Acute exacerbations of COPD (AECOPD) are associated with systemic inflammation and their etiology is predominantly infectious. The purpose of this study was to investigate the prevalence of common and atypical pathogens in COPD exacerbation and to evaluate their clinical importance.
92 patients, aged 72.4 ± 7.8 years, mean post FEV1% 37.5 ± 16.7%, who had been admitted in our department with AECOPD, were included. Quantitative sputum cultures and conventional PCR analysis of sputum for Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophilla were performed. The following variables were evaluated: Fever, peripheral neutrophilia, ESR, C-reactive protein, Anthonisen type of exacerbation, spirometry and outcome, in compination with culture and PCR results.
Among the 64 valid sputum samples there were 52 bacterial positive and 12 negative cultures. Community pathogens were isolated in 26 (50%), hospital pathogens in 18 (34.6%) and mixed pathogens (community and hospital) in 7 (13.5%) cultures. Most common pathogens were Haemophilus ifluenzae (22 strains, 42.3%) and Pseudomonas aeruginosa (13 strains, 25%). PCR was positive in 8 (12.5%) samples (5 for M. pneumoniae and 3 for C. pneumoniae). In 6 of those samples atypical strains were co-pathogens. Patients with positive culture results did not differ in terms of the above mentioned 8 parameters compared to patients with negative cultures. Patients with atypical pathogens ± bacterial pathogens, also did not differ compared to patients with bacterial pathogens alone.
Prevalence of bacterial pathogens was 81% and of atypical pathogens 12.5% in our population. Patients with positive cultures did not differ in clinical and functional parameters and inflammatory profile compared to patients with negative cultures. The presence of an atypical pathogen did not modify the clinical course of a severe COPD exacerbation.
The importance of the atypical pathogens in severe AECOPD are not yet adequately studied.
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