PURPOSE: To define the pathogenic microorganisms, including viruses and atypical bacteria, in patients with bronchiectasis
METHODS: A prospective observational study was designed and performed. Cystic fibrosis patients were excluded from the study since they are believed to have different epidemiological characteristics from the other patients with bronchiectasis. Total 33 patients with bronchiectasis were recruited and the follow up lasted 12 months. Bronchoscopy was performed in 4 months intervals, during baseline and exacerbations. Bronchoalveolar lavage (BAL) was collected and cultured for bacteria. Also, real time polymerase chain reaction (RT-PCR) was performed for the detection of Chlamydophila pneumoniae, Mycoplasma pneumoniae and Respiratory syncytial virus (RSV).
RESULTS: During the study, 116 patient visits were performed and 19 exacerbations were recorded. Microorganisms were identified in 29 visits (25%). More than one microorganism was isolated in 10 (34%) visits (5 baseline & 5 exacerbations). During baseline periods, in 18/97 visits (18,5%), 10 different microorganisms were found. Pseudomonas aeruginosa was isolated 8 times, Staphylococcus aureus 5 times, RSV (using PCR) 4 times, Haemophilus influenzae 3 times, and Proteus mirabilis, Enterobacter aerogenes, Klebsiella pneumoniae, Streptococcus pneumoniae, Serratia rubidaea and Eneterobacter cloacae once. Candida albicans that required treatment was also isolated also once. During exacerbations bacteria were isolated and cultured in 11/19 visits (57%). P. aeruginosa was isolated 5 times, H. Influenzae 4 times, S. aureus 3 times, S. pneumoniae twice and K. pneumoniae and P. Mirabillis once. All PCRs were negative for both atypical bacteria and viruses during exacerbations.
CONCLUSIONS: This is the first study, according to our knowledge, that contacted PCR in BAL samples for atypical bacteria and viruses in patients with bronchiectasis. Our findings further support previously contacted studies, which reported that bacteria are the main cause of exacerbations and baseline colonization, in patients with bronchiectasis.
CLINICAL IMPLICATIONS: Bronchiectasis' exacerbations should be confronted with antibiotics since viruses do not seem to be the culprits. Knowing the baseline bacteria, if any, will further assist the choice of antibiotic regimen.
DISCLOSURE: The following authors have nothing to disclose: Eugenios Metaxas, Evagelos Balis, Joseph Papaparaskevas, Nicholaos Spanakis, Konstantinos Kotsifas, George Tatsis, Athanasios Tsakris
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