Sputum bacteriology in patients with acute exacerbations of COPD in Hong Kong

Ko, Fanny W.S.; Ng, Tony Kwun-Tung; Li, Thomas S.T.; Fok, Joan P.C.; Chan, Michael; Wu, Alan; Hui, David S.

doi:10.1016/j.rmed.2004.09.011

Cited by 35 publications

(25 citation statements)

References 29 publications

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“…Many of the exacerbations are triggered by infections, with 40-60% of cases due to bacteria [100]. A recent retrospective study in a teaching hospital in Hong Kong has revealed that 37.8% of all cases of AECOPD had a positive bacterial culture from sputum [101].…”

Section: All Stagesmentioning

confidence: 99%

Increasing COPD awareness

Zieliński¹

2006

Eur Respir J

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Section: All Stagesmentioning

confidence: 99%

Increasing COPD awareness

Zieliński¹

2006

Eur Respir J

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“…Every year millions of patients suffer COPD exacerbation, and more than 1 million people die of COPD. 3 Thus far, the pathogenesis of COPD exacerbation has not been determined; some scholars believe that 80% of COPD exacerbation cases are caused by lower-respiratory-tract infection, and that 50 -60% of the pathogens that cause COPD exacerbation are bacteria. 4 Fanny et al found that the most frequent pathogens of COPD exacerbation were Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae, and Pseudomonas aeruginosa.…”

Section: Introductionmentioning

confidence: 99%

Bacteriological Differences Between COPD Exacerbation and Community-Acquired Pneumonia

et al. 2011

Respir Care

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OBJECTIVE: To study the differences in pathogen distribution and antibiotic susceptibility between patients with COPD exacerbation and patients with community-acquired pneumonia, and develop guidance for antibiotic treatment of those conditions. METHODS: We retrospectively analyzed the medical records of 586 COPD-exacerbation patients and 345 community-acquiredpneumonia patients from January 2007 to December 2008, including sputum culture results, antibiotic susceptibilities of the microorganisms, and clinical characteristics. RESULTS: 276 (47%) of the COPD-exacerbation patients, and 183 (53%) of the community-acquired-pneumonia patients had a positive sputum culture. In order, the most common pathogens in the COPD-exacerbation patients were Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Acinetobacter baumannii, and Haemophilus influenzae. The most common pathogens in the community-acquired-pneumonia patients were Streptococcus pneumoniae, H. influenzae, K. pneumoniae, S. aureus, and E. coli. CONCLUSIONS: P. aeruginosa was the most common pathogen in our patients with COPD exacerbation, and S. pneumoniae was the most common in our patients with community-acquired pneumonia. P. aeruginosa is especially common in the patients with serious or extremely serious COPD.

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“…While some patients with COPD exacerbation in the context of recent Pseudomonas isolation are treated as inpatients with prolonged intravenous antibiotics in our institution, we did not find any difference in the prevalence of previous Pseudomonas isolation between our two groups (data not shown). Consistent with this, no association of LoS was found with any particular sputum pathogen in a six-month study of 329 patients admitted with COPD exacerbation in Hong Kong [19].…”

Section: Discussionmentioning

confidence: 52%

Characterization of Chronic Obstructive Pulmonary Disease Patients with a Long Length of Stay: A Retrospective Observational Cohort Study

Madani¹,

Saigal²,

Sunny³

et al. 2017

Turk Thorac J

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OBJECTIVES:Chronic obstructive pulmonary disease (COPD) exacerbation is one of the most common reasons for hospital admission. Patients with COPD with a long length of stay (LoS) occupy a disproportionately high fraction of hospital bed-days. The objective of this study was to identify associations of long LoS in patients admitted with COPD exacerbation. MATERIAL AND METHODS:From December 2012 until June 2013, 499 patients were admitted to Queens Hospital, Romford, UK, with COPD exacerbation. Mean LoS was 7 days, with a median of 5 days, and a 90th percentile of 14 days. In this retrospective observational cohort study, 64 patients with a short LoS were compared with 62 patients with a long LoS. RESULTS:Relative to the short LoS, patients with long LoS had significantly lower arterial blood pH, higher arterial PaCO2 and HCO3, higher white cell count, higher globulin and more frequent chest X-ray changes, lower albumin levels, and lower Barthel and Braden scores. They were less likely to have seen the hospital COPD specialist nurse, more likely to require escalation of social care on discharge, and more likely to die during admission. Nearly 66% of the long LoS patients remained in hospital beyond the time of being medically fit for discharge. Commonly cited reasons for delayed discharge were the wait for therapy and social services assessments and the wait for commencement of community social care. CONCLUSION:Meticulous targeting of features peculiar to long LoS patients has the potential to reduce future hospital bed-days for patients with COPD in our and other hospitals. KEYWORDS:Chronic obstructive pulmonary diseases, length of stay INTRODUCTIONChronic obstructive pulmonary disease (COPD) is a common chronic disease in the UK with a likely prevalence of 3 million people or 4% of the population [1]. Episodic exacerbations are usual and often require hospital admission. COPD exacerbation is the second most common reason for emergency admission to hospital behind circulatory disease and is associated with considerable risks of re-admission, death, and expense. Each COPD hospital admission is estimated to cost NHS commissioners £1960 [2].Estimates of typical length of stay (LoS) vary in the published literature. A British Thoracic Society study found a mean value of 7.1 days, whereas in Norway, it was 8.9 days, and a study in Blackpool reported 9.8 days [3][4][5]. Importantly, there is significant variation across England and Wales between many aspects of service provision and clinical outcomes for patients with respiratory disease. The NHS Atlas of Variation in Healthcare 2010 highlighted a four-fold variation in hospital bed-days occupied by COPD patients [6]. In London, there is a variation in LoS between hospitals by nearly 5 days [7]. Those patients with long LoS also occupy disproportionately more bed-days, and 50% of bed-days have been shown to be occupied by the minority of patients who stay at least 11 days [8]. Previously described associations of long LoS in COPD include poor organization of care, lack...

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Sputum bacteriology in patients with acute exacerbations of COPD in Hong Kong

Abstract: H. influenzae was the commonest bacterium isolated in sputum in patients with AECOPD. In areas endemic of tuberculosis, it is advisable to use fluoroquinolones for AECOPD with caution.

Cited by 35 publications

References 29 publications

Increasing COPD awareness

Increasing COPD awareness

Bacteriological Differences Between COPD Exacerbation and Community-Acquired Pneumonia

Characterization of Chronic Obstructive Pulmonary Disease Patients with a Long Length of Stay: A Retrospective Observational Cohort Study

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