Clinical significance of respiratory bacteria and mycobacteria isolates in adult bronchiectasis in Taiwan

Chia-Ling Chang^{1

2}, Chau-Chyun Sheu^{3

4}, Ping-Huai Wang⁵, Meng-Heng Hsieh^{6

7}, Wu-Huei Hsu^{8

9

10}, Ming-Tsung Chen¹¹, Wei-Fan Ou¹², Yu-Feng Wei^{13

14}, Tsung-Ming Yang¹⁵, Chou-Chin Lan¹⁶, Cheng-Yi Wang¹⁷, Chih-Bin Lin^{18

19}, Ming-Shian Lin²⁰, Yao-Tung Wang^{21

22}, Ching-Hsiung Lin^{23

24

25}, Shih-Feng Liu^{7

26

27}, Meng-Hsuan Cheng^{3

28}, Yen-Fu Chen^{29

30}, Wen-Chien Cheng⁸, Chung-Kan Peng¹¹, Ming-Cheng Chan³¹, Ching-Yi Chen¹³, Lun-Yu Jao¹⁶, Ya-Hui Wang³², Chi-Jui Chen¹⁸, Shih-Pin Chen^{21

22}, Yi-Hsuan Tsai^{26

33}, Shih-Lung Cheng^{5

34}, Horng-Chyuan Lin^{6

7

35}, Jung-Yien Chien^{36

37}, Hao-Chien Wang^{36

38

37}

Affiliations

¹ Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
² Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
³ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
⁴ Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁵ Division of Thoracic Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
⁶ Department of Thoracic Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
⁷ College of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁸ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
⁹ Critical Medical Center, China Medical University Hospital, Taichung, Taiwan.
¹⁰ School of Medicine, China Medical University, Taichung, Taiwan.
¹¹ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
¹² Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
¹³ Division of Chest Medicine, Department of Internal Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan.
¹⁴ School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
¹⁵ Division of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
¹⁶ Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
¹⁷ Department of Internal Medicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
¹⁸ Division of Pulmonary Medicine, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
¹⁹ School of Medicine, Tzu Chi University, Hualien, Taiwan.
²⁰ Division of Pulmonary Medicine, Department of Internal Medicine, Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
²¹ Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
²² School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
²³ Department of Internal Medicine, Division of Chest Medicine, Changhua Christian Hospital, Changhua, Taiwan.
²⁴ Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan.
²⁵ PhD Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan.
²⁶ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.
²⁷ Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.
²⁸ Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
²⁹ Department of Internal Medicine, National Taiwan University Hospital, Yunlin Branch, Douliu, Taiwan.
³⁰ Thoracic Medicine Center, Department of Medicine and Surgery, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan.
³¹ School of Post Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
³² Medical Research Center, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
³³ Department of Pulmonary Medicine, Lee's Clinic, Pingtung, Taiwan.
³⁴ Department of Chemical Engineering and Materials Science, Yuan Ze University, Taoyuan City, Taiwan.
³⁵ Department of Respiratory Therapy, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
³⁶ Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
³⁷ J-Y. Chien and H-C. Wang contributed equally to this article as lead authors and supervised the work.
³⁸ Department of Medicine National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan.

PMID: 40661934
PMCID: PMC12257146
DOI: 10.1183/23120541.00865-2024

Clinical significance of respiratory bacteria and mycobacteria isolates in adult bronchiectasis in Taiwan

Chia-Ling Chang et al. ERJ Open Res. 2025.

. 2025 Jul 14;11(4):00865-2024.

doi: 10.1183/23120541.00865-2024. eCollection 2025 Jul.

Authors

Affiliations

¹ Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
² Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
³ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
⁴ Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁵ Division of Thoracic Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
⁶ Department of Thoracic Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
⁷ College of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁸ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
⁹ Critical Medical Center, China Medical University Hospital, Taichung, Taiwan.
¹⁰ School of Medicine, China Medical University, Taichung, Taiwan.
¹¹ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
¹² Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
¹³ Division of Chest Medicine, Department of Internal Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan.
¹⁴ School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
¹⁵ Division of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
¹⁶ Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
¹⁷ Department of Internal Medicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
¹⁸ Division of Pulmonary Medicine, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
¹⁹ School of Medicine, Tzu Chi University, Hualien, Taiwan.
²⁰ Division of Pulmonary Medicine, Department of Internal Medicine, Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
²¹ Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
²² School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
²³ Department of Internal Medicine, Division of Chest Medicine, Changhua Christian Hospital, Changhua, Taiwan.
²⁴ Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan.
²⁵ PhD Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan.
²⁶ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.
²⁷ Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.
²⁸ Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
²⁹ Department of Internal Medicine, National Taiwan University Hospital, Yunlin Branch, Douliu, Taiwan.
³⁰ Thoracic Medicine Center, Department of Medicine and Surgery, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan.
³¹ School of Post Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
³² Medical Research Center, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
³³ Department of Pulmonary Medicine, Lee's Clinic, Pingtung, Taiwan.
³⁴ Department of Chemical Engineering and Materials Science, Yuan Ze University, Taoyuan City, Taiwan.
³⁵ Department of Respiratory Therapy, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
³⁶ Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
³⁷ J-Y. Chien and H-C. Wang contributed equally to this article as lead authors and supervised the work.
³⁸ Department of Medicine National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan.

PMID: 40661934
PMCID: PMC12257146
DOI: 10.1183/23120541.00865-2024

Abstract

Background: The clinical impact of bacterial and mycobacterial isolates on bronchiectasis remains uncertain.

Methods: Patients with bronchiectasis at 16 hospitals in Taiwan were recruited with a 1-year follow-up. The patients were classified into six groups: Group 1, Pseudomonas aeruginosa; Group 2, Klebsiella pneumoniae; Group 3, other bacteria; Group 4, non-tuberculous mycobacteria (NTM); Group 5, daily sputum without bacterial or NTM colonisation; and Group 6, dry bronchiectasis.

Results: In total, 1416 patients (mean age 67 years; 43% males) were included. The mean modified Reiff score was 5 (range 1-18). 59% (829 patients) had sputum, whereas the remaining did not. The proportions of bacteria and NTM cultured from sputum within 1 year of observation were 27% (381/1416) and 15% (202/1416), respectively. The most common bacterial isolate was P. aeruginosa (13%), followed by K. pneumoniae (7%). 26% of the patients experienced severe exacerbations at least once within the year. The 1-year all-cause mortality rate was 3%. Patients with sputum exhibited a higher rate of severe exacerbations compared to patients with dry bronchiectasis, regardless of the presence of bacteria or NTM (p<0.001). Patients with bacterial colonisation had a higher mortality rate (p<0.001). Further, the highest mortality rate was observed among those with K. pneumoniae colonisation (hazard ratio (HR) 8.39 (95% CI 2.39-29.49)), followed by individuals colonised with other bacteria (HR 8.04 (95% CI 2.36-27.38)) and P. aeruginosa (HR 7.83 (95% CI 2.45-25.03)). Additionally, old age was an independent risk factor (HR 2.72 (95% CI 1.19-6.18)).

Conclusion: K. pneumoniae was more frequently isolated from patients with bronchiectasis in Taiwan compared to Western countries and was associated with unfavourable clinical outcomes.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: The authors declare no competing interests.

Figures

**FIGURE 1**
Microbiology in bronchiectasis. NTM: non-tuberculous mycobacteria.

**FIGURE 2**
Severe exacerbation of patients with bronchiectasis. Bonferroni-adjusted p-value <0.008. NTM: non-tuberculous mycobacteria.

**FIGURE 3**
Survival analysis of patients with bronchiectasis. NTM: non-tuberculous mycobacteria.

See this image and copyright information in PMC

References

1. Polverino E, Goeminne PC, McDonnell MJ, et al. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J 2017; 50: 1700629. doi: 10.1183/13993003.00629-2017 - DOI - PubMed
1. Diel R, Chalmers JD, Rabe KF, et al. Economic burden of bronchiectasis in Germany. Eur Respir J 2019; 53: 1802033. doi: 10.1183/13993003.02033-2018 - DOI - PubMed
1. Dhar R, Singh S, Talwar D, et al. Bronchiectasis in India: results from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India Registry. Lancet Glob Health 2019; 7: e1269–e1279. doi: 10.1016/S2214-109X(19)30327-4 - DOI - PubMed
1. Dhar R, Singh S, Talwar D, et al. Clinical outcomes of bronchiectasis in India: data from the EMBARC/Respiratory Research Network of India registry. Eur Respir J 2023; 61: 2200611. doi: 10.1183/13993003.00611-2022 - DOI - PMC - PubMed
1. Aksamit TR, O'Donnell AE, Barker A, et al. Adult patients with bronchiectasis: a first look at the US Bronchiectasis Research Registry. Chest 2017; 151: 982–992. doi: 10.1016/j.chest.2016.10.055 - DOI - PMC - PubMed

LinkOut - more resources

Full Text Sources
- PubMed Central

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Clinical significance of respiratory bacteria and mycobacteria isolates in adult bronchiectasis in Taiwan

Affiliations

Clinical significance of respiratory bacteria and mycobacteria isolates in adult bronchiectasis in Taiwan

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources