighted mean isolation rates according to the culture technique used in the studies

Click here to view

Analyses were performed to determine whether isolation rates were affected by the two different methods of culture performed [Table 3]. The isolation rates of five major pathogens except P. aeruginosa had no significant statistical difference. While P. aeruginosa was isolated more frequently in studies using sputum than those using BALF or BALF and sputum for culture (28% vs. 8%; P = 0.004). We also analyzed whether there are some statistical differences between major pathogens rates using two different methods among adults and children. Results of this analysis showed P. aeruginosa has a significant statistical difference among adults and children in sputum samples (33% vs. 6%; P = 0.029), while other four isolation rates of pathogens have no statistical difference.

  Discussion Top

The characteristics of brochiectasis are progressive inflammation and a cycle of worsening pulmonary damage. As a long-term disease which is hard to clear, appropriate further treatments and antibiotics use on bronchiectasis should be based on the exact prevalence percentages of pathogens. However, the microbiology of bronchiectasis varies among in different studies. This meta-analysis summarized and analyzed 30 articles of pathogens of non-CF bronchiectasis. Our results showed that H. influenzae accounted for the highest percentage in two kinds of culture methods. Sputum and BALF specimens suggested that the total positive culture rates and the proportion of P. aeruginosa had significant differences. Total positive culture rates in sputum specimens were higher than those in BALF specimens, which revealed that the results from sputum may combine with oropharyngeal flora from upper airways, as BALF are the golden standard for evaluating lower airway microorganisms and inflammation. [4]

King conducted several studies showing that H. influenzae ranked the first common pathogen (range: 29-70%), P. aeruginosa followed as range of 12-31%. [37] While Shah et al. found that 32% for H. influenzae, 14% for S. pneumoniae, 8% for M. catarrhails, 5% for S. aureus, and 2% for P. aeruginosa. Some studies of sputum microbiology and bronchoscopic sampling revealed that S. aureus occurred in non-CF bronchiectasis patients of 4-10%. [38] Stockley et al. found that the most common infected organisms isolated are H. influenzae and S. pneumoniae. In our study, the mean isolation rates was 29% for H. influenzae, 28% for P. aeruginosa by using sputum, which were in accordance with King's results. We found 11% for S. pneumoniae, 12% for S. aureus, and 8% for M. catarrhalis, which were similar with Shah study except the isolate rates of P. aeruginosa, which focused on children. Our study explored whether there were statistical differences between major pathogens rates by using two different methods among adults and children. Results of this analysis showed that P. aeruginosa had a significant statistical difference among adults and children, while other four isolation rates of pathogens did not. This result can best interpret Shah's study that P. aeruginosa rate was lower in children. Clinically, patients with P. aeruginosa infected in non-CF bronchiectasis would bring about a more rapid decline in lung function and earlier mortality. [2] Hence, more attention should be paid to P. aeruginosa. Recommendations for antibiotic therapy for non-CF bronchiectasis are periodically reviewed and updated by the British Thoracic Society. [1] These recommended uses were combination of antibiotics not required in patients colonized with H. influenzae, M. catarrhalis, S. aureus, and S. pneumoniae. In patients with P. aeruginosa, who are sensitive to ciprofloxacin, monotherapy with oral ciprofloxacin can be used as a first-line treatment.

In this study, we extracted FEV 1 data from the included articles. Articles that only part of patients did lung function in a study or did not provide any data on lung function were excluded. Then we divided the patients involved into three groups, <50%, 50-73%, and more than 73%, respectively. There was no obvious difference in the distribution of pathogens, which may be due to the relatively small number of sample, or the different health states of the patients. We revealed that S. aureus is increasing compared to the previous studies. Our study also found the positive culture rates of different methods had the obvious statistical difference (74% vs. 48%, P = 0.000). However, the isolation rates of four pathogens excepted P. aeruginosa (28% vs. 8%) using different methods have no statistical difference.

This study, like any systematic reviews, is limited by pool potential heterogeneous data. The included articles resulted from different countries, patients may have different races or may have different medical resources and conditions or some patients may obtain antibiotics before the study although there is no evidence showing that using antibiotics would change bacteria distribution. As a result, data derived from these studies may not actually show the true prevalence of five major pathogens in non-CF bronchiectasis.

  Conclusions Top

The data suggest that H. influenzae ranks the first as a major pathogen in non-CF bronchiectasis, followed by P. aeruginosa, S. pneumoniae, S. aureus, and M. catarrhalis. Methods using sputum or BALF have some statistical differences. The treatment of non-CF bronchiectasis patients may be according with the prevalence data from this study.

Financial support and sponsorship

This work was supported by grants from the National Natural Science Foundation of China (Nos. 81170003, 81370109), Science and Technology Commission of Shanghai Municipality (Nos. 134119a6400, 12JC1402300) and Shanghai Municipal Education Commission (No. 13SG21).

Conflicts of interest

There are no conflicts of interest.

  References Top

Pasteur MC, Bilton D, Hill AT; British Thoracic Society Bronchiectasis non-CF Guideline Group. British Thoracic Society guideline for non-CF bronchiectasis. Thorax 2010;65 Suppl 1:i1-58.  Back to cited text no. 1
Chalmers JD, Hill AT. Mechanisms of immune dysfunction and bacterial persistence in non-cystic fibrosis bronchiectasis. Mol Immunol 2013;55:27-34.  Back to cited text no. 2
King PT, Holdsworth SR, Freezer NJ, Villanueva E, Holmes PW. Microbiologic follow-up study in adult bronchiectasis. Respir Med 2007;101:1633-8.  Back to cited text no. 3
Nicolai T. Pediatric bronchoscopy. Pediatr Pulmonol 2001;31:150-64.  Back to cited text no. 4
Cabello H, Torres A, Celis R, El-Ebiary M, Puig de la Bellacasa J, Xaubet A, et al. Bacterial colonization of distal airways in healthy subjects and chronic lung disease : A bronchoscopic study. Eur Respir J 1997;10:1137-44.  Back to cited text no. 5
Karadag B, Karakoc F, Ersu R, Kut A, Bakac S, Dagli E. Non-cystic-fibrosis bronchiectasis in children : A persisting problem in developing countries. Respiration 2005;72:233-8.  Back to cited text no. 6
Edwards EA, Asher MI, Byrnes CA. Paediatric bronchiectasis in the twenty-first century : Experience of a tertiary children′s hospital in New Zealand. J Paediatr Child Health 2003;39:111-7.  Back to cited text no. 7
Stockley RA, Hill SL, Morrison HM. Effect of antibiotic treatment on sputum elastase in bronchiectatic outpatients in a stable clinical state. Thorax 1984;39:414-9.  Back to cited text no. 8
Ho PL, Chan KN, Ip MS, Lam WK, Ho CS, Yuen KY, et al. The effect of Pseudomonas aeruginosa infection on clinical parameters in steady-state bronchiectasis. Chest 1998;114:1594-8.  Back to cited text no. 9
Pang JA, Cheng A, Chan HS, Poon D, French G. The bacteriology of bronchiectasis in Hong Kong investigated by protected catheter brush and bronchoalveolar lavage. Am Rev Respir Dis 1989;139:14-7.  Back to cited text no. 10
Rayner CF, Tillotson G, Cole PJ, Wilson R. Efficacy and safety of long-term ciprofloxacin in the management of severe bronchiectasis. J Antimicrob Chemother 1994;34:149-56.  Back to cited text no. 11
Tsang KW, Ho PI, Chan KN, Ip MS, Lam WK, Ho CS, et al. A pilot study of low-dose erythromycin in bronchiectasis. Eur Respir J 1999;13:361-4.  Back to cited text no. 12
Pasteur MC, Helliwell SM, Houghton SJ, Webb SC, Foweraker JE, Coulden RA, et al. An investigation into causative factors in patients with bronchiectasis. Am J Respir Crit Care Med 2000;162 (4 Pt 1):1277-84.  Back to cited text no. 13
Angrill J, Agustí C, De Celis R, Filella X, Rañó A, Elena M, et al. Bronchial inflammation and colonization in patients with clinically stable bronchiectasis. Am J Respir Crit Care Med 2001;164:1628-32.  Back to cited text no. 14
Chang AB, Boyce NC, Masters IB, Torzillo PJ, Masel JP. Bronchoscopic findings in children with non-cystic fibrosis chronic suppurative lung disease. Thorax 2002;57:935-8.  Back to cited text no. 15
Palwatwichai A, Chaoprasong C, Vattanathum A, Wongsa A, Jatakanon A. Clinical, laboratory findings and microbiologic characterization of bronchiectasis in Thai patients. Respirology 2002;7:63-6.  Back to cited text no. 16
Angrill J, Agustí C, de Celis R, Rañó A, Gonzalez J, Solé T, et al. Bacterial colonisation in patients with bronchiectasis: Microbiological pattern and risk factors. Thorax 2002;57:15-9.  Back to cited text no. 17
Davies G, Wilson R. Prophylactic antibiotic treatment of bronchiectasis with azithromycin. Thorax 2004;59:540-1.  Back to cited text no. 18
Eastham KM, Fall AJ, Mitchell L, Spencer DA. The need to redefine non-cystic fibrosis bronchiectasis in childhood. Thorax 2004;59:324-7.  Back to cited text no. 19
Lai SH, Wong KS, Liao SL. Clinical analysis of bronchiectasis in Taiwanese children. Chang Gung Med J 2004;27:122-8.  Back to cited text no. 20
Li AM, Sonnappa S, Lex C, Wong E, Zacharasiewicz A, Bush A, et al. Non-CF bronchiectasis : Does knowing the aetiology lead to changes in management? Eur Respir J 2005;26:8-14.  Back to cited text no. 21
Banjar HH. Clinical profile of Saudi children with bronchiectasis. Indian J Pediatr 2007;74:149-52.  Back to cited text no. 22
Martínez-García MA, Soler-Cataluña JJ, Perpiñá-Tordera M, Román-Sánchez P, Soriano J. Factors associated with lung function decline in adult patients with stable non-cystic fibrosis bronchiectasis. Chest 2007;132:1565-72.  Back to cited text no. 23
Kapur N, Masters IB, Chang AB. Exacerbations in noncystic fibrosis bronchiectasis: Clinical features and investigations. Respir Med 2009;103:1681-7.  Back to cited text no. 24
Hare KM, Grimwood K, Leach AJ, Smith-Vaughan H, Torzillo PJ, Morris PS, et al. Respiratory bacterial pathogens in the nasopharynx and lower airways of Australian indigenous children with bronchiectasis. J Pediatr 2010;157:1001-5.  Back to cited text no. 25
Macfarlane JG, McAlinden P, De Soyza A. Longitudinal study of sputum microbiology in adult Non-CF bronchiectasis. Thorax 2010;65:A177.  Back to cited text no. 26
Kapur N, Grimwood K, Masters IB, Morris PS, Chang AB. Lower airway microbiology and cellularity in children with newly diagnosed non-CF bronchiectasis. Pediatr Pulmonol 2012;47:300-7.  Back to cited text no. 27
Murray MP, Govan JR, Doherty CJ, Simpson AJ, Wilkinson TS, Chalmers JD, et al. A randomized controlled trial of nebulized gentamicin in non-cystic fibrosis bronchiectasis. Am J Respir Crit Care Med 2011;183:491-9.  Back to cited text no. 28
Sahabudeen WA, Smith DL. Longitudinal microbiology of adult Non-CF brochiectasis. Thorax 2011;66:A49.  Back to cited text no. 29
Chalmers JD, Smith MP, McHugh BJ, Doherty C, Govan JR, Hill AT. Short- and long-term antibiotic treatment reduces airway and systemic inflammation in non-cystic fibrosis bronchiectasis. Am J Respir Crit Care Med 2012;186:657-65.  Back to cited text no. 30
Hare KM, Leach AJ, Morris PS, Smith-Vaughan H, Torzillo P, Bauert P, et al. Impact of recent antibiotics on nasopharyngeal carriage and lower airway infection in Indigenous Australian children with non-cystic fibrosis bronchiectasis. Int J Antimicrob Agents 2012;40:365-9.  Back to cited text no. 31
Smith DJ, Anderson GJ, Bell SC, Reid DW. Elevated metal concentrations in the CF airway correlate with cellular injury and disease severity. J Cyst Fibros 2014;13:289-95.  Back to cited text no. 32
Wilson R, Welte T, Polverino E, De Soyza A, Greville H, O′Donnell A, et al. Ciprofloxacin dry powder for inhalation in non-cystic fibrosis bronchiectasis : A phase II randomised study. Eur Respir J 2013;41:1107-15.  Back to cited text no. 33
Rogers GB, van der Gast CJ, Cuthbertson L, Thomson SK, Bruce KD, Martin ML, et al. Clinical measures of disease in adult non-CF bronchiectasis correlate with airway microbiota composition. Thorax 2013;68:731-7.  Back to cited text no. 34
Pizzutto SJ, Grimwood K, Bauert P, Schutz KL, Yerkovich ST, Upham JW, et al. Bronchoscopy contributes to the clinical management of indigenous children newly diagnosed with bronchiectasis. Pediatr Pulmonol 2013;48:67-73.  Back to cited text no. 35
Chalmers JD, Goeminne P, Aliberti S, McDonnell MJ, Lonni S, Davidson J, et al. The bronchiectasis severity index. An international derivation and validation study. Am J Respir Crit Care Med 2014;189:576-85.  Back to cited text no. 36
King PT. The pathophysiology of bronchiectasis. Int J Chron Obstruct Pulmon Dis 2009;4:411-9.  Back to cited text no. 37
Shah PL, Mawdsley S, Nash K, Cullinan P, Cole PJ, Wilson R. Determinants of chronic infection with Staphylococcus aureus in patients with bronchiectasis. Eur Respir J 1999;14:1340-4.  Back to cited text no. 38


  [Figure 1]

  [Table 1], [Table 2], [Table 3]

This article has been cited by
1 The Prevalence and Significance of Staphylococcus aureus in Patients with Non–Cystic Fibrosis Bronchiectasis
Mark L. Metersky,Timothy R. Aksamit,Alan Barker,Radmila Choate,Charles L. Daley,Leigh A. Daniels,Angela DiMango,Edward Eden,David Griffith,Margaret Johnson,Michael Knowles,Anne E. O’Donnell,Kenneth Olivier,Matthias Salathe,Byron Thomashow,Gregory Tino,Gerard Turino,Kevin L. Winthrop,David Mannino
Annals of the American Thoracic Society. 2018; 15(3): 365
[Pubmed] | [DOI]
2 Understanding the Role of Staphylococcus aureus in Non–Cystic Fibrosis Bronchiectasis: Where Are We Now?
Ranjani Somayaji,Kathleen J. Ramos,Lucas R. Hoffman
Annals of the American Thoracic Society. 2018; 15(3): 310
[Pubmed] | [DOI]
3 Comparison of Bronchoalveolar Lavage and Sputum Microbiology in Patients with Primary Ciliary Dyskinesia
Nagehan Emiralioglu,Banu Sancak,Gökcen Dilsa Tugcu,Burcin Sener,Ebru Yalcin,Deniz Dogru,Nural Kiper,Ugur Ozcelik
Pediatric Allergy, Immunology, and Pulmonology. 2017; 30(1): 14
[Pubmed] | [DOI]
4 Diagnostic Value of Nasopharyngeal Aspirates in Children with Lower Respiratory Tract Infections
Ai-Zhen Lu,Peng Shi,Li-Bo Wang,Li-Ling Qian,Xiao-Bo Zhang
Chinese Medical Journal. 2017; 130(6): 647
[Pubmed] | [DOI]
5 Macrolides protect against Pseudomonas aeruginosa infection via inhibition of inflammasomes
Li-Chao Fan,Jie-Lu Lin,Jia-Wei Yang,Bei Mao,Hai-Wen Lu,Bao-Xue Ge,Augustine M. K. Choi,Jin-Fu Xu
American Journal of Physiology-Lung Cellular and Molecular Physiology. 2017; 313(4): L677
[Pubmed] | [DOI]
6 Swimming Motility Mediates the Formation of Neutrophil Extracellular Traps Induced by Flagellated Pseudomonas aeruginosa
Madison Floyd,Matthew Winn,Christian Cullen,Payel Sil,Benoit Chassaing,Dae-goon Yoo,Andrew T. Gewirtz,Joanna B. Goldberg,Linda L. McCarter,Balázs Rada,Vincent T Lee
PLOS Pathogens. 2016; 12(11): e1005987
[Pubmed] | [DOI]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Article Figures
Article Tables

 Article Access Statistics
    PDF Downloaded358    
    Comments [Add]    
    Cited by others 6    

Recommend this journal