| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Guest Access | Sign In via User Name/Password
|
|
|
|||||||
Guest Access | Sign In via User Name/Password |
|||||||||
* From the Pneumology Department (Dr. Miravitlles), Hospital Vall d'Hebron, Barcelona, Spain; the RD Department (Dr. Espinosa), QF Bayer, Barcelona, Spain; the Pneumology Department, Hospital Magdalena, Castellon, Spain (Dr. Fernández-Laso); the Pneumology Unit, Hospital San Rafael (Dr. Martos), Barcelona, Spain; the Pneumology Department, Hospital Juan Ramón Jiménez, Huelva, Spain (Dr. Maldonado); and the Pneumology Unit (Dr. Gallego), Hospital Parc Taulí, Sabadell, Barcelona, Spain.
Correspondence to: Marc Miravitlles, MD, Rocafort 173–177, 3°1a, 08015 Barcelona, Spain; e-mail: marcm{at}separ.es
Study objectives: To investigate the possible relationship between functional respiratory impairment measured by FEV1 and isolation of diverse pathogens in the sputum of patients with exacerbations of COPD.
Design: Multicenter, cross-sectional, epidemiologic study.
Setting: Pneumology units in six secondary or tertiary hospitals in Spain.
Patients: Ninety-one patients with acute exacerbation of COPD were included.
Interventions: A quantitative sputum culture was performed, and bacterial growth was considered significant only when the germ was isolated at concentrations > 106 cfu (> 105 for Streptococcus pneumoniae) in samples with < 10 epithelial cells and > 25 leukocytes per low magnification field (x100).
Results: Germs isolated were the following: Haemophilus influenzae (20 cases; 22%), Pseudomonas aeruginosa (14 cases; 15%), S pneumoniae (9 cases; 10%), Moraxella catarrhalis (8 cases; 9%), other Gram-negative bacteria (7 cases; 7%), and non-potentially pathogenic microorganisms (non-PPMs; 33 cases; 36%). P aeruginosa and H influenzae were isolated more frequently among the patients with FEV1 < 50% than among those with FEV1 > 50% (p < 0.05). All patients with P aeruginosa in sputum had FEV1 < 1,700 mL. FEV1 < 50% was associated with a very high risk of P aeruginosa or H influenzae isolation: the odds ratios (ORs) are 6.62 (95% confidence interval [CI], 1.2 to 123.6) and 6.85 (95% CI, 1.6 to 52.6), respectively. Furthermore, active tobacco smoking was associated with a high risk of H influenzae isolation (OR, 8.1; 95% CI, 1.9 to 43.0).
Conclusions: Patients with the greatest degree of functional impairment, as measured by their FEV1, presented a higher probability of having an isolation of P aeruginosa or H influenzae in significant concentrations in sputum during an exacerbation. The diagnostic yield of sputum in patients with an FEV1 > 50% was low, with a predominance of non-PPMs. Low FEV1 and active tobacco smoking are data that should be considered when establishing an empiric antibiotic treatment for exacerbated COPD.
Key Words: antibiotics • bacterial resistance • COPD • etiology of exacerbations • exacerbations
This article has been cited by other articles:
|
|
 |
|
  G. Dimopoulos, I. I. Siempos, I. P. Korbila, K. G. Manta, and M. E. Falagas Comparison of First-Line With Second-Line Antibiotics for Acute Exacerbations of Chronic Bronchitis: A Metaanalysis of Randomized Controlled Trials Chest, August 1, 2007; 132(2): 447 - 455. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Brook and A. E. Gober Effect of Smoking Cessation on the Microbial Flora Arch Otolaryngol Head Neck Surg, February 1, 2007; 133(2): 135 - 138. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Mallia and S. L. Johnston Mechanisms and Experimental Models of Chronic Obstructive Pulmonary Disease Exacerbations Proceedings of the ATS, November 1, 2005; 2(4): 361 - 366. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Rosell, E. Monso, N. Soler, F. Torres, J. Angrill, G. Riise, R. Zalacain, J. Morera, and A. Torres Microbiologic Determinants of Exacerbation in Chronic Obstructive Pulmonary Disease Arch Intern Med, April 25, 2005; 165(8): 891 - 897. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Strassburg, D. Droemann, G. van Zandbergen, H. Kothe, and K. Dalhoff Enhanced PMN response in chronic bronchitis and community-acquired pneumonia Eur. Respir. J., November 1, 2004; 24(5): 772 - 778. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Sethi Bacteria in Exacerbations of Chronic Obstructive Pulmonary Disease: Phenomenon or Epiphenomenon? Proceedings of the ATS, April 1, 2004; 1(2): 109 - 114. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Miravitlles and A. Torres No More Equivalence Trials for Antibiotics in Exacerbations of COPD, Please Chest, March 1, 2004; 125(3): 811 - 813. [Full Text] [PDF]
|
|
|
|
 |
|
 E. Kolker, S. Purvine, M. Y. Galperin, S. Stolyar, D. R. Goodlett, A. I. Nesvizhskii, A. Keller, T. Xie, J. K. Eng, E. Yi, et al. Initial Proteome Analysis of Model Microorganism Haemophilus influenzae Strain Rd KW20 J. Bacteriol., August 1, 2003; 185(15): 4593 - 4602. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Inoue, H. Nakamura, K. Otake, H. Saito, K. Terashita, J. Sato, H. Takeda, and H. Tomoike Impaired Pulmonary Inflammatory Responses Are a Prominent Feature of Streptococcal Pneumonia in Mice with Experimental Emphysema Am. J. Respir. Crit. Care Med., March 1, 2003; 167(5): 764 - 770. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A J White, S Gompertz, and R A Stockley Chronic obstructive pulmonary disease * 6: The aetiology of exacerbations of chronic obstructive pulmonary disease Thorax, January 1, 2003; 58(1): 73 - 80. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G C Donaldson, T A R Seemungal, A Bhowmik, and J A Wedzicha Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease Thorax, October 1, 2002; 57(10): 847 - 852. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I S Patel, T A R Seemungal, M Wilks, S J Lloyd-Owen, G C Donaldson, and J A Wedzicha Relationship between bacterial colonisation and the frequency, character, and severity of COPD exacerbations Thorax, September 1, 2002; 57(9): 759 - 764. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Sethi, N. Evans, B. J.B. Grant, and T. F. Murphy New Strains of Bacteria and Exacerbations of Chronic Obstructive Pulmonary Disease N. Engl. J. Med., August 15, 2002; 347(7): 465 - 471. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Sohy, C. Pilette, M.S. Niederman, and Y. Sibille Acute exacerbation of chronic obstructive pulmonary disease and antibiotics: what studies are still needed? Eur. Respir. J., May 1, 2002; 19(5): 966 - 975. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Miravitlles, C. Murio, T. Guerrero, and R. Gisbert Pharmacoeconomic Evaluation of Acute Exacerbations of Chronic Bronchitis and COPD* Chest, May 1, 2002; 121(5): 1449 - 1455. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Hayashi Latent Adenovirus Infection in COPD* Chest, May 1, 2002; 121(5_suppl): 183S - 187S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Ioanas, J. Angrill, X. Baldo, F. Arancibia, J. Gonzalez, T. Bauer, E. Canalis, and A. Torres Bronchial bacterial colonization in patients with resectable lung carcinoma Eur. Respir. J., February 1, 2002; 19(2): 326 - 332. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. M. Verduin, C. Hol, A. Fleer, H. van Dijk, and A. van Belkum Moraxella catarrhalis: from Emerging to Established Pathogen Clin. Microbiol. Rev., January 1, 2002; 15(1): 125 - 144. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J Angrill, C Agusti, R de Celis, A Rano, J Gonzalez, T Sole, A Xaubet, R Rodriguez-Roisin, and A Torres Bacterial colonisation in patients with bronchiectasis: microbiological pattern and risk factors Thorax, January 1, 2002; 57(1): 15 - 19. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. F. Murphy, A. L. Brauer, N. Yuskiw, E. R. McNamara, and C. Kirkham Conservation of Outer Membrane Protein E among Strains of Moraxella catarrhalis Infect. Immun., June 1, 2001; 69(6): 3576 - 3580. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Miravitlles, C. Murio, and T. Guerrero Factors associated with relapse after ambulatory treatment of acute exacerbations of chronic bronchitis Eur. Respir. J., May 1, 2001; 17(5): 928 - 933. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Wilson Bacteria, antibiotics and COPD Eur. Respir. J., May 1, 2001; 17(5): 995 - 1007. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Sethi and T. F. Murphy Bacterial Infection in Chronic Obstructive Pulmonary Disease in 2000: a State-of-the-Art Review Clin. Microbiol. Rev., April 1, 2001; 14(2): 336 - 363. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. C. McCrory, C. Brown, S. E. Gelfand, and P. B. Bach Management of Acute Exacerbations of COPD : A Summary and Appraisal of Published Evidence Chest, April 1, 2001; 119(4): 1190 - 1209. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. V. Hirschmann, T. F. Murphy, S. Sethi, and M. S. Niederman Bacteria and COPD Exacerbations Redux Chest, February 1, 2001; 119(2): 663 - 667. [Full Text] [PDF]
|
|
|
|
|
|
S. Sethi, T. F. Murphy, K. L. Nichol, T. K. Marras, L. C. Marras, and P. J. Barnes Chronic Obstructive Pulmonary Disease N. Engl. J. Med., December 28, 2000; 343(26): 1969 - 1971. [Full Text]
|
|
|
|
|
|
S. Sethi, K. Muscarella, N. Evans, K. L. Klingman, B. J. B. Grant, and T. F. Murphy Airway Inflammation and Etiology of Acute Exacerbations of Chronic Bronchitis Chest, December 1, 2000; 118(6): 1557 - 1565. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. V. Hirschmann Do Bacteria Cause Exacerbations of COPD? Chest, July 1, 2000; 118(1): 193 - 203. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. F. Murphy, S. Sethi, and M. S. Niederman The Role of Bacteria in Exacerbations of COPD : A Constructive View Chest, July 1, 2000; 118(1): 204 - 209. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
