Bacterial etiology in acute hospitalized chronic obstructive pulmonary disease exacerbations

Abstract

Introduction. 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). Conclusion. 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.

Keywords

• Acute exacerbation
• chronic obstructive pulmonary disease
• sputum
• bacteriology

References

1. Gunen H, Hacievliyagil SS, Yetkin O, Gulbas G, Mutlu LC, Pehlivan E. Prevalence of COPD: first epidemiological study of a large region in Turkey. Eur J Intern Med 2008;19:499-504.
2. Kocabas A, Hancioglu A, Turkyilmaz S, Unalan T, Umut S, Cakir B, et al. Prevalence of COPD in Adana, Turkey (BOLD-Turkey Study). Proc Am Thorac Soc 2006;3:A543.
3. Dikis OS, Dulger SU, Karadag M, Demirci H. COPD cases detected by spirometry on world COPD day event in Bursa. Eur Res J 2015;1:61-5.
4. Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2013;187:347-65.
5. Seemungal TA, Donaldson GC, Paul EA, Bestall JC, Jeffries DJ, Wedzicha JA. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998;157:1418-22.
6. Donaldson GC, Seemungal TA, Bhowmik A, Wedzicha JA. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax 2002;57:847-52.
7. Perera PN, Armstrong EP, Sherrill DL, Skrepnek GH. Acute exacerbations of COPD in the United States: inpatient burden and predictors of costs and mortality. COPD 2012;9:131-41.
8. Mullerova H, Maselli DJ, Locantore N, Vestbo J, Hurst JR, Wedzicha JA, et al. Hospitalized exacerbations of COPD: risk factors and outcomes in the ECLIPSE cohort. Chest 2015;147:999-1007.

9. Eller J, Ede A, Schaberg T, Niederman MS, Mauch H, Lode H. Infective exacerbations of chronic bronchitis: relation between bacteriologic etiology and lung function. Chest 1998;113:1542-8.
10. Miravitlles M, Espinosa C, Fernández-Laso E, Martos JA, Maldonado JA, Gallego M. Relationship between bacterial flora in sputum and functional impairment in patients with acute exacerbations of COPD. Chest 1999;116:40-46.
11. Roussos C, Koutsoukou A. Respiratory failure. Eur Respir J 2003;22:3-14.
12. Bartlett JG, Brewer NS, Ryan KJ, Washington JA. Laboratory diagnosis of lower respiratory tract infections. In: Washington JA II, ed. Cumitech 7A: Washinton, DC: American Society for Microbiology;1987;1-18.
13. Cabello H, Torres A, Celis R, El-Ebiary M, de la Bellacasa JP, Xaubet A, Gonzalez J, Agusti C, Soler N. Bacterial colonization of distal airways in healthy subjects and chronic lung disease: a bronchoscopic study. Eur Respir J 1997;10:1137-44.
14. Sethi S. Etiology and management of infections in chronic obstructive pulmonary disease. Clin Pulm Med 1999;6:327-32.
15. Ewig S, Soler N, Gonzalez J, Celis R, El-Ebiary M, Torres A. Evaluation of antimicrobial treatment in mechanically ventilated patients with severe chronic obstructive pulmonary disease exacerbations. Crit Care Med 2000;28:692-7.
16. Stolz D, Christ-Crain M, Morgenthaler NG, Leuppi Jr, Miedinger D, Bingisser R, Muller C, Struck J, Muller B, Tamm M. Copeptin, C-reactive protein, and procalcitonin as prognostic biomarkers in acute exacerbation of COPD. Chest 2007;131:1058-67.
17. Chawla K, Mukhopadhay C, Majumdar M, Bairy I. Bacteriological profile and their antibiogram from cases of acute exacerbations of chronic obstructive pulmonary disease: A hospital based study. J Clin Diagn Res 2008;2:612-6.
18. ElKorashy R, El-Sherif R. Gram negative organisms as a cause of acute exacerbation of COPD. Egypt J Chest Dis Tuberc 2014;63:345-9.
19. Li XJ, Li Q, Si LY, Yuan QY. Bacteriological differences between COPD exacerbation and community-acquired pneumonia. Respir Care 2011;56:1818-24.
20. Dai MY, Qiao JP, Xu YH, Fei GH. Respiratory infectious phenotypes in acute exacerbation of COPD: an aid to length of stay and COPD Assessment Test. Int J Chron Obstruct Pulmon Dis 2015;10:2257-63.
21. Soler N, Torres A, Ewig S, Gonzalez J, Celis R, El-Ebiary M, et al. Bronchial microbial patterns in severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation. Am J Respir Crit Care Med 1998;157:1498-505.
22. Nakou A, Papaparaskevas J, Diamantea F, Skarmoutsou N, Polychronopoulos V, Tsakris A. A prospective study on bacterial and atypical etiology of acute exacerbation in chronic obstructive pulmonary disease. Future Microbiol 2014;9:1251-60.