Pseudomonas Aeruginosa in Hospitalized Patients with Infective Exacerbations of Bronchiectasis: Clinical and Research Implications

Abstract

A Al-Mobeireek, A-M Kambal, SR Al-Balla, H Al-Sawwaf, S Saleemi, Pseudomonas Aeruginosa in Hospitalized Patients with Infective Exacerbations of Bronchiectasis: Clinical and Research Implications. 1998; 18(5): 469-471 Bronchiectasis is becoming less of a problem in developed countries since the advent of antibiotics and the implementation of immunization programs.1,2 It is still, however, a significant cause of illness in developing countries. To our knowledge, there are no statistics on the prevalence of bronchiectasis in Saudi Arabia. Nonetheless, many chest physicians would agree that patients with this disease are seen frequently, both in the outpatient and the inpatient settings.Acute infective exacerbations related to bacterial pathogens are common and remain an important cause of morbidity and mortality in bronchiectasis. Even in the "stable" status between these exacerbations, it is believed that these organisms contribute to the perpetuation of the chronic inflammatory process and progressive lung damage. Identification and appropriate treatment of these pathogens is an essential part of the management.2 The objective of this study was to determine the range and sensitivity of bacterial pathogens that are isolated from the respiratory secretions of patients admitted with infective exacerbations of bronchiectasis. Findings are compared with other studies, and the significance of bacterial isolates, particularly Pseudomonas aeruginosa, is discussed. Patients and MethodsThe study was conducted prospectively at King Khalid University Hospital (KKUH) and Sahary Chest Hospital in Riyadh, during the years 1994-1995. Both health institutions function as general and tertiary referral hospitals, serving the Central Province (Najd), but also at times accepting patients from other parts of the Kingdom.All patients had bronchiectasis, defined by a history of chronic productive cough and an abnormal permanent dilatation of one or more bronchi on plain film or computed tomography. These patients were admitted to one of the above hospitals through the emergency department on the basis of features that were compatible with infective exacerbations. For the purpose of this study, an infective exacerbation was defined as an increase in sputum quantity, or a change in the character of the sputum from mucoid to purulent. Patients were questioned about cough, sputum (quantity, color), hemoptysis, dyspnea, fever, the chronicity of these symptoms, any recent change, any preceding flu-like illness suggesting an upper respiratory tract infection (URTI), and the use of antibiotics within one month before admission. None of the patients had clinical features of cystic fibrosis (CF), and all patients under 20 years of age underwent sweat chloride tests.Sputum samples were collected in sterile bottles and sent to the Microbiology Laboratory at KKUH and processed within one to two hours, or were kept at 4°C until processing. Gram staining was done by selecting a purulent portion of the specimen and spreading it on a microscopic sli...

Bacterial Flora in Sputum and Antibiotic Sensitivity in Exacerbations of Bronchiectasis

“…The mean age of cases in the current study was 58.44.This was comparable with another study, conducted by Abdullah Al-Mobeireek et al with a mean age of 60. 10 In another study by Onen ZP et al the mean age was 61. 11 Out of fifty two (52) patients 28(54%) were males and 24(46%) were females which shows not much gender difference in bronchiectasis exacerbation.…”

“…Dyspnoea, fever, haemoptysis was present in 70%, 65% and 30% respectively. 10 In a study by Finklea JD et althe most common symptoms associated with exacerbation were change in the characteristics of sputum (88%), increase cough (84%), and increase dyspnea (72%). 12 In the present study sputum culture showed significant bacterial growth in 76.9% of cases.…”

The Saudi Thoracic Society guidelines for diagnosis and management of noncystic fibrosis bronchiectasis

“…In adults with bronchiectasis, H. influenzae is the most frequently isolated pathogen (35%–47%) followed by P. aeruginosa in up to 31% of cases in adults, but not in children. [ 35 49 ] In Saudi Arabia, P. aeruginosa was the most common isolated organism among hospitalized patients with bronchiectasis[ 10 ] and among those who have chronic lung disease. [ 120 ] Among children with bronchiectasis, H. influenzae is the most commonly isolated (37%), followed by S. pneumoniae (17%) and P. aeruginosa (16%).…”

“…In one study among adult hospitalized patients with bronchiectasis, it was found that P. aeruginosa was the most common organism. [ 10 ] Another study found that P. aeruginosa was a common pathogen among patients with bronchiectasis who have associated chronic lung disease. [ 178 ] P. aeruginosa accounts for only 16% of children <14 years with bronchiectasis in one tertiary center.…”

“…In a study by Al-Mobeireek et al ., bronchiectasis was found to represent only 5% of adult cases of chronic persistent cough referred to pulmonary clinics and Pseudomonas aeruginosa was found to be the most common pathogen in hospitalized patients in another study. [ 10 11 ] Attar et al . reported a 35% prevalence of asymptomatic bronchiectasis in patients with rheumatoid arthritis.…”