Urinary tract infection (UTI), which is typically caused by Escherichia coli (E. coli), is an insufficiently recognized co-morbidity among patients with chronic obstructive pulmonary disease (COPD). Adequate treatment can be complicated by resistance of the causative pathogen to beta-lactam antibiotics, which often produce beta-lactamase enzymes that destroy the antibiotic. The beta-lactamase family of enzymes is extremely diverse, including different types of enzyme and mutant forms. In this study, we analyzed 580 patients with COPD (236 females and 344 males) and thus found 218 patients with co-morbid UTIs, including 58 patients with UTI caused by E. coli (38 females and 20 males). We also investigated cases of uncomplicated symptomatic and asymptomatic UTI caused by E. coli and the presence of resistance to beta-lactam antibiotics among those patients. The E. coli strains resistant to beta-lactam antibiotics were selected for their ability to grow on selective media, before DNA microarrays were applied for specific identification of three beta-lactamase gene types (i.e., TEM, SHV and CTX-M). Overall, 83% of E. coli strains responsible for UTIs in COPD patients carried extended-spectrum beta-lactamase genes. The most prevalent were those producing CTX-M, with CTX-M-15 being predominant. The rare CTX-M-27 and TEM-15 genes were also detected in two samples. Three samples contained several extended-spectrum beta-lactamase genes simultaneously (CTX-M-15 or CTX-M-14 plus SHV-5 or TEM-15). This high prevalence of resistant E. coli strains necessitates rational antibiotic selection when treating UTI to prevent COPD exacerbations. Additionally, antibiotic therapy should be aligned with and adapted to existing and potential COPD co-morbidities.

ABSTRACT

Traffic is the most significant noise source in urban areas. The village of Kamenari in Boka Kotorska

Introduction The St. George's Respiratory Questionnaire (SGRQ), Modified Medical Research Council (mMRC) Dyspnea Scale, Hospital Anxiety and Depression Scale (HADS), and general health questionnaire (SF-36) are widely used for chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD). Aim We examined the reliability and validity of a modified questionnaire (MQ) to create a model for assessing the health-related quality of life (HRQOL) in COPD. Method In total, 132 COPD patients completed the MQ. Lung function, smoking index, and exacerbation frequency were measured. Cronbach's α coefficient of correlation, standard deviation, and multifactorial nonlinear regression analysis were used to verify the internal validity of the MQ and to develop the mathematical model. Results Female (63) patients had lesser airway obstruction than, and exacerbation frequency similar to that of, male patients. Exacerbation frequency significantly correlated with spirometry parameters in female patients. The MQ total score achieved high internal consistency (Cronbach's α = 0.89) and showed significant correlations with exacerbation frequency, smoking habit, and spirometry parameters in male patients (p < 0.005). Conclusion The HRQOL questionnaire was shown to be a good indicator of the health status of COPD patients. The mathematical model easily and precisely confirmed the score of HRQOL questionnaire.