PURPOSE: The microbiological flora associated with exacerbations of chronic obstructive pulmonary disease (COPD) in patients in the intensive care unit (ICU) has not been well studied. The objective of this study was to evaluate the most common bacteria associated with exacerbations of COPD in patients admitted to the ICU.
METHODS: Retrospective review of an electronic database maintained in the institution of all patients admitted between 1/1/2003 and 12/31/2006 to a medical ICU with a diagnosis of COPD, emphysema, or chronic bronchitis.
RESULTS: 1562 patients with the above diagnoses were admitted. The length of stay in the ICU was 4.39 days (SD±6.45), 63% were male and 797 (51%) were intubated. Sputum cultures were obtained in 299 patients (19%) of which 73% were obtained in the intubated patients. Fifty-one percent (N=153) of the patients grew Streptococcus pneumoniae, 50% (N=150) Staphylococcus aureus of which 54% (N=80) were methicillin resistant Staphylococcus aureus (MRSA), 34% patients Escherichia coli, 16% patients Klebsiella pneumoniae, 12% patients Moraxella catarrhalis and 9% patients Haemophilus influenzae.
CONCLUSION: Streptococcus pneumoniae and Staphylococcus aureus are the most common pathogens in patients with exacerbation of COPD admitted to the ICU. MRSA was isolated in 50% of cases of S. aureus with a significant implication for the management of these patients.
CLINICAL IMPLICATIONS: Consideration of MRSA as a common microbiological flora in patients in the ICU with exacerbations of COPD should impact choice of initial empiric antibiotic coverage.
DISCLOSURE: Gul Khan, None.