Infective exacerbations of COPD. Relation between the bacteriologic etiology and severity of the disease
2014
Bacterial infection is a major cause of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Streptococcus pneumoniae (SP) and Haemophilus influenza (HI) are the most frequently encountered. Objectives: Studying the relation between the bacteriologic etiology of AECOPD and severity of the disease. Methods: This is a retrospective study of patients with COPD hospitalised for AECOPD and whose bacteriological sputum was used to isolate the causative agent. In this study, we correlated the parameters of severity of the disease with isolated bacteria. Results: 225 germs were isolated from 180 patients. The infection was polymicrobial in 19 patients. The bacteria isolated were: SP:18 cases, HI:42 cases, Pseudomonas:37 cases and Acinetobacter:14 cases. Patients that experienced pyocyanic and/or Acinetobacter infections are more symptomatic than COPD patients with past history of exacerbations due to HI and/or SP (mMRC=2-4: 86% vs 71%, p=0,049), most often GOLD 3 and 4 (89% vs 69%,p=0,009), had lower FEV1 (0,88L vs 1,07L, p=0,005), lower PaO2 (63 vs 68,2 mmHg, p=0,048), a higher PaCO2 (43,5 vs 40,6 mmHg, p=0,024) and significantly faster FEV1 decline (-70 vs -33,5 ml/year, p=0,001). Past history of AECOPD due to Pseudomonas and/or Acinetobacter was significantly associated with higher number of severe exacerbations per year (1.92 vs 1.3, p=0,003), higher number of hospitalisations in the respiratory medicine department (p=0,002), in the ICU (p=0,047) and more resort to home oxygen (p=0,024). Conclusions:Pyocyanic and acinetobacter infections were observed more frequently in patients with severe deterioration of lung function and are associated with poor outcomes.
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