Sputum Bacteriology in Chronic Obstructive Pulmonary Disease Exacerbation Patients
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Abstract
Background: Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous respiratory condition characterized by persistent airflow limitation and associated with inflammatory responses in the lungs. COPD exacerbations can significantly impact patient health and often necessitate medical intervention. Understanding the bacterial etiology of these exacerbations can aid in optimizing treatment strategies.
Objective: The objective of this study was to determine the frequency of bacterial pathogens in the sputum of patients experiencing COPD exacerbations at a tertiary care hospital.
Methods: This cross-sectional study was conducted in the Department of Pulmonology at Pakistan Emirates Military Hospital, Rawalpindi, from December 12, 2023, to June 12, 2024. A total of 160 patients aged 18 to 60 years, admitted with acute exacerbation of COPD, were included using non-probability purposive sampling. Exclusion criteria were patients with lung malignancy, acute asthma exacerbations, bronchiectasis, or interstitial lung disease. Sputum samples were collected, and standard microbiological procedures were followed. Microscopy with Gram staining was performed, and specimens with more than 10 epithelial cells per low power field were cultured. Quantitative culture was conducted using blood agar and chocolate blood agar plates incubated in 5% CO2 at 35°C for 18–24 hours. Isolates with higher than 10^5 colony-forming units were reported as positive growth. Statistical analysis was performed using SPSS Version 25.
Results: The mean age of the patients was 37.89 ± 11.2 years, with 94 (58.8%) males and 66 (41.3%) females. The average duration of COPD was 4.87 ± 1.19 years. Among the participants, 89 (55.6%) were from urban areas, and 71 (44.4%) from rural areas. Educational status showed 33 (20.6%) illiterate, 111 (69.4%) with intermediate education, and 16 (10.0%) graduates. Comorbid conditions included diabetes mellitus in 37 (23.1%) patients, hypertension in 29 (18.1%), ischemic heart disease in 15 (9.4%), and smoking in 62 (38.8%). Sputum cultures revealed pathogens in 43 (26.9%) patients. Klebsiella pneumoniae was the most frequently identified bacterium (19 cases, 11.9%), followed by Staphylococcus aureus (10 cases, 6.3%), Pseudomonas aeruginosa (5 cases, 3.1%), Actinobacter (1 case, 0.6%), and Streptococcus pneumoniae (10 cases, 6.3%).
Conclusion: The study concluded that COPD exacerbation patients exhibited a variety of single pathogenic bacterial isolates, with Klebsiella pneumoniae and Streptococcus pneumoniae being the most common. Sputum culture is a valuable tool in identifying bacterial pathogens in COPD exacerbations, guiding appropriate antibiotic therapy.
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References
Vermylen JH, Kalhan R. Revealing the Complexity of Chronic Obstructive Pulmonary Disease. Translational Research. 2013;162(4):203-7.
Huang X, Mu X, Deng L, Fu A, Pu E, Tang T, et al. The Etiologic Origins for Chronic Obstructive Pulmonary Disease. International Journal of Chronic Obstructive Pulmonary Disease. 2019;14:1139-58.
Rastogi S, Jain A, Basu SK, Rastogi D. Current Overview of COPD With Special Reference to Emphysema. Chronic Obstructive Pulmonary Disease—Current Concepts and Practice. 2012;117-52.
Sethi S, Murphy TF. Bacterial Infection in Chronic Obstructive Pulmonary Disease in 2000: A State-of-the-Art Review. Clinical Microbiology Reviews. 2001;14(2):336-63.
Donaldson G, Seemungal TA, Bhowmik A, Wedzicha J. Relationship Between Exacerbation Frequency and Lung Function Decline in Chronic Obstructive Pulmonary Disease. Thorax. 2002;57(10):847-52.
Vestbo J, Edwards LD, Scanlon PD, Yates JC, Agusti A, Bakke P, et al. Changes in Forced Expiratory Volume in 1 Second Over Time in COPD. New England Journal of Medicine. 2011;365(13):1184-92.
Ritchie A. Understanding Mechanisms of Exacerbations in Early and Established Chronic Obstructive Pulmonary Disease. 2020.
Noorudheen Z. A Study On Association Between Clinical And Bacteriological Profile In Patients Of Acute Exacerbation Of Chronic Obstructive Pulmonary Disease In A Tertiary Care Centre. Rajiv Gandhi University of Health Sciences (India); 2020.
Murphy TF, Sethi S. Bacterial Infection in Chronic Obstructive Pulmonary Disease. American Review of Respiratory Disease. 1992;146:1087-103.
Devanath S. A Bacteriological Study of Acute Exacerbation of Chronic Obstructive Pulmonary Disease Over a Period of One Year. Rajiv Gandhi University of Health Sciences (India); 2009.
André S, Conde B, Fragoso E, Boléo-Tomé J, Areias V, Cardoso J. COPD and Cardiovascular Disease. Pulmonology. 2019;25(3):168-76.
Roca M, Verduri A, Corbetta L, Clini E, Fabbri LM, Beghé B. Mechanisms of Acute Exacerbation of Respiratory Symptoms in Chronic Obstructive Pulmonary Disease. European Journal of Clinical Investigation. 2013;43(5):510-21.
Burge S, Wedzicha J. COPD Exacerbations: Definitions and Classifications. European Respiratory Journal. 2003;21(41 Suppl):46s-53s.
Lin SH, Kuo PH, Hsueh PR, Yang PC, Kuo SH. Sputum Bacteriology in Hospitalized Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Taiwan With an Emphasis on Klebsiella Pneumoniae and Pseudomonas Aeruginosa. Respirology. 2007;12(1):81-7.
Ko FW, Ng TK, Li TS, Fok JP, Chan MC, Wu AK, et al. Sputum Bacteriology in Patients With Acute Exacerbations of COPD in Hong Kong. Respiratory Medicine. 2005;99(4):454-60.
Parameswaran GI, Murphy TF. Chronic Obstructive Pulmonary Disease: Role of Bacteria and Updated Guide to Antibacterial Selection in the Older Patient. Drugs & Aging. 2009;26:985-95.
Erkan L, Uzun O, Findik S, Katar D, Sanic A, Atici AG. Role of Bacteria in Acute Exacerbations of Chronic Obstructive Pulmonary Disease. International Journal of Chronic Obstructive Pulmonary Disease. 2008;3(3):463-7.
Arafa MA. Sputum Bacteriology in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease. The Egyptian Journal of Hospital Medicine. 2021;84(1):2510-5.
Patel A, Luhadia A, Luhadia S. Sputum Bacteriology and Antibiotic Sensitivity Pattern of Patients Having Acute Exacerbation of COPD in India: A Preliminary Study. Journal of Pulmonary & Respiratory Medicine. 2015;5(1):238.
Huang C, Shi G. Smoking and Microbiome in Oral, Airway, Gut and Some Systemic Diseases. Journal of Translational Medicine. 2019;17(1):1-15.
Amatngalim GD, Hiemstra PS. Airway Epithelial Cell Function and Respiratory Host Defense in Chronic Obstructive Pulmonary Disease. Chinese Medical Journal. 2018;131(9):1099-107.
Bartal M. COPD and Tobacco Smoke. Monaldi Archives for Chest Disease. 2005;63(4).