Seung Won Ra1, Yong Soo Kwon2, Sung Ho Yoon3, Chi Young Jung4, Jusang Kim5, Hye Sook Choi6, Seung Soo Sheen7, Hun Gyu Hwang8, Ji-Hyun Lee9, Tae-Hyung Kim10. 1. Department of Medicine, Division of Pulmonology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea. 2. Department of Medicine, Division of Pulmonology, Chonnam National University Hospital, Gwangju, South Korea. 3. Department of Medicine, Division of Pulmonology, Chosun University Hospital, Gwangju, South Korea. 4. Department of Medicine, Division of Pulmonology, Daegu Catholic University Medical Center, Daegu, South Korea. 5. Department of Medicine, Division of Pulmonology, St. Mary's Hospital, Catholic University, Incheon, South Korea. 6. Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, South Korea. 7. Department of Medicine, Division of Pulmonology, Ajou University School of Medicine, Suwon, South Korea. 8. Department of Medicine, Division of Pulmonology, Soonchunhyang University Gumi Hospital, Gumi, South Korea. 9. Department of Medicine, Division of Pulmonology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea. 10. Department of Medicine, Division of Pulmonology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea.
Abstract
BACKGROUND: Presence of purulent sputum during an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is considered sufficient indication for starting empirical antibiotics. We investigated the relationship between detection of potentially pathogenic bacteria (PPB) using sputum culture or polymerase chain reaction (PCR) and clinical response and sought the risk factors for PPB growth. METHODS: In 342 outpatients with AECOPD, we compared detection rates of H. influenzae (HI) and S. pneumoniae (SP) using conventional sputum culture versus PCR. The utility of either technique to predict clinical cure or failure after effective antibiotics was assessed. The factors predicting positive sputum cultures were evaluated using logistic regression. RESULTS: Using sputum culture, 132 PPB were detected. The predominant bacteria were HI (40.9%) and SP (19.7%). Detection of HI or SP in sputum was higher using PCR than culture growth (60.8% vs 18.6%; P < .001). Clinical response was not affected by the results of either technique. Independent risk factors for PPB isolation were Gram-negative bacteria on sputum smear (OR 15.78, 95% CI 6.38-39.06; P < .001), sputum purulence (OR 2.31, 95% CI, 1.05-5.11; P = .04), body temperature (OR 0.16, 95% CI 0.05-0.54; P = .003), albumin level (OR 0.29, 95% CI 0.09-0.88; P = .03) and dyspnea grade (OR 0.51, 95% CI 0.27-0.96; P = .04). CONCLUSIONS: Neither culture growth nor PCR positivity for HI or SP in sputum predicted clinical response to antibiotics; therefore, these tests are not necessary for outpatients with AECOPD. Examining Gram-staining and purulence on sputum smear, however, was significant to predict PPB growth in sputum.
BACKGROUND: Presence of purulent sputum during an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is considered sufficient indication for starting empirical antibiotics. We investigated the relationship between detection of potentially pathogenic bacteria (PPB) using sputum culture or polymerase chain reaction (PCR) and clinical response and sought the risk factors for PPB growth. METHODS: In 342 outpatients with AECOPD, we compared detection rates of H. influenzae (HI) and S. pneumoniae (SP) using conventional sputum culture versus PCR. The utility of either technique to predict clinical cure or failure after effective antibiotics was assessed. The factors predicting positive sputum cultures were evaluated using logistic regression. RESULTS: Using sputum culture, 132 PPB were detected. The predominant bacteria were HI (40.9%) and SP (19.7%). Detection of HI or SP in sputum was higher using PCR than culture growth (60.8% vs 18.6%; P < .001). Clinical response was not affected by the results of either technique. Independent risk factors for PPB isolation were Gram-negative bacteria on sputum smear (OR 15.78, 95% CI 6.38-39.06; P < .001), sputum purulence (OR 2.31, 95% CI, 1.05-5.11; P = .04), body temperature (OR 0.16, 95% CI 0.05-0.54; P = .003), albumin level (OR 0.29, 95% CI 0.09-0.88; P = .03) and dyspnea grade (OR 0.51, 95% CI 0.27-0.96; P = .04). CONCLUSIONS: Neither culture growth nor PCR positivity for HI or SP in sputum predicted clinical response to antibiotics; therefore, these tests are not necessary for outpatients with AECOPD. Examining Gram-staining and purulence on sputum smear, however, was significant to predict PPB growth in sputum.
Authors: Nick A Francis; David Gillespie; Mandy Wootton; Patrick White; Janine Bates; Jennifer Richards; Hasse Melbye; Kerenza Hood; Christopher C Butler Journal: Int J Chron Obstruct Pulmon Dis Date: 2020-12-01