[Bacterial pathogens in sputum and degree of bronchial obstruction in patients with acute exacerbation of chronic obstructive pulmonary disease]

Abstract

In 114 patients with acute exacerbation of chronic obstructive pulmonary disease (AECB) we performed a microbiological sputum study. In four sub-groups of patients, divided on the basis of the isolated pathogens, we looked for the best forced expiratory volume in one second (FEV1) registered in a previous test (< 12 months), in stable clinical conditions. In 65 samples of sputum (57% of all) the distribution of the isolated pathogens was: H. parainfluenzae 23%, H. influenzae 8%, M. catarrhalis 3%, S. pneumoniae 4%, Enterobacteriaceae (EN) 22%, Pseudomonas and other related germs (BN) 32%, S. aureus 8%. EN and BN showed high sensitivity to various antibiotics. In the patients of the BN sub-group the mean FEV1 showed a significant lower value than in the other sub-groups (from p < 0.01 to p < 0.001). The high percentage of EN and BN seems to be likely explained by the population we studied because there were many subjects with severe clinical and functional conditions, with many comorbidity and frequently treated with oral steroids and antibiotics. The association between the lowest values of FEV1 in stable clinical conditions and the isolation of BN in sputum during AECB could be useful in the choice of the empiric antibiotic therapy during exacerbations.