Acute exacerbations of chronic obstructive pulmonary disease: etiological bacterial pathogens and antibiotic resistance in Upper Egypt
Egyptian Journal of Bronchology volume 10, pages 283–290 (2016)
Previous data on etiologic bacteria in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in Upper Egypt are limited.
The aim of this study was to identify the causative bacteria in AECOPD and to determine the antibiotic resistance patterns for AECOPD in Upper Egypt.
Settings and design
The study design was a prospective one and was conducted in a University Hospital.
Materials and methods
Patients who were admitted in Assiut University Hospital with AECOPD were prospectively enrolled. Sputum specimens were investigated using culture. Susceptibilities of the isolated bacterial strains to different antibiotics were determined using the disk diffusion method.
During 18 months, 156 patients who experienced 218 AECOPD were enrolled. A significant bacterial growth was found in 77% of patients during 81% of exacerbations. The most commonly detected bacteria were Haemophilus influenzae (18%), Streptococcus pneumoniae (15%), and Klebsiella pneumoniae (14%). The majority of the isolated strains showed high resistance rates to most groups of antibiotics; 63% of the isolated strains were multidrug resistant, 29% were extensively drug resistant, and 5% were pandrug resistant. High resistance rates were observed against penicillins and cephalosporins, moderate rates against fluoroquinolones, and lowest rates against the carbapenems. All gram-positive bacteria were sensitive to linezolid. Increased severity of chronic obstructive pulmonary disease was related to increased prevalence of antibiotic resistance.
The predominant bacterial pathogens for AECOPD in Upper Egypt are H. influenzae, S. pneumoniae, and K. pneumoniae. Bacterial resistance rates were the highest against penicillins and cephalosporins, moderate against fluoroquinolones, and least against carbapenems. Increased severity of chronic obstructive pulmonary disease is related to an increased prevalence of antibiotic resistance.
Perera WR, Hurst JR, Wilkinson TM, Sapsford RJ, Müllerova H, Donaldson GC, Wedzicha JA. Inflammatory changes, recovery and recurrence at COPD exacerbation. Eur Respir J 2007; 29:527–534.
Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management and prevention of COPD, updated 2015. Available at: http://www.goldcopd.org
Donaldson GC, Seemungal TA, Bhowmik A, Wedzicha JA. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax 2002; 57:847–852.
Kyd JM, McGrath J, Krishnamurthy A. Mechanisms of bacterial resistance to antibiotics in infections of COPD patients. Curr Drug Targets 2011; 12:521–530.
Agmy G, Mohamed S, Gad Y, Farghally E, Mohammedin H, Rashed H. Bacterial profile, antibiotic sensitivity and resistance of lower respiratory tract infections in Upper Egypt. Mediterr J Hematol Infect Dis 2013; 5: e2013056.
Indrayan A, Kumar R, Dwivedi S. “A simple index of smoking” (November 2008). COBRA Preprint Series. Working Paper 40. Available at: http://biostats.bepress.com/cobra/ps/art40
Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. ATS/ERS Task Force General considerations for lung function testing. Eur Respir J 2005; 26:153–161.
Henig NR, Tonelli MR, Pier MV, Burns JL, Aitken ML. Sputum induction as a research tool for sampling the airways of subjects with cystic fibrosis. Thorax 2001; 56:306–311.
Holt JG, Krieg NR, Sneath PHA, Staley H, Williams ST. Bergey’s manual of determinative bacteriology. 9th ed. Baltimore, MD: Lippincott Williams and Wilkins; 1994.
Clinical and Laboratory Standards Institute. Performance standards for antimicrobial disk susceptibility tests. 9th ed. Wayne, PA: Clinical and Laboratory Standards Institute; 2006.
Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pan drug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012; 18:268–281.
White AJ, Gompertz S, Stockley RA. Chronic obstructive pulmonary disease. 6: the aetiology of exacerbations of chronic obstructive pulmonary disease. Thorax 2003; 58:73–80.
Wedzicha JA, Donaldson GC. Exacerbations of chronic obstructive pulmonary disease. Respir Care 2003; 48:1204–1213 discussion 1213–1215.
Zalacain R, Sobradillo V, Amilibia J, Barrón J, Achótegui V, Pijoan JI, Llorente JL. Predisposing factors to bacterial colonization in chronic obstructive pulmonary disease. Eur Respir J 1999; 13:343–348.
Hill AT, Campbell EJ, Hill SL, Bayley DL, Stockley RA. Association between airway bacterial load and markers of airway inflammation in patients with stable chronic bronchitis. Am J Med 2000; 109:288–295.
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; 9:1251–1260.
White AJ, Gompertz S, Bayley DL, Hill SL, O’Brien C, Unsal I, Stockley RA. Resolution of bronchial inflammation is related to bacterial eradication following treatment of exacerbations of chronic bronchitis. Thorax 2003; 58:680–685.
Hunter MH, King DE. COPD: management of acute exacerbations and chronic stable disease. Am Fam Physician 2001; 64:603–612.
Nowiński A, Kamiński D, Korzybski D, Stokłosa A, Górecka D. The impact of comorbidities on the length of hospital treatment in patients with chronic obstructive pulmonary disease. Pneumonol Alergol Pol 2011; 79:388–396.
Mohan A, Premanand R, Reddy LN, Rao MH, Sharma SK, Kamity R, Bollineni S. Clinical presentation and predictors of outcome in patients with severe acute exacerbation of chronic obstructive pulmonary disease requiring admission to intensive care unit. BMC Pulm Med 2006; 6:27.
Ko FW, Ng TK, Li TS, Fok JP, Chan MC, Wu AK, Hui DS. Sputum bacteriology in patients with acute exacerbations of COPD in Hong Kong. Respir Med 2005; 99:454–460.
Molyneaux PL, Mallia P, Cox MJ, Footitt J, Willis-Owen SA, Homola D, et al. Outgrowth of the bacterial airway microbiome after rhinovirus exacerbation of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2013; 188:1224–1231.
Bogaert D, van der Valk P, Ramdin R, Sluijter M, Monninkhof E, Hendrix R, et al. Host-pathogen interaction during pneumococcal infection in patients with chronic obstructive pulmonary disease. Infect Immun 2004; 72:818–823.
Groenewegen KH, Wouters EF. Bacterial infections in patients requiring admission for an acute exacerbation of COPD: a 1-year prospective study. Respir Med 2003; 97:770–777.
González-Castillo J, Cenci C, Rodriguez-Adrada E, Candel FJ, de la Torre-Misiego F, Fernández C, Martín-Sánchez FJ. Staphylococcus aureus infections and factors associated with resistance to methicillin in a hospital emergency department. Rev Esp Quimioter 2013; 26:337–345.
Falagas ME, Karveli EA, Kelesidis I, Kelesidis T. Community-acquired Acinetobacter infections. Eur J Clin Microbiol Infect Dis 2007; 26:857–868.
Li XJ, Li Q, Si LY, Yuan QY. Bacteriological differences between COPD exacerbation and community-acquired pneumonia. Respir Care 2011; 56:1818–1824.
Madhavi S, Rama Rao MV, Janardhan Rao R. Bacterial etiology of acute exacerbations of chronic obstructive pulmonary disease. J Microbiol Biotech Res 2012; 2:440–444.
Lode H, Eller J, Linnhoff A, Ioanas M, Evaluation of Therapy-Free Interval in COPD Patients Study Group. Levofloxacin versus clarithromycin in COPD exacerbation: focus on exacerbation-free interval. Eur Respir J 2004; 24:947–953.
Thwaites GE. The management of Staphylococcus aureus bacteremia in the United Kingdom and Vietnam: a multicentre evaluation. PLoS One 2010; 5:14170.
Borg MA, de Kraker M, Scicluna E, van de Sande-Bruinsma N, Tiemersma E, Monen J, Grundmann H, ARMed Project Members and Collaborators. Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in invasive isolates from southern and eastern Mediterranean countries. J Antimicrob Chemother 2007; 60:1310–1315.
Johnson AP, Warner M, Livermore DM. Activity of linezolid against multiresistant gram-positive bacteria from diverse hospitals in the United Kingdom. J Antimicrob Chemother 2000; 45:225–230.
El-Korashy RI, El-Sherif RH. Gram negative organisms as a cause of acute exacerbation of COPD. EJCDT 2014; 63:345–349.
Ye F, He LX, Cai BQ, Wen FQ, Chen BY, Hadiarto M, et al. Spectrum and antimicrobial resistance of common pathogenic bacteria isolated from patients with acute exacerbation of chronic obstructive pulmonary disease in mainland of China. Chin Med J (Engl) 2013; 126:2207–2214.
Nseir S, Di Pompeo C, Cavestri B, Jozefowicz E, Nyunga M, Soubrier S, et al. Multiple-drug-resistant bacteria in patients with severe acute exacerbation of chronic obstructive pulmonary disease: prevalence, risk factors, and outcome. Crit Care Med 2006; 34:2959–2966.
Fogarty CM, Kohno S, Buchanan P, Aubier M, Baz M. Communityacquired respiratory tract infections caused by resistant pneumococci: clinical and bacteriological efficacy of the ketolide telithromycin. J Antimicrob Chemother 2003; 51:947–955.
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
About this article
Cite this article
Hassan, A.T., Mohamed, S.A.A., Mohamed, M.S.E. et al. Acute exacerbations of chronic obstructive pulmonary disease: etiological bacterial pathogens and antibiotic resistance in Upper Egypt. Egypt J Bronchol 10, 283–290 (2016). https://doi.org/10.4103/1687-8426.193640