PURPOSE: To investigate the possible relationship between functional respiratory impairment measured by FEV1%pred, clinical and laboratory parameters and sputum culture results in patients with COPD exacerbation.
METHODS: We prospectively evaluated clinical (fever, hospitalization days), laboratory data (Spirometry, ESR, CRP) and quantitative sputum culture results in 73 patients admitted to our hospital with an acute exacerbation of COPD. Pathogens sensitivities to first line used antibiotics were also recorded.
RESULTS: 73 patients, (61 males, 12 females), age 70.2±9.7 years, FEV1 1±0.5lt, FEV1%pred 40.3±18%, FEV1/FVC% 50.9±13.6%, were included. Patients were classified in 4 stages according to GOLD criteria: Stage I, 2 cases(3.2%), Stage II 13(21%), Stage III 29(46.8%), Stage IV 18 cases(29%). Isolated pathogens were as follows: Haemophilus influenzae (18 cases,33.3%), Pseudomonas aeruginosa (7,13.7%), Brahamella catarhalis (6,11.8%), Klebsiella pneumoniae (2,3.9%), Acinetobacter baumannii (2,3.9%), Serratia marcescens (1,2%), Stenotrophomonas maltophilia (1,2%), Enterobacter cloaca (1,2%), and Streptococcus pneumoniae (1,2%). All but 2 stains of H.influenzae were sensitive to Ampicillin. Positive culture results were more frequent among the patients with Stage III and IV than among those with Stage I-II, (p=0.018). Gram (-) hospital stains including P.aeruginosa were isolated in patients with FEV1≤35% pred,(p=0.05). Positive culture results were positively correlated with fever≥38, (p=0.05), ESR>20 (p=0.032) and CRP≥+++ (p=0.05). There was no correlation between days of hospitalization and positive culture results (p=0.46).
CONCLUSION: Patients with the greatest degree of functional impairment presented a higher probability of having positive culture results. Enterobacteriaceae and Pseudomonas spp are the predominant bacteria in patients with FEV1≤35% pred and that should be considered when establishing an empiric antibiotic treatment for exacerbated COPD. Fever, ESR and CRP are also correlated with a bacteriologic etiology of an exacerbation.
CLINICAL IMPLICATIONS: Disease severity in COPD exacerbation as measured by FEV1%pred should always be considered in choosing empiric antibiotic treatment. Haemophilus influenzae, still remains sensitive to Ampicillin in our group of patients.
DISCLOSURE: Vlasios Polychronopoulos, None.