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Clinical Investigations: COPD |

Relationship Between Bacterial Flora in Sputum and Functional Impairment in Patients With Acute Exacerbations of COPD*

Marc Miravitlles, MD; Cristina Espinosa, MD; Enrique Fernández-Laso, MD; José Alberto Martos, MD; José Antonio Maldonado, MD; Miguel Gallego, MD; Study Group of Bacterial Infection in COPD
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*From the Pneumology Department (Dr. Miravitlles), Hospital Vall d’Hebron, Barcelona, Spain; the RD Department (Dr. Espinosa), QF Bayer, Barcelona, Spain; the Pneumology Department, Hospital Magdalena, Castellon, Spain (Dr. Fernández-Laso); the Pneumology Unit, Hospital San Rafael (Dr. Martos), Barcelona, Spain; the Pneumology Department, Hospital Juan Ramón Jiménez, Huelva, Spain (Dr. Maldonado); and the Pneumology Unit (Dr. Gallego), Hospital Parc Taulí, Sabadell, Barcelona, Spain.

Correspondence to: Marc Miravitlles, MD, Rocafort 173–177, 3°1a, 08015 Barcelona, Spain; e-mail: marcm@separ.es


*From the Pneumology Department (Dr. Miravitlles), Hospital Vall d’Hebron, Barcelona, Spain; the RD Department (Dr. Espinosa), QF Bayer, Barcelona, Spain; the Pneumology Department, Hospital Magdalena, Castellon, Spain (Dr. Fernández-Laso); the Pneumology Unit, Hospital San Rafael (Dr. Martos), Barcelona, Spain; the Pneumology Department, Hospital Juan Ramón Jiménez, Huelva, Spain (Dr. Maldonado); and the Pneumology Unit (Dr. Gallego), Hospital Parc Taulí, Sabadell, Barcelona, Spain.


Chest. 1999;116(1):40-46. doi:10.1378/chest.116.1.40
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Study objectives: To investigate the possible relationship between functional respiratory impairment measured by FEV1 and isolation of diverse pathogens in the sputum of patients with exacerbations of COPD.

Design: Multicenter, cross-sectional, epidemiologic study.

Setting: Pneumology units in six secondary or tertiary hospitals in Spain.

Patients: Ninety-one patients with acute exacerbation of COPD were included.

Interventions: A quantitative sputum culture was performed, and bacterial growth was considered significant only when the germ was isolated at concentrations > 106 cfu (> 105 for Streptococcus pneumoniae) in samples with < 10 epithelial cells and > 25 leukocytes per low magnification field (×100).

Results: Germs isolated were the following: Haemophilusinfluenzae (20 cases; 22%), Pseudomonasaeruginosa (14 cases; 15%), S pneumoniae (9 cases; 10%), Moraxellacatarrhalis (8 cases; 9%), other Gram-negative bacteria (7 cases; 7%), and non-potentially pathogenic microorganisms (non-PPMs; 33 cases; 36%). P aeruginosa and H influenzae were isolated more frequently among the patients with FEV1 < 50% than among those with FEV1 > 50% (p < 0.05). All patients with P aeruginosa in sputum had FEV1 < 1,700 mL. FEV1 < 50% was associated with a very high risk of P aeruginosa or H influenzae isolation: the odds ratios (ORs) are 6.62 (95% confidence interval [CI], 1.2 to 123.6) and 6.85 (95% CI, 1.6 to 52.6), respectively. Furthermore, active tobacco smoking was associated with a high risk of H influenzae isolation (OR, 8.1; 95% CI, 1.9 to 43.0).

Conclusions: Patients with the greatest degree of functional impairment, as measured by their FEV1, presented a higher probability of having an isolation of P aeruginosa or H influenzae in significant concentrations in sputum during an exacerbation. The diagnostic yield of sputum in patients with an FEV1 > 50% was low, with a predominance of non-PPMs. Low FEV1 and active tobacco smoking are data that should be considered when establishing an empiric antibiotic treatment for exacerbated COPD.

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