Bacterial infection in chronic obstructive pulmonary disease. A study of stable and exacerbated outpatients using the protected specimen brush.

Monsó, Eduard; Ruíz, Jordi; Rosell, Antoni; Manterola, J. M.; Fiz, J.A.; Morera, Josep; Ausina, V.

doi:10.1164/ajrccm.152.4.7551388

Cited by 511 publications

(340 citation statements)

References 27 publications

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“…mL -1 in 55.5% (10/18) of the patients reported by CABELLO et al [10] and in 33.3% (6/18) of those reported by VEREEN et al [11]. MONSO Â et al [12], using a similar protocol to that of the present study, obtained positive PSB cultures mainly for H. influenzae and S. pneumoniae, in 10 of 40 (25%) stable COPD outpatients. In the present study, the most frequently cultured pathogens were H. influenzae, S. viridans, S. pneumoniae and M. catarrhalis.…”

Section: Discussionsupporting

confidence: 71%

“…Although PSB sampling is a common and standard procedure, it may be argued that a single negative PSB sample is considered representative of the bacterial environment of the whole two lungs, assuming that PSB samples taken at the same time from other parts of the lungs would also be sterile. This has been accepted by other authors [10,12] and no previous studies addressing the reproducibility of results of PSB sampling between specimens and in different parts of the lung have been published. A standard criterion for colonization of the lower airways has not yet been defined and, although a cut-off point of $10 2 CFU .…”

Section: Discussionmentioning

confidence: 70%

“…mL -1 was used in a recent report [10], the $10 3 CFU . mL -1 criterion was adopted here as the cut-off point as commonly used in other studies [11,12,21]. The present study investigated a homogeneous group of patients with stable COPD in clinical terms (no increased dyspnoea, sputum production or Streptococcus pneumoniae <1000 5…”

Section: Discussionmentioning

confidence: 99%

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Predisposing factors to bacterial colonization in chronic obstructive pulmonary disease

Zalacaín¹,

Sobradillo²,

Amilibia³

et al. 1999

Eur Respir J

199

139

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The aim of this prospective observational study was to determine those factors influencing bacterial colonization in patients with stable chronic obstructive pulmonary disease (COPD).Eighty-eight outpatients with stable COPD and 20 patients with normal spirometry and chest radiography (controls) had a fibreoptic bronchoscopy performed with topical aerosol anaesthesia. Bacterial colonization was determined using the protected specimen brush (PSB) with a cut-off $10 3 colony-forming units (CFU . mL -1 ). The influence of age, degree of airflow obstruction, smoking habit, pack-yrs of smoking, and chest radiographic findings on bacterial colonization were assessed by univariate and multivariate analysis.Significant bacterial growth was found in 40% of patients and in none of the controls. Haemophilus influenzae, Streptococcus viridans, S. pneumoniae and Moraxella catarrhalis were the most frequent pathogens. After adjustment for other variables, severe airflow limitation (odds ratio (OR) 5.11, 95% confidence interval (CI) 1.45±17.9) and current smoking (OR 3.17, 95% CI 2.5±8) remained associated with positive bacterial cultures. When only potentially pathogenic micro-organisms were considered, significant bacterial growth was found in 30.7% of patients, with severe airflow obstruction (OR 9.28, 95% CI 2.19±39.3) being the only variable independently associated with positive bacterial cultures.Our results show that stable chronic obstructive pulmonary disease patients have a high prevalence of bacterial colonization of distal airways which is mainly related to the degree of airflow obstruction and cigarette smoking. Eur Respir J 1999; 13: 343±348. Despite intensive investigation, the precise role of bacterial infection in the production and recurrent aspects of chronic obstructive pulmonary disease (COPD) has yet to be elucidated [1,2]. It has been estimated that the lower respiratory tract of stable COPD patients is colonized in 50±100% of cases [3,4]. In most studies, however, the tracheobronchial microflora was characterized by unreliable diagnostic techniques (e.g. expectorated sputum, transtracheal aspiration) owing to the lack of specificity and the absence of quantitative cultures [5±8]. Fibreoptic bronchoscopy using a protected specimen brush (PSB) catheter is a highly sensitive and specific technique used to obtain uncontaminated specimens for culture from the lower respiratory tract [9]. In patients with stable COPD, the prevalence of lower airway bacterial colonization using the PSB varies between 25 and 55.5% [10±12]. However, predisposing factors to bacterial colonization in patients with stable COPD have not been well defined.To determine precisely the influence of different factors, such as age, degree of airflow obstruction, smoking habit, pack-yrs of smoking and chest radiographic findings, on the detection of bacteria in COPD patients, a prospective study was conducted using the PSB and quantitative cultures. Materials and methods Study populationThe study was carried out in a 1,000-bed te...

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 70%

See 1 more Smart Citation

Predisposing factors to bacterial colonization in chronic obstructive pulmonary disease

Zalacaín¹,

Sobradillo²,

Amilibia³

et al. 1999

Eur Respir J

199

139

View full text Add to dashboard Cite

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“…Numerous factors can influence the results of quantitative cultures, including the timing of the pneumonia, the skill and experience of the operator, the adequacy of the specimen, technical aspects such as appropriate processing and delays in transport to the laboratory, special populations such as those with chronic obstructive pulmonary disease (who may have relatively high bacterial counts without pneumonia), and prior or concurrent antibiotic therapy (149).…”

Section: Microbiologic Diagnosismentioning

confidence: 99%

Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention

2006

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SUMMARY While critically ill patients experience a life-threatening illness, they commonly contract ventilator-associated pneumonia. This nosocomial infection increases morbidity and likely mortality as well as the cost of health care. This article reviews the literature with regard to diagnosis, treatment, and prevention. It provides conclusions that can be implemented in practice as well as an algorithm for the bedside clinician and also focuses on the controversies with regard to diagnostic tools and approaches, treatment plans, and prevention strategies.

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“…These latter effects may facilitate bacterial colonization, which is present in patients with COPD [15]. However, for neutrophil elastase to have these effects, it has to overcome the antielastases that protect the tissues.…”

mentioning

confidence: 99%

Airways inflammation in chronic bronchitis: the effects of smoking and alpha1-antitrypsin deficiency

Hill¹,

Bayley²,

Campbell³

et al. 2000

Eur Respir J

104

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Airways inflammation in chronic bronchitis is thought predominantly to be a direct consequence of neutrophil recruitment and release of elastase in response to factors such as cigarette smoke. The aims of this study were to assess the role of smoking and determine whether the serum elastase inhibitor α1‐antitrypsin (α1AT) influenced the process. Airways inflammation was compared between patients with chronic obstructive bronchitis with (n=39) and without (n=42) severe α1AT deficiency. The authors assessed the sputum concentration of the neutrophil chemoattractants interleukin‐8 (IL‐8) and leukotriene (LT)B4, myeloperoxidase (MPO) as a marker of neutrophil influx, neutrophil elastase activity and its natural inhibitors, α1AT and secretory leukoprotease inhibitor (SLPI). Finally serum α1AT was measured to determine the degree of protein leakage (sputum sol serum α1AT ratio). Compared to current smokers, the exsmokers had a lower concentration of the chemoattractant IL‐8 (p<0.05) and a lower MPO concentration, although this failed to reach conventional statistical significance (p=0.06). Patients with α1AT deficiency had greater inflammation in the larger airways with increased LTB4 (p<0.005), MPO (p<0.001), neutrophil elastase activity (p<0.01), protein leak (p<0.001), and were found to have a lower anti‐proteinase screen with both reduced sputum α1AT (p<0.001) and SLPI concentrations (p<0.05). The reduction in sputum interleukin‐8 levels in exsmokers may decrease neutrophil influx and thus explain the slower rate of neutrophil mediated progression of lung disease compared to subjects who continue to smoke. Patients with α1‐antitrypsin deficiency had greater inflammation suggesting that α1‐antitrypsin plays an important role in protecting the larger airways from the inflammatory effects of elastase activity and may explain their more rapid progression of disease.

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Bacterial infection in chronic obstructive pulmonary disease. A study of stable and exacerbated outpatients using the protected specimen brush.

Cited by 511 publications

References 27 publications

Predisposing factors to bacterial colonization in chronic obstructive pulmonary disease

Predisposing factors to bacterial colonization in chronic obstructive pulmonary disease

Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention

Airways inflammation in chronic bronchitis: the effects of smoking and alpha1-antitrypsin deficiency

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