Data regarding the role of bacterial infection in acute exacerbation of IPF are scarce. The primary goal of this study was to investigate the possible role of different bacteria in triggering acute exacerbations of IPF. The secondary goal was to define the pattern of antibiotic resistance in such organisms.
Consecutive IPF patients who had acute exacerbation were recruited in this prospective study in chest diseases department, Assiut University Hospital, Egypt. They did not receive antibiotics during the last 14 days and had symptoms and/or signs of active chest infection. High resolution chest CT, spirometry, arterial blood gases, gram stain, direct smear for acid fast bacilli, fungus examination and quantitative sputum culture tests were done. Then susceptibility tests using the MicroScan walk away 96 method was carried out for positive growths.
We recruited 25 patients with IPF (17 females and 8 males) with mean age ± SD of 43.16 years. Their mean PH was 7.43 ± 0.05, PaCO2 39.7 ± 11.7 mm hg, PaO2 55 ± 13.6 mm hg, Saturation 86.3 ± 9.03%, FEV1 (% Pred) 0.94 liter (43%), FVC 1.27 liter (45.7%), FEV1/FVC 78% and prednisolone dose before exacerbation of 19 ± 11.3 mg. We had positive sputum culture in 80% of patients (20/25) with no spirometric or gasometric differences between both groups. The majority of patients with positive sputum cultures (16/20) were infected with Pneumococci and staphylococci while a minority had gram negative growth (4/20). There were 28% (7/25) cases mixed with fungal infection and only one case positive for acid fast bacilli. The majority (85%, 17/20) of the isolated bacterial growths showed multidrug-resistance to antibiotics including 3rd generation cephalosporins and respiratory quinolones.
Bacterial infection should be considered as a cause of exacerbation in idiopathic pulmonary fibrosis admitted to hospital especially gram positive and fungal infections.
Combination antibiotic should be started empirically during exacerbation of IPF especially if patients show symptoms and/or signs of active chest infection. Moreover, culture sensitivity of the sputum should be done including fungal examination to augment antibiotic therapy accordingly.
Mohamed Metwally, No Financial Disclosure Information; No Product/Research Disclosure Information