A one-year prospective study of infectious etiology in patients hospitalized with acute exacerbations of COPD and concomitant pneumonia (original) (raw)
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Bacterial etiology in acute hospitalized chronic obstructive pulmonary disease exacerbations
The European Research Journal, 2016
Objectives. The most common cause of acute COPD exacerbation (AECOPD) is the respiratory tract infections. We sought to determine the bacteriological etiology of hospitalized acute exacerbations of COPD requiring hospitalization in consecutive two years. Methods. We aimed to determine the bacteriological etiology underlying in patients whom admitted to Uludag University Faculty of Medicine, Department of Pulmonary Medicine and hospitalized with AECOPD in the last two years. Medical records of the study participants were screened retrospectively and sociodemographic characteristics, routine laboratory tests and sputum culture results were analyzed. Results. A total of 242 patients hospitalized for AECOPD were enrolled. Of these 86.4% (n=209) were male. The mean age of the group was 66.6±11 years old. Sputum cultures were available in the 45 % (n=109) of the study group. The most frequent bacteria isolated from the sputum cultures of the study group were Pseudomonas aeruginosa, Streptococcus pneumonia, Haemophilus influenzae and Acinetobacter baumanii. Length of stay was longer in patients with the A. baumanii isolate than the rest of the group (p=0.024). Length of stay in hospital was independently associated with in-hospital mortality (OR: 1.37, 95% CI: 1.05-1.78). Isolation of A. baumanii and/or Staphylococcus aureus in sputum culture were identified as independent risk factors for prolonged length of stay in-hospital (b=0.26, p=0.008; b=15.40, p=0.003). Conclusions. Our study shows that P. aeruginosa, S. pneumonia, H. influenzae are common sputum isolates in AECOPD patients requiring hospitalization. Isolation of A. baumanii and/or S. aureus in sputum culture is associated with prolonged length of stay in hospital, which is an independent risk factor for in-hospital mortality.
Vojnosanitetski pregled, 2016
Background/Aim. Infection is the major cause of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The aim of the study was to establish the most common bacterial agents of AE-COPD in patients hospitalized in a tertiary medical care institution. Methods. This retrospective study included the patients hospitalized due to infective AE-COPD in the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica in a 12-month period. We evaluated clinical data, spirometry, pathogen etiology in the patients with positive sputum findings and disease outcome. Results. The study included a total of 81 patients, 47 (58.02%) males and 34 (41.97%) females of the mean age of 65.7 years. The mean history of the disease was 14.5 years. The median forced expiratory volume in one second (FEV1) was 30.12%. The most common isolated pathogens was Pseudomonas aeruginosa (n = 36; 38.29%), followed by Haemophilus influenzae (n = 25; 26.59%) and Streptococcus pneumoniae (n = 16; 17.02%)....
Journal of Morphological Sciences, 2021
Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a negative event in disease evolution which leads to higher morbidity and mortality of patients. Infectious agents are the main cause of exacerbations and they can be easily obtainedusing new molecular methods. Our objective was to detect respiratory pathogens in patients hospitalized for severe acute exacerbation of COPD and to analyze their relationship with respiratory failure. We examined sputum from 49 patients (male, n=32) older than 40 years, using multiplex PCR microarray for 34 targets of which 18 bacteria, 9 viruses and 7 markers of antibiotic resistance. Blood gas analyses and other clinical and laboratory measures were provided. Infectious etiology was found in 51% of acute exacerbations in hospitalized patients. Of all sputum samples, influenza A was the most frequently detected respiratory pathogen (n = 9, 18.4%) followed by Haemophilus influenzae (n = 7, 14.3 %). We found asignificant negative correlation between the presence of the type of detected pathogens and the level of pCO2 in the blood (r =-0.437; p = 0.029); thus, the higher the level of pCO2, the greater likelihood that it is a bacterial infection. Detection of sputum bacteria in patients with severe acute exacerbation of COPD can be an independent risk factor for acute hypercapnic respiratory failure.
Infections and Airway Inflammation in Chronic Obstructive Pulmonary Disease Severe Exacerbations
American Journal of Respiratory and Critical Care Medicine, 2006
Severe exacerbations of chronic obstructive pulmonary disease (COPD) are major causes of health care costs mostly related to hospitalization. The role of infections in COPD exacerbations is controversial. Objectives: We investigated whether COPD exacerbations requiring hospitalization are associated with viral and/or bacterial infection and evaluated relationships among infection, exacerbation severity, assessed by reduction of FEV 1 , and specific patterns of airway inflammation. Methods: We examined 64 patients with COPD when hospitalized for exacerbations, and when in stable convalescence. We measured lung function, blood gases, and exhaled nitric oxide, and examined sputum for inflammation and for viral and bacterial infection. Results: Exacerbations were associated with impaired lung function (p Ͻ 0.01) and increased sputum neutrophilia (p Ͻ 0.001). Viral and/or bacterial infection was detected in 78% of exacerbations: viruses in 48.4% (6.2% when stable, p Ͻ 0.001) and bacteria in 54.7% (37.5% when stable, p ϭ 0.08). Patients with infectious exacerbations (29.7% bacterial, 23.4% viral, 25% viral/bacterial coinfection) had longer hospitalizations (p Ͻ 0.02) and greater impairment of several measures of lung function (all p Ͻ 0.05) than those with noninfectious exacerbations. Patients with exacerbations with coinfection had more marked lung function impairment (p Ͻ 0.02) and longer hospitalizations (p ϭ 0.001). Sputum neutrophils were increased in all exacerbations (p Ͻ 0.001) and were related to their severity (p Ͻ 0.001), independently of the association with viral or bacterial infections; sputum eosinophils were increased during (p Ͻ 0.001) virus-associated exacerbations. Conclusions: Respiratory infections are associated with the majority of COPD exacerbations and their severity, especially those with viral/bacterial coinfection. Airway neutrophilia is related to exacerbation severity regardless of viral and/or bacterial infections. Eosinophilia is a good predictor of viral exacerbations.
Bacterial flora in the sputum and comorbidity in patients with acute exacerbations of COPD
International Journal of Chronic Obstructive Pulmonary Disease, 2015
Objective: To determine in patients admitted with an acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) the association between the isolation of potential pathogens in a conventional sputum culture and comorbidities. Patients and methods: The ESMI study is a multicenter observational study. Patients with AE-COPD admitted to the Internal Medicine departments of 70 hospitals were included. The clinical characteristics, treatments, and comorbidities were gathered. The results of conventional sputum cultures were recorded. Results: A total of 536 patients were included, of which 161 produced valid sputum and a potentially pathogenic microorganism was isolated from 88 subjects (16.4%). The isolation of Pseudomonas aeruginosa (30.7%) was associated with a greater severity of the lung disease (previous admissions [P= 0.026], dyspnea scale [P=0.047], post-broncodilator forced expiratory volume in 1 second (FEV 1) [P=0.005], and the BODEx index [P=0.009]); also with higher prevalence of cor pulmonale (P=0.017), heart failure (P=0.048), and cerebrovascular disease (P=0.026). Streptococcus pneumoniae (26.1%) was associated with more comorbidity according to number of diseases (P=0.018); notably, peripheral artery disease (P=0.033), hypertension (P=0.029), dyslipidemia (P=0.039), osteoporosis (P=0.0001), and depression (P=0.005). Conclusion: Patients with AE-COPD and P. aeruginosa present higher severity of COPD, while those with S. pneumoniae present greater comorbidity. The potentially pathogenic microorganism obtained in the sputum culture depends on the associated comorbidities.
Bacterial flora in the sputum and comorbidity in patients with acute exacerbations of COPD
International Journal of Chronic Obstructive Pulmonary Disease, 2015
Objective: To determine in patients admitted with an acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) the association between the isolation of potential pathogens in a conventional sputum culture and comorbidities. Patients and methods: The ESMI study is a multicenter observational study. Patients with AE-COPD admitted to the Internal Medicine departments of 70 hospitals were included. The clinical characteristics, treatments, and comorbidities were gathered. The results of conventional sputum cultures were recorded. Results: A total of 536 patients were included, of which 161 produced valid sputum and a potentially pathogenic microorganism was isolated from 88 subjects (16.4%). The isolation of Pseudomonas aeruginosa (30.7%) was associated with a greater severity of the lung disease (previous admissions [P= 0.026], dyspnea scale [P=0.047], post-broncodilator forced expiratory volume in 1 second (FEV 1) [P=0.005], and the BODEx index [P=0.009]); also with higher prevalence of cor pulmonale (P=0.017), heart failure (P=0.048), and cerebrovascular disease (P=0.026). Streptococcus pneumoniae (26.1%) was associated with more comorbidity according to number of diseases (P=0.018); notably, peripheral artery disease (P=0.033), hypertension (P=0.029), dyslipidemia (P=0.039), osteoporosis (P=0.0001), and depression (P=0.005). Conclusion: Patients with AE-COPD and P. aeruginosa present higher severity of COPD, while those with S. pneumoniae present greater comorbidity. The potentially pathogenic microorganism obtained in the sputum culture depends on the associated comorbidities.
Sputum Bacteriology In Patients With Acute Exacerbations of COPD In Hong Kong
Respiratory …, 2005
Study objective: To study the demographics and sputum microbiology of patients admitted to a teaching hospital with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Design: A retrospective study. Setting: A tertiary university hospital in Hong Kong. Patients: All episodes of AECOPD, patient demographics, length of stay, sputum culture and radiological results admitted in the first half of the year 2000 were retrieved from hospital records. Results: There were 329 patients with 418 episodes of AECOPD without concomitant pneumonia. The age of the patients was 74.478.3 years. The acute hospital length of stay for an episode of AECOPD was 7.376.5 days. Haemophilus influenzae was the commonest organism found in sputum (23.1%), followed by Pseudomonas aeruginosa (6.3%) and Streptococcus pneumoniae (4.0%). Mycobacterium tuberculosis was found in 1.1% of the admissions. Presence of organisms in sputum had no association with the hospital length of stay and intensive care unit admissions. In patients whose FEV 1 was 450% of predicted values, there was a higher chance of positive sputum growth of H. influenzae than those with FEV 1 o50% (16/ 44 vs. 31/162 episodes, respectively, P ¼ 0:02). Conclusions: H. influenzae was the commonest bacterium isolated in sputum in patients with AECOPD. In areas endemic of tuberculosis, it is advisable to use fluoroquinolones for AECOPD with caution.
The Indian journal of chest diseases & allied sciences, 2022
Background. Infections are the common cause of death in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods. A prospective cohort study was conducted on 100 patients with AECOPD in a tertiary care hospital in Hyderabad city in South India. Sputum culture of 100 patients was evaluated for the presence of Gram-positive and Gram-negative microorganisms. Sensitivity and resistance patterns of the microorganisms against commonly used antibiotics were also investigated. Results. During the period October 2015 to April 2016, 67% of the patients had sputum culture positive for the presence of pathogenic microorganisms. Pathogens, most commonly, isolated were Gram-negative organisms like Klebsiella oxytoca (13%), followed by Klebsiella species (11%) and Klebsiella pneumoniae (10%). Amikacin was found to be the most effective antibiotic against all microorganisms. A significantly higher proportion of organisms were pathogenic compared to non-pathogenic organisms (p=0.0014). Among pathogenic organisms, a significantly higher proportion of Gram-positive organisms were found compared to Gram-negative organisms (p=0.0180). Pathogenic microorganisms showed a high resistance rate to commonly used antibiotics. Except few strains of Klebsiella, Pseudomonas and Streptococcus, overall 62.9% strains were sensitive to doxycycline. Conclusions. Our observations suggest that doxycycline can be used as an empirical antibiotic in the treatment of AECOPD.