PURPOSE: COPD Exacerbation: Correlation between Sputum Culture Results with Indices of Systemic Inflammation, Respiratory Function and Factors related to Exacerbation Outcome.
METHODS: We explored the correlation between systemic inflammatory markers (fever, neutrophilia, ESR, CRP, Fibrinogen), respiratory function (FEV1% pred) and factors related to exacerbation outcome (previous use of antibiotics, duration of symptoms before admission and duration of hospital stay) with positive or negative bacterial culture results, in patients admitted to our department with an acute exacerbation of COPD.
RESULTS: 67 patients were included (59 males, 8 females, age 71.9 ± 8.2 years). 25 (37.3%) patients had very severe obstruction (FEV1<30% pred), 29 (43.3%) severe, 10 (14.9%) moderate and 3 (4.5%) mild, according to GOLD criteria. Positive quantitative sputum culture results observed in 28 (54.9%) patients, negative in 23 (45.1%), whereas 16 patients didn't produce sputum. The predominant pathogens were Haemophilus influenzae (10 strains) and Pseudomonas aeruginosa (12 strains). Peripheral blood neutrophils were significantly raised in patients with positive culture results (12.364 ± 809) comparable with those with negative culture (9.975± 797), p=0.0427. There was no relationship between positive culture results (bacterial infection) and fever, CRP, ESR, fibrinogen and previous use of antibiotics (for current exacerbation before admission). Patients with bacterial infection had worse lung function (FEV1% pred 31.23 ± 2.21 vs 45.39 ± 4.65, p=0.0102) and longer duration of hospital stay (10 ± 0.92 days vs 7.6 ± 0.74, p=0.0523). Patients in whom nosocomial pathogens were isolated had shorter duration of symptoms before admission comparable with patients with community pathogens (6.6± 0.95 days vs 7.9 ± 0.98, p=0.0387).
CONCLUSION: Bacterial infections were correlated with increased numbers of neutrophils, worse lung function and longer hospital stay. Patients with neutrophilia (> 12.000/mm3) and moderate to severe obstruction have been at risk of having a bacterial infection and should be candidates for empiric antibiotic treatment.
CLINICAL IMPLICATIONS: : Bacterial infections deteriorate lung function and increase hospital stay in acute exacerbations of COPD and should be treated appropriately soon after admission.
DISCLOSURE: Filia Diamantea, No Financial Disclosure Information; No Product/Research Disclosure Information