Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2018 Jun 15;19(1):119.
doi: 10.1186/s12931-018-0820-1.

Microorganisms resistant to conventional antimicrobials in acute exacerbations of chronic obstructive pulmonary disease

Cristina Estirado  1 , Adrian Ceccato  2 , Monica Guerrero  2 , Arturo Huerta  2 , Catia Cilloniz  2 , Olivia Vilaró  2 , Albert Gabarrús  2 , Joaquim Gea  1 , Ernesto Crisafulli  3 , Nestor Soler  2 , Antoni Torres  4   5
Affiliations
Observational Study

Microorganisms resistant to conventional antimicrobials in acute exacerbations of chronic obstructive pulmonary disease

Cristina Estirado et al. Respir Res. .

Abstract

Background: Antimicrobial treatment for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) remains controversial. In some cases AECOPD are caused by microorganisms that are resistant to treatments recommended by guidelines. Our aims were: 1) identify the risk factors associated with infection by microorganisms resistant to conventional treatment (MRCT), 2) Compare the clinical characteristics and outcomes of patients with AECOPD resulting from MRCT against those with AECOPD from other causes.

Methods: We prospective analysed a cohort of patients admitted with severe AECOPD (2009 to 2015) who were assigned to three groups: patients with MRCT (those patients with germs resistant to antibiotics recommended in guidelines), patients with microorganisms sensitive to conventional antimicrobial treatment (MSCT), and patients with negative microbiology results who had not previously received antibiotics. Multinomial logistic regression analyses were used to examine the associations between microbial aetiology groups and risk factors. The association between LOS and risk factors was also tested in simple and multiple analyses, and similar inclusion criteria were applied for the linear regression analysis.

Results: Of the 451 patients admitted, 195 patients (43%) were included. Respiratory cultures were positive in 86(44%) and negative in 109(56%). MRCT were isolated in 34 cases (40%) and MSCT in 52 (60%). Patients with MRCT had more AECOPD in the previous year, received more antibiotic treatment in the previous three months, had more severe disease, higher dyspnoea and a positive respiratory culture in the previous year (mainly for Pseudomonas aeruginosa). The following conditions were independent factors for MRCT isolation: non-current smoker (odds ratio [OR] 4.19 [95% confidence interval [CI] 1.29-13.67], p = 0.017), ≥ 2 AECOPD or ≥ 1 admission for AECOPD in the previous year (OR 4.13 [95% CI 1.52-11.17], p = 0.005), C-reactive protein < 5 mg/dL; (OR 3.58 [95% CI 1.41-9.07], p = 0.007). Mortality rates were comparable at 30-days, one year and 3 years; however, patients in the MRCT group had longer hospital stays.

Conclusion: In conclusion, there are risk factors for resistant germs in AECOPD; however, the presence of these germs does not increase mortality. Patients with isolation of MRCT had longer length of stay.

Keywords: COPD; Exacerbation; Resistance to antimicrobials.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

The study protocol was approved by the Hospital Research and Ethics Committee (CEIC 2008/4106) and the study was conducted in accordance with good clinical practice guidelines and the declaration of Helsinki. Written informed consent was obtained from all enrolled patients.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart
Fig. 2
Fig. 2
Microbial aetiology. Panel a Microorganisms Resistant to Conventional Treatment (n = 34). Panel b Patients with Microorganisms Sensitive to Conventional Treatment (n = 52). Polymicrobial Isolation includes: 3 Pseudomonas aeruginosa, 2 Stenotrophomonas maltophilia, 1 Staphylococcus aureus, 3 Streptococcus pneumoniae, 1 other. Others isolation include: 3 Corynebacterium spp., 2 Pasteurella spp., 1 Capnocytophaga spp.
Fig. 3
Fig. 3
Receiver operating characteristic curve for multinomial logistic regression model to predict MRCT isolation. Abbreviations: AUC indicates area under the curve; CI, confidence interval
Fig. 4
Fig. 4
Kaplan–Meier analysis of the effect of microbial aetiology groups on time to death
See this image and copyright information in PMC

References

    1. Soler-Cataluña JJ, Martínez-García MA, Román Sánchez P, Salcedo E, Navarro M, Ochando R. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax. 2005;60:925–931. doi: 10.1136/thx.2005.040527. - DOI - PMC - PubMed
    1. Soler N, Torres A, Ewig S, Gonzalez J, Celis R, El-Ebiary M, et al. Bronchial microbial patterns in severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation. Am J Respir Crit Care Med. 1998;157:1498–1505. doi: 10.1164/ajrccm.157.5.9711044. - DOI - PubMed
    1. Wedzicha JA, Seemungal TAR. COPD exacerbations: defining their cause and prevention. Lancet Lond Engl. 2007;370:786–796. doi: 10.1016/S0140-6736(07)61382-8. - DOI - PMC - PubMed
    1. 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. doi: 10.1136/thorax.58.1.73. - DOI - PMC - PubMed
    1. From the Global Strategy for the Diagnosis, Management and Prevention of COPD Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017. Available http://www.goldcopd.org/. Accessed 1 Nov 2018.

Publication types

MeSH terms

Substances