SESSION TITLE: COPD Epidemiology & Physiology Posters
SESSION TYPE: Poster Presentations
PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM
PURPOSE: European respiratory society (ERS) guidelines recommend to stratify patients with acute exacerbations of COPD (AECOPD) according to the presence or not of risk factors(RF) for Pseudomonas aeruginosa (PA). There is controversy regarding the need to empirically cover PA in clinical practice. Therefore a better understanding of the prevalence and RF for PA in hospitalized patients with AECOPD is critical in order to appropriately adhere to clinical practice guidelines. Aim: 1) Determine the prevalence of PA pathogens and PA risk RF in hospitalized patients with AECOPD; and 2) Assess the association of PA isolation and PA RF among hospitalized patients with AECOPD.
METHODS: Retrospective cohort study at a tertiary hospital at la Coruna, Spain in 2009. Inclussion:1) Age >40 years old, 2) former or active smokers (>10 ppk/years), 3) prior spirometry (FEV1/FVC<70), and 4) an admission diagnosis of AECOPD. Exclussion: radiological confirmation of pneumonia as the cause of the AECOPD. We assessed the following risk factors: 1) recent hospitalization, 2) frequent or recent administration of antibiotics, 3) FEV <30%, and 4) oral steroid use (>10 mg of prednisolone daily in the last 2 weeks). We performed descriptive statistics and assessed for associations with a p value <0.05 for statistical significant values
RESULTS: We identify a PA prevalence rate of 4.2% (n=6) among 143 subjects hospitalized with an AECOPD. The most common PA RF was “frequent or recent administration of antibiotics” (n=33[23%]), followed by severe COPD disease (n=17[12%]), oral steroid use (n=10[7%]), and recent hospitalization (n=3[2%]). PA AECOPD was not associated with frequent or recent administration of antibiotics (Odds ratio [OR] 3.6; 95% confidence interval [CI] 0.7-18.5, p=.13), severe COPD disease (OR 1.5; 95%CI .2-13.8, p=.7), oral steroid use (OR 2.8; 95%CI .3-27.0, p=.4) and recent hospitalization (OR 0, p>.05).
CONCLUSIONS: There is a low prevalence of PA among patients with AECOPD. Despite the common presence of PA risk factors, there is no association between risk factors and PA-AECOPD.
CLINICAL IMPLICATIONS: Despite the presence of PA risk factors is significative, a small percentage of them are infected with PA. So, at this moment it is difficult to rely only on this factors when deciding PA antibiotic coverage.
DISCLOSURE: The following authors have nothing to disclose: Pedro Marcos, Pilar Sanjuan, Santiago Rodriguez-Segade, Natalia Uribe-Giraldo, Marina Blanco-Aparicio, Isabel Otero, Jorge Ricoy, Hector Verea, Marcos Restrepo
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