A Multicenter Study to Identify the Respiratory Pathogens Associated with Exacerbation of Chronic Obstructive Pulmonary Disease in Korea

Abstract

Background: Although respiratory tract infection is one of the most important trigger factors for acute exacerbation of chronic obstructive pulmonary disease (AE-COPD), there are limited data on the epidemiologic patterns of microbiology in South Korea.Methods: A multicenter observational study was conducted in 28 hospitals in South Korea between January 2015 and December 2018. Adult COPD patients with moderate to severe acute exacerbations were eligible for the present study. They underwent all conventional tests to identify etiologic microbiologic pathogens. The primary outcome was the percentage of different microbiological pathogens that caused AE-COPD. Comparative microbiological analysis was performed between the patients with asthma-COPD overlap (ACO) and pure COPD. Results:We included 1,186 patients with AE-COPD. Pure COPD patients were 87.9% and ACO patients were 12.1%. Nearly half of the patients used an ICS-containing regimen and one-fifth used systemic corticosteroids. Among them, respiratory pathogens were found in 55.3%. Bacteria and viruses were found in 33% and 33.2%, respectively. Bacterial and viral coinfections were found in 10.9%. The most frequently detected bacteria were Pseudomonas aeruginosa (9.8%), and the most frequently detected virus was influenza A (10.4%). Multiple 7 bacterial infections were more likely found in ACO compared to pure COPD (8.3% vs 3.6%, p-value=0.016). Conclusion:Distinct microbiological patterns were identified in patients with moderate to severe AE-COPD in South Korea. These findings may improve evidence-based management for AE-COPD and become the basis for further research related with infectious pathogens in COPD patients.

Bacterial etiology and pneumococcal urinary antigen in moderate exacerbation of chronic obstructive pulmonary disease

“…P. aeruginosa was the third most common bacteria and its prevalence was 14.0%, even more than that of M. catarrhalis (9.0%), which is noticeably different from the global prevalence. Previous studies also reported a high incidence rate of P. aeruginosa isolation ( 11 , 13 , 14 ), which is expected and may be attributed to more severe patients being transferred to large metropolitan hospitals clustered in this area after being treated at smaller local hospitals. Furthermore, since the patients in this study had moderate COPD exacerbation and were recruited in outpatient settings without a mandatory computed tomography scan, it is possible that some of them had co-existing bronchiectasis but were unaware about its presence, contributing to the high incidence of P. aeruginosa .…”

“…It is possible that our large sample size and multicenter approach provide more reliable results than some previous studies from South Korea that reported no H. influenzae or M. catarrhalis detection: these were single-centered studies with less than 200 samples ( 13 , 14 ). A recent multicenter retrospective study conducted in South Korea reported that P. aeruginosa was the most prevalent bacterial species ( 11 ). The study included patients with moderate-to-severe AECOPD, whereas our study only included patients with moderate AECOPD who were not hospitalized.…”

“…Globally, Haemophilus Influenzae (H. influenzae), Streptococcus pneumoniae (S. pneumoniae), Moraxella catarrhalis (M. catarrhalis), and Pseudomonas aeruginosa (P. aeruginosa) are the most common bacterial pathogens associated with AECOPD, with prevalence varying in different study settings (3,(6)(7)(8)(9). In South Korea, Jeong et al reported S. pneumoniae and P. aeruginosa as the most prevalent bacterial pathogens in hospitalized patients with community acquired pneumonia (CAP) and COPD exacerbations (10), whereas other studies in Seoul, South Korea, reported P. aeruginosa as the most prevalent bacteria in this population (11,12). However, most reports on the bacterial prevalence in Korean patients with COPD are solely based on sputum culture results (13,14) and are single-center studies (10,12).…”

Clinical and molecular features of virus-induced acute exacerbations of chronic obstructive pulmonary diseas

“…Так, 29,5-44,1% обострений хронической обструктивной болезни легких (ХОБЛ) связаны с респираторными вирусами. Доказана этиологическая роль инфекции вирусов гриппа, риновируса, респираторно-синцитиального вируса и других [1][2][3][4], не исключена роль новой коронавирусной инфекции [5].…”

Letter from Korea

“…For example, the chronic obstructive pulmonary disease (COPD) study group recently published a multicentre study to identify the respiratory pathogens associated with exacerbation. 1 The asthma study group published many studies regarding asthma-COPD overlap. [2][3][4] The pulmonary rehabilitation study group is currently performing a multicentre prospective trial to evaluate the efficacy of N-acetylcysteine inhalation in patients with COPD.…”