Prognosis of COPD patients requiring frequent hospitalization: Role of airway infection

Renom, Feliu; Yáñez, Aina M.; Garau, Margarita; Rubí, Mateu; Centeno, Maria-José; Gorriz, Maria-Teresa; Medinas, Magdalena; Ramis, Ferran; Soriano, Joan B.; Agustí, Àlvar

doi:10.1016/j.rmed.2009.12.010

Cited by 30 publications

(27 citation statements)

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“…These figures were similar to those reported in previous studies in patients with advanced disease, as shown by Murphy et al [30] and Renom et al [9], who reported P. aeruginosa isolation in over one third of the sputum samples obtained from COPD patients.…”

Section: Discussionsupporting

confidence: 92%

“…Two studies [4,5] have shown that individuals with a FEV1 below 50% of the reference level have a six-fold higher risk of suffering exacerbations due to H. influenzae and P. aeruginosa than patients with mild or moderate COPD. Likewise, P. aeruginosa infection in COPD has also been related to risk factors such as previous hospital admissions and use of oral corticosteroids or antibiotics [6-9] but the importance of these individual determinants has not been elucidated. Moreover, the role of other potential factors such as bronchiectasis, as a risk factor of P. aeruginosa in cursive infection-a factor associated with severe airflow obstruction in COPD [10], has been addressed only marginally [8].…”

Section: Introductionmentioning

confidence: 99%

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Pseudomonas aeruginosaisolates in severe chronic obstructive pulmonary disease: characterization and risk factors

et al. 2014

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BackgroundPatients with severe chronic obstructive pulmonary disease (COPD) are at increased risk of infection by P. aeruginosa. The specific role of bronchiectasis in both infection and chronic colonization by this microorganism in COPD, however, remains ill defined.To evaluate the prevalence and risk factors for P. aeruginosa recovery from sputum in outpatients with severe COPD, characterizing P. aeruginosa isolates by pulsed-field gel electrophoresis (PFGE) and focusing on the influence of bronchiectasis on chronic colonization in these patients.MethodsA case-cohort study of 118 patients with severe COPD attended at a Respiratory Day Unit for an acute infectious exacerbation and followed up over one year. High-resolution CT scans were performed during stability for bronchiectasis assessment and sputum cultures were obtained during exacerbation and stability in all patients. P. aeruginosa isolates were genotyped by PFGE. Determinants of the recovery of P. aeruginosa in sputum and chronic colonization by this microorganism were assessed by multivariate analysis.ResultsP. aeruginosa was isolated from 41 of the 118 patients studied (34.7%). Five of these 41 patients (12.2%) with P. aeruginosa recovery fulfilled criteria for chronic colonization. In the multivariate analysis, the extent of bronchiectasis (OR 9.8, 95% CI: 1.7 to 54.8) and the number of antibiotic courses (OR 1.7, 95% CI: 1.1 to 2.5) were independently associated with an increased risk of P. aeruginosa isolation. Chronic colonization was unrelated to the presence of bronchiectasis (p=0.75). In patients with chronic colonization the isolates of P. aeruginosa retrieved corresponded to the same clones during the follow-up, and most of the multidrug resistant isolates (19/21) were harbored by these patients.ConclusionsThe main risk factors for P. aeruginosa isolation in severe COPD were the extent of bronchiectasis and exposure to antibiotics. Over 10% of these patients fulfilled criteria for chronic colonization by P. aeruginosa and showed clonal persistence, independently of the presence of bronchiectasis.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Pseudomonas aeruginosaisolates in severe chronic obstructive pulmonary disease: characterization and risk factors

et al. 2014

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“…Two main reasons may account for this finding. First, it may be related to the fact that COPD patients more frequently received antibiotics before admission, and this has been shown to be protective against severe CAP [17,18]. Accordingly, it has also been demonstrated in a large series of 388,406 CAP patients in Germany that death occurs most frequently within the first day after admission [19].…”

Section: Discussionmentioning

confidence: 99%

Severity and outcomes of hospitalised community-acquired pneumonia in COPD patients

Liapikou¹,

Polverino²,

Ewig³

et al. 2011

Eur Respir J

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Chronic obstructive pulmonary disease (COPD) is a frequent comorbidity in patients with community-acquired pneumonia (CAP). We investigated the impact of COPD on outcomes of CAP patients.We prospectively studied the clinical presentation of 1,379 patients admitted with CAP during a 4-yr period. A comparative analysis of disease severity and course was performed between 212 patients with COPD, as confirmed by spirometry, and 1,167 non-COPD patients.COPD patients (mean forced expiratory volume in 1 s 47.7¡16.3% predicted) were older and more likely to have previously received antibiotics (37.1% versus 28.3%; p,0.01) than those without COPD. They presented with more severe respiratory failure (arterial oxygen tension/ inspiratory oxygen fraction 270.4 versus 287.8; p,0.01) and more severe pneumonia (pneumonia severity index 118.3 versus 108.5; p,0.001) compared with non-COPD patients. However, COPD patients had less multilobar infiltration (44 (21%) versus 349 (30%); p,0.01) and fewer pulmonary complications (24 (14%) versus 241 (24%); p,0.01). A total of 89 (6.5%) patients died within 30 days. COPD patients had no significant difference in their 30-day mortality rate compared with non-COPD patients (nine (4.2%) patients versus 81 (7%); p50.14).Despite worse clinical presentation, COPD patients had a similar mortality rate compared to non-COPD patients. Previous antibiotic treatment and the decreased incidence of pulmonary complications in COPD may account for these findings.

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“…Another more recent prospective publication performed in 116 ambulatory patients with severe disease obtained similar results. However, the data reported by the authors suggest that the study was conducted in a highly selected population with up to 71% of patients with nonusual flora, mainly PA and Enterobacteriaceae [25]. …”

Section: Discussionmentioning

confidence: 99%

<b><i>Pseudomonas aeruginosa</i></b> and Mortality after Hospital Admission for Chronic Obstructive Pulmonary Disease

Almagro¹,

Salvadó²,

García-Vidal³

et al. 2011

Respiration

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Background:Pseudomonas aeruginosa (PA) is isolated in advanced stages of chronic obstructive pulmonary disease (COPD). Objectives: The aim of our study was to determine whether PA isolation during hospitalization for COPD exacerbation was associated with a poorer prognosis after discharge. Methods: We prospectively studied all patients with COPD exacerbation admitted between June 2003 and September 2004. A sputum culture was obtained at admission. Comorbidity, functional dependence, hospitalizations during the previous year, dyspnea, quality of life and other variables previously associated with mortality in COPD were studied. Spirometry and a 6-min walking test were performed 1 month after discharge. Mortality was evaluated 3 years after discharge. Results: A total of 181 patients were included in the study. Of these, 29 (16%) had PA in the sputum. The mean age was 72 years, and mean basal postbronchodilator forced expiratory volume in 1 s was 45.2% predicted (SD 14.4). The mean point value on the BODE index was 5.1 (SD 2.5). At 3 years, 17 of 29 patients (58.6%) in the PA group had died, compared to 53 of the 152 non-PA patients [34.9%; p < 0.004; hazard ratio (HR) 2.23, 95% confidence interval (CI) 1.29–3.86]. In the multivariate analysis, PA remained statistically related to posthospital mortality (p = 0.02; HR 2.2, 95% CI 1.2–4.2) after adjustment for age (p < 0.02; HR 1.04, 95% CI 1.007–1.07), BODE index (p < 0.02; HR 1.15, 95% CI 1.02–1.3) and comorbidity (p < 0.02; HR 1.24, 95% CI 1.03–1.5). Conclusions: PA isolation in sputum in patients hospitalized for acute exacerbation of COPD is a prognostic marker of 3-year mortality. Poor prognosis is independent of other significant predictors of mortality such as BODE index, age and comorbidity, as measured by the Charlson index.

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Prognosis of COPD patients requiring frequent hospitalization: Role of airway infection

Abstract: Airway infection by non-usual pathogens appears to be a key driver of frequent hospitalizations and mortality in COPD.

Cited by 30 publications

References 41 publications

Pseudomonas aeruginosaisolates in severe chronic obstructive pulmonary disease: characterization and risk factors

Pseudomonas aeruginosaisolates in severe chronic obstructive pulmonary disease: characterization and risk factors

Severity and outcomes of hospitalised community-acquired pneumonia in COPD patients

<b><i>Pseudomonas aeruginosa</i></b> and Mortality after Hospital Admission for Chronic Obstructive Pulmonary Disease

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