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Communications to the Editor |

Infective Exacerbations of COPD FREE TO VIEW

Abdullah Sayiner, MD; Nurtac Okyay, MD; Ipek Unsal, MD; Nesrin Colpan, MD
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Ege University Medical School Izmir, Turkey



Chest. 1999;115(5):1481. doi:10.1378/chest.115.5.1481
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To the Editor:

We read with great interest the article by Eller and colleagues (June 1998)1 in which they showed that there was a correlation between deterioration of lung function (as measured with FEV1 levels) and the bacteria isolated from patients with infective exacerbations of COPD, in that a significantly higher rate of Enterobacteriaceae and Pseudomonas aeruginosa were isolated from patients with more severe disease. We would like to extend these observations with our own experience.

We retrospectively reviewed the records of COPD patients with severe exacerbation hospitalized according to the American Thoracic Society standards2 between January 1995 and June 1997. We excluded the following individuals: patients with evidence of other disease that can cause chronic cough and sputum production (bronchiectasis, asthma) or radiographically apparent pneumonia; those who were unable to produce any sputum or whose sputum was not of good quality (>25 leukocytes, <10 epithelial cells/100× magnified field); or those who were admitted to the ICU and a nonprotected endotracheal suction material was obtained. COPD patients who had a nosocomial respiratory infection or whose sputum was obtained after antibiotics were given were also not evaluated. Data for 232 patients (38 were female and 194 were male; mean age, 64.4 ± 9.0 years) who matched these criteria are presented here. These were all current or ex-smokers with a mean duration of COPD of 13.1 ± 7.5 years and a mean FEV1 level of 1.14 ± 0.69 L.

The microbiologic examination of the sputum revealed normal flora in 108 (46.6%) of the patients. The most frequently isolated bacteria were as follows: Streptococcus pneumoniae (37 cases, 15.9%), Haemophilus influenzae (26 cases, 11.2%), Enterobacteriaceae (20 cases, 8.6%), P aeruginosa (16 cases, 6.9%), Moraxella catarrhalis (14 cases, 6.0%), Acinetobacter spp (3 cases, 1.3%). The cases were evaluated in two groups: group A included the cases whose sputum examination revealed Enterobacteriaceae, P aeruginosa, or Acinetobacter spp (n = 39). Group B (n = 193) contained all others whose sputum examination revealed either normal flora or any other bacteria not included in group A.

There was no difference between the two groups as to the following: age; duration of COPD; levels of Paco2, hematocrit, and serum creatinine; number of exacerbations during the previous year; and use of inhaled steroids. The two groups differed, however, in that group A cases had lower levels of FEV1 (0.86 ± 0.45 vs 1.23 ± 0.76 L, p < 0.01) and Pao2 (51.7 ± 17.7 vs 56.7 ± 17.1 mm Hg, p = 0.053), higher rate of hypoalbuminemia (albumin levels <3.5 g/dL in 9.5% vs 27.9%, p < 0.05), and a history of more frequent hospitalizations (5.7 ± 3.2 vs 4.0 ± 2.8, p < 0.01). Group A bacteria were also more frequently isolated from those who were using H2-antagonists than from those who were not (29.3% vs 14.1%, p < 0.05).

As in the study by Eller and colleagues,1 we also observed a trend for increasing rates of isolation of group A bacteria with decreasing FEV1 levels (Fig 1). A similar trend was seen with decreasing levels of Pao2 (data not shown).

The only other study on the microbiologic findings of severe COPD exacerbations showed similar results.3 These data support and extend the observations by Eller and colleagues that Enterobacteriaceae and P aeruginosa are isolated more frequently than other organisms and should be taken into account in infective exacerbations of patients with severe disease, as reflected by low levels of FEV1, deeper hypoxemia, malnutrition, and more frequent hospitalizations.

Correspondence to: Abdullah Sayiner, MD, Ege Universitesi Tip Fakültesi, Gögüs Hast. A.D., Bornova, Izmir 35100, Turkey; e-mail: asayiner@med.ege.edu.tr

Figure Jump LinkFigure 1. Prevalences of group A and group B bacteria according to patients’ FEV1 levels. The numbers express the percentage of patients infected with bacteria in subpopulations with FEV1 levels below the indicated values.Grahic Jump Location

References

Eller, J, Ede, A, Schaberg, T, et al (1998) Infective exacerbations of chronic bronchitis: relation between bacteriologic etiology and lung function.Chest113,1542-1548. [PubMed] [CrossRef]
 
American Thoracic Society statement. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease.Am J Respir Crit Care Med1995;152,S77-S120. [PubMed]
 
Fagon, J-Y, Chastre, J, Trouillet, J-L, et al Characterization of distal bronchial microflora during acute exacerbation of chronic bronchitis.Am Rev Respir Dis1990;142,1004-1008. [PubMed]
 

Figures

Figure Jump LinkFigure 1. Prevalences of group A and group B bacteria according to patients’ FEV1 levels. The numbers express the percentage of patients infected with bacteria in subpopulations with FEV1 levels below the indicated values.Grahic Jump Location

Tables

References

Eller, J, Ede, A, Schaberg, T, et al (1998) Infective exacerbations of chronic bronchitis: relation between bacteriologic etiology and lung function.Chest113,1542-1548. [PubMed] [CrossRef]
 
American Thoracic Society statement. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease.Am J Respir Crit Care Med1995;152,S77-S120. [PubMed]
 
Fagon, J-Y, Chastre, J, Trouillet, J-L, et al Characterization of distal bronchial microflora during acute exacerbation of chronic bronchitis.Am Rev Respir Dis1990;142,1004-1008. [PubMed]
 
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