The lower airways of asymptomatic chronic obstructive pulmonary disease (COPD) patients can be colonized by bacteria, mainly Haemophilus influenza, Streptococcus pneumoniae, and Moraxella catarrhalis. However, the role of lower airway bacteria in stable and exacerbated COPD has not been well defined. To determine the importance of lower airway bacterial infection in COPD we studied 40 outpatients with stable COPD (Group A: age 61.1 +/- 9.9 yr; [mean +/- SD]; FEV1/FVC 51.7 +/- 12.5) and 29 outpatients with exacerbated COPD (Group B: age 63.4, SD 9.0 yr; FEV1/FVC 52.0, SD 9.6), using the protected specimen brush (PSB) for microbiology sampling. Group A consisted of outpatients with stable COPD having normal or near-normal chest X-rays, with clinical indications for performing fiber-bronchoscopy (pulmonary nodule, remote hemoptysis); Group B consisted of patients with exacerbated COPD who voluntarily accepted lower airway microbiology sampling. To avoid contamination by upper airway flora the PSB was used for bacterial sampling in all the cases and concentrations > or = 1,000 colony-forming units/milliliter (CFU/ml) were considered positive. Results were as follows: Group A: Lung function data in outpatients with stable COPD were lower than the reference values for this population (FVC 2.97 +/- 1.02 L, FVC% 71.4 +/- 22.4, FEV1 1.59 +/- 0.79 L, FEV1% 51.2 +/- 23.0). Positive PSB cultures were obtained in 10 of 40 cases (25%), mainly of H. influenzae and S. pneumoniae. Two of 40 cases had positive cultures at concentrations > or = 10,000 CFU/ml (5.0%).(ABSTRACT TRUNCATED AT 250 WORDS)

The aim of this study was to determine the prevalence and risk factors for lower airway bacterial colonization (LABC) in stable chronic bronchitis (CB).Forty-one outpatients with CB were enrolled in the study (age 63.89.1 yrs (mean SD); forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) 62.811.2; current/former smokers 24/17). All patients had normal chest radiographs and an indication for performing fibreoptic bronchoscopy (pulmonary nodule, remote haemoptysis). The protected specimen brush (PSB) was used for bacterial sampling, and concentrations $1,000 colony-forming units (cfu) . mL -1 were considered positive for LABC. The repeatability of the procedure in CB was assessed in a random subsample of 18 subjects.A 72.2% quantitative agreement was found in the repeatability assessment of the PSB technique. Positive PSB cultures, obtained in 9 out of 41 (22%) patients, mainly yielded Haemophilus influenzae. The logistic regression model, used to determine which variables were related to colonization, showed that LABC was associated with current smoking (odds ratio (OR) 9.83, confidence interval (CI) 1.16±83.20) and low FVC (OR 0.73, CI 0.65±0.81). Age and FEV1 were not related to LABC.It was concluded that the prevalence of LABC in stable CB is high (22%), and current smoking is an important risk factor. Eur Respir J 1999; 13: 338±342. A cross-sectional study of 41 outpatients with stable CB was conducted using the protected specimen brush (PSB) technique [6,7], in order to determine the prevalence of LABC and the risk factors associated with such colonization in this population. Materials and methods PopulationA series of 41 stable CB outpatients were defined as having chronic phlegm (>3 months . yr -1 for $2 yrs) and normal or near-normal (pulmonary nodule <3 cm diameter) chest radiographs, with no acute lung disease [8]. Only patients with no changes in the volume or appearance of sputum or level of dyspnoea in the previous 15 days were considered to have stable CB. Patients who had been admitted to hospital within the last 6 months, who had been treated with antibiotics during the month prior to microbiological sampling, with clinical or radiological signs suggestive of bronchiectasis or who had alveolar or interstitial opacities on a chest radiograph were not included. Patients with a history of diagnosed bronchial asthma or positive reversibility tests were also excluded. All patients meeting the inclusion criteria who had been examined with fibreoptic bronchoscopy (indication: pulmonary nodule <3 cm diameter or remote haemoptysis) over a 1-yr period were included in a cohort study on the effect of bronchial colonization on lung health (age 63.89.1 yrs (meanSD), height 164.36.5 cm, all males, current/former smokers 24/17). This paper describes the findings of the initial cross-sectional phase of this cohort study.Forced spirometry was performed in all patients using a dry spirometer (Micro Medical, Rochester, UK) 1 h before premedication and fibreoptic bronchoscopy. The high...

The aim of this study was to prospectively analyze the bacterial etiology of community-acquired pneumonia in adults in Spain. From May 1994 to February 1996, 392 episodes of CAP diagnosed in the emergency department of a 600-bed university hospital were studied. An etiological diagnosis based on noninvasive microbiological investigations was achieved in 228 cases (58%); 173 of these diagnoses were definitive and 55 probable. Streptococcus pneumoniae, which caused 23.9% of the episodes, was the predominant pathogen observed, followed by Chlamydia pneumoniae (13.5%) and Legionella pneumophila (12.5%). Other less frequent pathogens found were Haemophilus influenzae (2.3%), Pseudomonas aeruginosa (1.5%), Mycoplasma pneumoniae (1.3%), Coxiella burnetii (1%), Moraxella catarrhalis (2 cases), Nocardia spp. (2 cases), and Staphylococcus aureus (2 cases). Streptococcus pneumoniae was significantly more frequent in patients with underlying disease and/or age > or =60 years (28% vs. 13%, P = 0.002), while Legionella pneumophila was more frequent in patients below 60 years of age and without underlying disease (20% vs. 9%, P = 0.006). Likewise, Streptococcus pneumoniae and Legionella pneumophila were the most frequent etiologies in patients requiring admission to the intensive care unit, occurring in 29% and 26.3% of the patients, respectively. In addition to Streptococcus pneumoniae, other microorganisms such as Chlamydia pneumoniae and Legionella spp. should be seriously considered in adults with community-acquired pneumonia when initiating empiric treatment or ordering rapid diagnostic tests.

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