- Original article
- Open Access
Pattern of sputum bacteriology in acute exacerbations of chronic obstructive pulmonary disease
Egyptian Journal of Bronchology volume 9, pages 170–177 (2015)
Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality worldwide.
Acute exacerbation of COPD is redefined as a sustained worsening of a patient’s condition from a stable state (beyond normal day-to-day variations) that is acute in onset and that may warrant additional treatment in a patient with underlying COPD.
This study aimed at searching for a pattern of sputum bacteriology and antibiotic sensitivity for acute exacerbation of COPD in patients admitted to Abbassia Chest Diseases Hospital.
Patients and methods
This study included 110 patients who presented with acute exacerbation of COPD. The patients were classified into several groups according to different variables, such as severity, respiratory acidosis, and smoking habits. Bacteriological investigations were performed for all patients including Gram stain examination together with culture and sensitivity testing after proper processing of sputum or endotracheal samples.
Results and conclusion
Klebsiella pneumoniae and Acinetobacter spp. were the most common isolates in patients with mild to moderate COPD admitted to the respiratory ICU and to the ward. Each had an incidence of five (15.15%) isolates in the ICU, whereas in the ward there were 13 (14.9%) isolates of Klebsiella spp. and seven (8.04%) isolates of Acinetobacter spp. Acinetobacter spp., however, was the most common isolate in patients with severe to very severe COPD, with an incidence of five (17.9%) isolates. Imipenem was the most sensitive antibiotic in all patient groups in the ICU and ward.
Global Initiative for Chronic Obstructive Lung Disease (GOLD). Workshop report, global strategy for diagnosis, management, and prevention of COPD. Bethesda, MD: National Institutes of Health, National Heart, Lung, and Blood Institute; 2006.
Barnes PJ. Chronic obstructive pulmonary disease. N Engl J Med 2000; 343:269–280.
Burge S, Wedzicha JA. COPD exacerbations: definitions and classifications. Eur Respir J Suppl 2003; 41:46s–53s.
Wilkinson TM, Patel IS, Wilks M, Donaldson GC, Wedzicha JA. Airway bacterial load and FEV1 decline in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2003; 167:1090–1095.
Chernecky CC, Brown SE, Light TIW. Culture techniques and results. Infect Immun 2001; 122:341–349.
Altman DG, Schulz KF, Moher D, Egger M, Davidoff F, Elbourne D, et al. The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med 2001; 134:663–694.
Cukic V. The most common detected bacteria in sputum of patients with the acute exacerbation of COPD. Mater Sociomed 2013; 25:226–229.
Hui DS, Ip M, Ling T, Chang SC, Liao CH, Yoo CG, et al. A multicentre surveillance study on the characteristics, bacterial aetiologies and in vitro antibiotic susceptibilities in patients with acute exacerbations of chronic bronchitis. Respirology 2011; 16:532–539.
Lin SH, Kuo PH, Hsueh PR, Yang PC, Kuo SH. Sputum bacteriology in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease in Taiwan with an emphasis on Klebsiella pneumoniae and Pseudomonas aeruginosa. Respirology 2007; 12:81–87.
Li H, Kuo S-H, Yang P-C. Bacteria in acute exacerbations of chronic bronchitis. Chest 2006; 363:600–607.
Fagon JY, Chastre J, Trouillet JL, Domart Y, Dombret MC, Bornet M, Gibert C. Characterization of distal bronchial microflora during acute exacerbation of chronic bronchitis. Use of the protected specimen brush technique in 54 mechanically ventilated patients. Am Rev Respir Dis 1990; 142:1004–1008.
Monsó E, Ruiz J, Rosell A, Manterola J, Fiz J, Morera J, Ausina V. Bacterial infection in chronic obstructive pulmonary disease. A study of stable and exacerbated outpatients using the protected specimen brush. Am J Respir Crit Care Med 1995; 152(Pt 1):1316–1320.
Miravittles M, Epsinosa C, Fernandez-Laso E, Martos JA Maldonado JA, Gallego M. Relationship between bacterial flora in sputum and functional impairment in patients with acute exacerbation s of COPD. Chest 1999; 116:40–46.
Brunton S, BP Carmichael, Colgan R. Acute exacerbation of chronic bronchitis. Am J Manag Care 2004; 10:689–696.
Noweta K, Frankowska M, Grzelewska-Rzymowska I. Exacerbations of chronic obstructive pulmonary disease and the role of sputum bacteriological examination. Pneumonol Alergol Pol 2006; 74:396–402.
Lior C, Cots JM, Herreras A. Bacterial etiology of chronic bronchitis exacerbations. Arch Bronconeumol 2006; 42:388–393.
Lode H, Allewelt M, Balk S, De Roux A, Mauch H, Niederman M, Schmidt-Ioanas M. A prediction model for bacterial etiology in acute exacerbations of COPD. Infection 2007; 35:143–149.
Rosell A, Monsó E, Soler N, Torres F, Angrill J, Riise G, et al. Microbiological determinants of exacerbations in chronic obstructive pulmonary disease. Arch Intern Med 2005; 165:891–897.
Gates KL, Howell HA, Nair A, Vohwinkel CU, Welch LC, Beitel GJ, et al. Hypercapnia impairs lung neutrophil function and increases mortality in murine Pseudomonas pneumonia. Am J Respir Cell Mol Biol 2013; 49:821–828.
Monsó E, Garcia-Aymerich J, Soler N, Farrero E, Felez MA, Antó JM, Torres A. EFRAM Investigators. Bacterial infection in exacerbated COPD with changes in sputum characteristics. Epidemiol Infect 2003; 131(1): 799–804.
Destache CJ, Dewan N, O’Donohue WJ, Campbell JC, Angelillo VA. Clinical and economic considerations in the treatment of acute exacerbations of chronic bronchitis. J Antimicrob Chemother 1999; 43(Suppl A ):107–113.
Wilson R, Anzueto A, Miravitlles M, Arvis P, Faragó G, Haverstock D, et al. A novel study design for antibiotic trials in acute exacerbations of COPD: MAESTRAL methodology. Int J Chron Obstruct Pulmon Dis 2011; 6:373–383.
Erkan L, Uzun O, Findik S, Katar D, Sanic A, Atici AG. Role of bacteria in acute exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2008; 3:463–467.
Fein A, Fein AM. Management of acute exacerbations in chronic obstructive pulmonary disease. Curr Opin Pulm Med 2000; 6:122–126.
About this article
Cite this article
Sobhy, K.E., Abd El-Hafeez, A.M., Shoukry, F.A. et al. Pattern of sputum bacteriology in acute exacerbations of chronic obstructive pulmonary disease. Egypt J Bronchol 9, 170–177 (2015). https://doi.org/10.4103/1687-8426.158065
- chronic obstructive pulmonary disease