Klebsiella pneumoniae in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Menoufia University Hospitals

Abstract

Background: Klebsiella pneumoniae is an important etiological agent of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) which is a progressive, debiliting lung disease with multiple co-morbidities. Infections with multidrug resistant (MDR) K. pneumoniae strains are usually associated with high morbidity and mortality, long hospital stay and high healthcare costs. Objectives: to determine the incidence of aerobic bacteria isolated from patients with COPD, to detect plasmidmediated quinolones resistance genes (PMQR);5,6,8, among K. pneumoniae isolates and to investigate the relation between antimicrobial susceptibility patterns and biofilm production. Methodology:The study enrolled 25 patients with stable COPD (group 1), 50 patients with AECOPD (group 2) and 25 patients with other chest diseases as control group (group 3). K. pneumoniae isolates were identified by standard microbiological methods and their antibiograms were tested by the modified Kirby Bauer disk diffusion method. Biofilm production was detected by congo red agar and modified congo red agar methods. Quinolone resistance and distribution of PMQR encoding genes were detected by multiplex PCR. Results: Klebsiella spp. represented 35.4% of all isolates from the studied groups. By vitek-2system, K. pneumoniae was the predominant spp. (94.3%). K. pneumoniae isolates were highly resistant to Amoxicillin (84.9%), Amoxicillin/clavulanic acid (75.8%) followed by ciprofloxacin (63.6%) and levofloxacin (57.6%). Biofilm production was found among78.8% and 84.8% by CRA and MCRA methods respectively. About 57.6% of K. pneumoniae isolates had PMQR genes by Multiplex PCR. Conclusion: The presence of quinolone resistance in the majority of K. pneumoniae isolates emphasizes the need for establishing tactful policies associated with infection-control measures to prevent dissemination of the multidrug resistant strains

Relation between airway cellular and bacterial findings and severity of COPD exacerbations: A multicentric study

“…In accordance with these findings, a Korean study analyzed patients with severe ECOPD and found a direct correlation between severity of airway obstruction and bacterial identification rate, with P.aeruginosa and strept.pneumoniae showing strongest association [20]. Also, it was reported that a highly significant relationship was detected between severity of ECOPD and K.pneumoniae isolation [21]. Other investigations of the relationship between bacteriologic etiology and lung function in patients with ECOPD demonstrated that P.aeruginosa and enterobacteriaceae were predominant in patients with severely impaired lung function [22].…”