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Lower respiratory Tract Infection (LRTI) is one of the fourth most common cause of mortality across the globe, and constitutes to be a major portion in critically ill patients associated with prolonged hospitalisation. Apart from age factor, other risk factors which predispose to the LRTI include poor sanitization, severe malnutrition, and lack of breast feeding for infants, HIV infection, lack of immunization, chronic illness, family history of LRTI and exposure to tobacco smoke/air pollutants. The third generation cephalosporins are used in management and treatment of gram-negative and gram-positive organism. Common bacteria implicated in these infections include S. pneumoniae, H. influenzae, Chlamydia pneumoniae, and Staphylococcus aureus. Third generation cephalosporins also target respiratory ailments like acute bronchitis, pneumonia, acute exacerbation of chronic lung diseases (such as COPD or bronchiectasis).  Cefotaxime and ceftriaxone have been widely recommended in guidelines to be used for many infections and diseases, but, some serious adverse effects have been seen in past few years with ceftriaxone like cholelithiasis, encephalopathy, memory impairment, tonic- clonic seizures, neurotoxicity and auto-immune haemolytic anaemia. This fact compels us to revisit the clinically safer and efficacious drug Cefotaxime which have been used since decades but have not developed any resistance till date. Cefotaxime has been found to be well tolerated and not associated with hypo-prothrombinemia/coagulopathies, disulfiram-like reactions, as with other cephalosporins. It can readily cross the blood-brain barrier when administered intravenously and may treat gram-negative infections resistant to previous generations of cephalosporins. Cefotaxime, demonstrates good efficacy and safety in the management of LRTIs including CAP, hospital acquired/nosocomial acquired pneumonia, acute exacerbation of pneumonia and acute bronchitis caused by both gram positive as well as gram negative bacteria. Keywords: LRTI, Cefotaxime, cephalosporins, CAP, pneumonia, respiratory tract

PurposeLower respiratory tract infections (LRTI) are the most frequent infectious complication in patients admitted to the intensive care unit (ICU). We aim to report the clinical characteristics of ICU-admitted patients due to nosocomial LRTI and to describe their microbiology and clinical outcomes.MethodsA prospective observational study was conducted in 13 countries over two continents from 9th May 2016 until 16th August 2019. Characteristics and outcomes of ventilator-associated pneumonia (VAP), ventilator-associated tracheobronchitis (VAT), ICU hospital-acquired pneumonia (ICU-HAP), HAP that required invasive ventilation (VHAP), and HAP in patients transferred to the ICU without invasive mechanical ventilation were collected. The clinical diagnosis and treatments were per clinical practice and not per protocol. Descriptive statistics were used to compare the study groups.Results1060 patients with LRTI (72.5% male sex, median age 64 [50–74] years) were included in the study; 160 (15.1%) developed VAT, 556 (52.5%) VAP, 98 (9.2%) ICU-HAP, 152 (14.3%) HAP, and 94 (8.9%) VHAP. Patients with VHAP had higher serum procalcitonin (PCT) and Sequential Organ Failure Assessment (SOFA) scores. Patients with VAP or VHAP developed acute kidney injury, acute respiratory distress syndrome, multiple organ failure, or septic shock more often. One thousand eight patients had microbiological samples, and 711 (70.5%) had etiological microbiology identified. The most common microorganisms were Pseudomonas aeruginosa (18.4%) and Klebsiella spp (14.4%). In 382 patients (36%), the causative pathogen shows some antimicrobial resistance pattern. ICU, hospital and 28-day mortality were 30.8%, 37.5% and 27.5%, respectively. Patients with VHAP had the highest ICU, in-hospital and 28-day mortality rates.ConclusionVHAP patients presented the highest mortality among those admitted to the ICU. Multidrug-resistant pathogens frequently cause nosocomial LRTI in this multinational cohort study.

Abstract Rationale Lower respiratory tract illness is a major cause of childhood morbidity and mortality. It is unknown whether infants are predisposed to illness because of impaired lung function or whether respiratory illness reduces lung function. Objectives To investigate the impact of early life exposures, including lower respiratory tract illness, on lung function during infancy. Methods Infants enrolled in the Drakenstein child health study had lung function at 6 weeks and 1 year. Testing during quiet natural sleep included tidal breathing, exhaled nitric oxide, and multiple breath washout measures. Risk factors for impaired lung health were collected longitudinally. Lower respiratory tract illness surveillance was performed and any episode investigated. Measurements and Main Results Lung function was tested in 648 children at 1 year. One hundred and fifty (29%) infants had a lower respiratory tract illness during the first year of life. Lower respiratory tract illness was independently associated with increased respiratory rate (4%; 95% confidence interval [CI], 1.01–1.08; P = 0.02). Repeat episodes further increased respiratory rate (3%; 95% CI, 1.01–1.05; P = 0.004), decreased tidal volume (−1.7 ml; 95% CI, −3.3 to −0.2; P = 0.03), and increased the lung clearance index (0.13 turnovers; 95% CI, 0.04–0.22; P = 0.006) compared with infants without illness. Tobacco smoke exposure, lung function at 6 weeks, infant growth, and prematurity were other independent predictors of lung function at 1 year. Conclusions Early life lower respiratory tract illness impairs lung function at 1 year, independent of baseline lung function. Preventing early life lower respiratory tract illness is important to optimize lung function and promote respiratory health in childhood.

Respiratory syncytial virus (RSV) is responsible for a significant proportion of global morbidity and mortality affecting young children and older adults. In the aftermath of formalin-inactivated RSV vaccine development, the effort to develop an immunizing agent was carefully guided by epidemiologic and pathophysiological evidence of the virus, including various vaccine technologies. The pipeline of RSV vaccine development includes messenger ribonucleic acid (mRNA), live-attenuated (LAV), subunit, and recombinant vector-based vaccine candidates targeting different virus proteins. The availability of vaccine candidates of various technologies enables adjustment to the individualized needs of each vulnerable age group. Arexvy® (GSK), followed by Abrysvo® (Pfizer), is the first vaccine available for market use as an immunizing agent to prevent lower respiratory tract disease in older adults. Abrysvo is additionally indicated for the passive immunization of infants by maternal administration during pregnancy. This review presents the RSV vaccine pipeline, analyzing the results of clinical trials. The key features of each vaccine technology are also mentioned. Currently, 24 vaccines are in the clinical stage of development, including the 2 licensed vaccines. Research in the field of RSV vaccination, including the pharmacovigilance methods of already approved vaccines, promotes the achievement of successful prevention.

Respiratory syncytial virus (RSV) is the leading global cause of respiratory infections in infants and the second most frequent cause of death during the first year of life. This highly contagious seasonal virus is responsible for approximately 3 million hospitalizations and 120,000 deaths annually among children under the age of 5 years. Bronchiolitis is the most common severe manifestation; however, RSV infections are associated with an increased long-term risk for recurring wheezing and the development of asthma. There is an unmet need for new agents and a universal strategy to prevent RSV infections starting at the time of birth. RSV is active between November and April in Italy, and prevention strategies must ensure that all neonates and infants under 1 year of age are protected during the endemic season, regardless of gestational age at birth and timing of birth relative to the epidemic season. Approaches under development include maternal vaccines to protect neonates during their first months, monoclonal antibodies to provide immediate protection lasting up to 5 months, and pediatric vaccines for longer-lasting protection. Meanwhile, improvements are needed in infection surveillance and reporting to improve case identification and better characterize seasonal trends in infections along the Italian peninsula. Rapid diagnostic tests and confirmatory laboratory testing should be used for the differential diagnosis of respiratory pathogens in children. Stakeholders and policymakers must develop access pathways once new agents are available to reduce the burden of infections and hospitalizations.

Introduction Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection (LRTI)-related hospitalizations in older adults. Without RSV-specific treatment for adults, testing is uncommon, leading to potential underestimation of RSV incidence in real-world data studies. This study aimed to quantify the frequency of RSV testing during LRTI-related hospitalizations of older adults to inform interpretation of incidence estimates. Methods Administrative and billing data for hospitalizations of adults aged ≥ 65 years with a primary or secondary diagnosis of LRTI during the 2016–2019 RSV seasons (October–April) were extracted from the US all-payer Premier Healthcare Database (PHD). Billing codes identified RSV tests administered during eligible hospitalizations. The proportion of LRTI-related hospitalizations with a billed RSV test was calculated for each hospital in PHD, and summarized descriptively by hospital bed size, teaching status, and population served. Results Most of the 937 study hospitals performed RSV testing infrequently during LRTI hospitalization; median percentage of LRTI hospitalizations with RSV testing was 4.3%, and 78.4% of hospitals performed RSV testing in less than 25% of LRTI-related hospitalizations. RSV testing varied extensively by hospital type. Median percentage tested was significantly higher for hospitals with ≥ 200 beds (9.1%) versus < 200 beds (1.6%), for teaching (11.0%) versus non-teaching (2.5%) hospitals, and in urban (7.4%) versus rural (0.7%) settings. The median percentage of RSV testing increased over time, from 0.8% to 6.3% between the 2016/17 and 2018/19 seasons. Conclusion A small proportion of older adults hospitalized with LRTI are tested for RSV in US hospitals. Large variability occurs across hospital types. Consequently, retrospective database analyses likely result in a substantial underestimation of the true RSV-related hospitalization incidence. RSV incidence studies using real-world data need to assess for RSV testing frequency and adjust their results for under ascertainment associated with limited testing.

Clesrovimab (MK-1654) is a next-generation monoclonal antibody (mAb) engineered for the prophylaxis of Respiratory Syncytial Virus (RSV or HRSV), a major etiological agent of lower respiratory tract infections in newborns, the elderly, and immunocompromised individuals. Having received regulatory approval in the United States and the United Arab Emirates in 2025, and currently under review in additional global markets, Clesrovimab has demonstrated robust immunoprophylactic efficacy in clinical trials. A single-dose administration provides durable protection, a significant reduction in RSV-associated infections and hospitalizations versus placebo, and a favorable safety profile with a lower incidence of adverse events (AEs) compared with existing standard-of-care interventions. This narrative review summarizes Clesrovimab’s molecular characteristics and clinical development, outlining key improvements observed in late-phase trials. Relevant data were identified through a literature search of PubMed, Scopus, and ClinicalTrials.gov (2018–2025) using the keywords “Clesrovimab,” “MK-1654,” and “respiratory syncytial virus”. A comparative analysis is presented with currently approved RSV-targeting mAbs, such as Palivizumab and Nirsevimab. The aim is to highlight Clesrovimab’s potential as a novel preventive strategy against RSV infection, emphasizing its enhanced binding affinity for the viral fusion (F) protein, superior biodistribution within the respiratory tract, and capacity to provide more effective and sustained protection. These features support its promising role in reducing RSV-related morbidity and mortality among high-risk populations.

Intelligent systems are transforming the world, as well as our healthcare system. We propose a deep learning-based cough sound classification model that can distinguish between children with healthy versus pathological coughs such as asthma, upper respiratory tract infection (URTI), and lower respiratory tract infection (LRTI). To train a deep neural network model, we collected a new dataset of cough sounds, labelled with a clinician’s diagnosis. The chosen model is a bidirectional long–short-term memory network (BiLSTM) based on Mel-Frequency Cepstral Coefficients (MFCCs) features. The resulting trained model when trained for classifying two classes of coughs—healthy or pathology (in general or belonging to a specific respiratory pathology)—reaches accuracy exceeding 84% when classifying the cough to the label provided by the physicians’ diagnosis. To classify the subject’s respiratory pathology condition, results of multiple cough epochs per subject were combined. The resulting prediction accuracy exceeds 91% for all three respiratory pathologies. However, when the model is trained to classify and discriminate among four classes of coughs, overall accuracy dropped: one class of pathological coughs is often misclassified as the other. However, if one considers the healthy cough classified as healthy and pathological cough classified to have some kind of pathology, then the overall accuracy of the four-class model is above 84%. A longitudinal study of MFCC feature space when comparing pathological and recovered coughs collected from the same subjects revealed the fact that pathological coughs, irrespective of the underlying conditions, occupy the same feature space making it harder to differentiate only using MFCC features.

Abstract Severe viral lower respiratory tract infection (LRTI), resulting in both acute and long-term pulmonary disease, constitutes a substantial burden among young children. Viral LRTI triggers local oxidative stress pathways by infection and inflammation, and supportive care in the pediatric intensive care unit may further aggravate oxidative injury. The main goal of this exploratory study was to identify and monitor breath markers linked to oxidative stress in children over the disease course of severe viral LRTI. Exhaled breath was sampled during invasive ventilation, and volatile organic compounds (VOCs) were analyzed using gas chromatography and mass spectrometry. VOCs were selected in an untargeted principal component analysis and assessed for change over time. In addition, identified VOCs were correlated with clinical parameters. Seventy breath samples from 21 patients were analyzed. A total of 15 VOCs were identified that contributed the most to the explained variance of breath markers. Of these 15 VOCs, 10 were previously linked to pathways of oxidative stress. Eight VOCs, including seven alkanes and methyl alkanes, significantly decreased from the initial phase of ventilation to the day of extubation. No correlation was observed with the administered oxygen dose, whereas six VOCs showed a poor to strong positive correlation with driving pressure. In this prospective study of children with severe viral LRTI, the majority of VOCs that were most important for the explained variance mirrored clinical improvement. These breath markers could potentially help monitor the pulmonary oxidative status in these patients, but further research with other objective measures of pulmonary injury is required.

The human respiratory syncytial virus (hRSV) is one of the most important causes of upper and lower respiratory tract infections in children and the main cause of bronchiolitis worldwide. Disease manifestations caused by hRSV may vary from mild to severe, occasionally requiring admission and hospitalization in intensive care units. Despite the high morbidity rates associated to bronchiolitis, treatment options against hRSV are limited and there are no current vaccination strategies to prevent infection. Importantly, the early identification of high-risk patients can help improve disease management and prevent complications associated with hRSV infection. Recently, the characterization of pro- and anti-inflammatory cytokine patterns produced during hRSV-related inflammatory processes has allowed the identification of potential prognosis biomarkers. A suitable biomarker should allow predicting the severity of the infection in a simple and opportune manner and should ideally be obtained from non-invasive samples. Among the cytokines associated with hRSV disease severity, IL-8, interferon-alpha (IFN-alpha), and IL-6, as well as the Th2-type cytokines thymic stromal lymphopoietin (TSLP), IL-3, and IL-33 have been highlighted as molecules with prognostic value in hRSV infections. In this review, we discuss current studies that describe molecules produced by patients during hRSV infection and their potential as biomarkers to anticipate the severity of the disease caused by this virus.