Ana Rodrigo-Troyano1,2, Valentina Melo3, Pedro J Marcos4, Elena Laserna5, Meritxell Peiro1,2, Guillermo Suarez-Cuartin1,2, Lidia Perea2, Anna Feliu2, Vicente Plaza1,2, Paola Faverio6, Marcos I Restrepo3, Antonio Anzueto3, Oriol Sibila1,2. 1. Department of Respiratory, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona (UAB) Medicine department UAB, Barcelona, Spain. 2. Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain. 3. South Texas Veterans Health Care System and University of Texas Health Science Centre at San Antonio, San Antonio, Texas, USA. 4. Complejo Hospitalario Universitario de A Coruña (CHUAC), La Coruña, Spain. 5. Hospital Comarcal de Mollet, Mollet del Vallès, Barcelona, Spain. 6. Cardio-Thoracic-Vascular Department, University of Milan Bicocca, Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy.
Abstract
BACKGROUND: Pseudomonas aeruginosa (PA) is a common microorganism related to severe exacerbations in Chronic Obstructive Pulmonary Disease (COPD). However, their role in COPD patients with frequent hospitalized exacerbations (FHE) is not well described. OBJECTIVES: We aimed to determine prevalence, risk factors, susceptibility patterns and impact on outcomes of PA in COPD patients with FHE. METHODS: Prospective observational multicentre study that included COPD patients with FHE. The cohort was stratified in 2 groups according to the presence or absence of PA isolation in sputum. Patients were followed up for 12 months. RESULTS: We enrolled 207 COPD patients with FHE. In 119 patients (57%), a valid sputum culture was collected. Of them, PA was isolated in 21 patients (18%). The risk factors associated with PA were prior use of systemic corticosteroids (OR 3.3, 95% CI 1.2-9.7, p = 0.01) and prior isolation of PA (OR 4.36, 95% CI 1.4-13.4, p < 0.01). Patients with PA had an increased risk of having ≥3 readmissions (OR 4.1, 95% CI 1.3-12.8, p = 0.01) and higher PA isolation rate (OR 7.7, 95% CI 2.4-24.6, p < 0.001) during the follow-up period. In 14 patients (67%), PA was resistant to at least one antibiotic tested. PA persisted in the sputum in 70% of patients. CONCLUSIONS: The presence of PA was related to 3 or more readmissions during the 1-year follow-up and PA persisted in the sputum despite an appropriate antibiotic treatment. This finding suggested an important role of PA in the course of the disease of COPD patients with FHE.
BACKGROUND:Pseudomonas aeruginosa (PA) is a common microorganism related to severe exacerbations in Chronic Obstructive Pulmonary Disease (COPD). However, their role in COPDpatients with frequent hospitalized exacerbations (FHE) is not well described. OBJECTIVES: We aimed to determine prevalence, risk factors, susceptibility patterns and impact on outcomes of PA in COPDpatients with FHE. METHODS: Prospective observational multicentre study that included COPDpatients with FHE. The cohort was stratified in 2 groups according to the presence or absence of PA isolation in sputum. Patients were followed up for 12 months. RESULTS: We enrolled 207 COPDpatients with FHE. In 119 patients (57%), a valid sputum culture was collected. Of them, PA was isolated in 21 patients (18%). The risk factors associated with PA were prior use of systemic corticosteroids (OR 3.3, 95% CI 1.2-9.7, p = 0.01) and prior isolation of PA (OR 4.36, 95% CI 1.4-13.4, p < 0.01). Patients with PA had an increased risk of having ≥3 readmissions (OR 4.1, 95% CI 1.3-12.8, p = 0.01) and higher PA isolation rate (OR 7.7, 95% CI 2.4-24.6, p < 0.001) during the follow-up period. In 14 patients (67%), PA was resistant to at least one antibiotic tested. PA persisted in the sputum in 70% of patients. CONCLUSIONS: The presence of PA was related to 3 or more readmissions during the 1-year follow-up and PA persisted in the sputum despite an appropriate antibiotic treatment. This finding suggested an important role of PA in the course of the disease of COPDpatients with FHE.
Authors: Jill Zupetic; Hernán F Peñaloza; William Bain; Mei Hulver; Roberta Mettus; Peter Jorth; Yohei Doi; Jennifer Bomberger; Joseph Pilewski; Mehdi Nouraie; Janet S Lee Journal: Chest Date: 2021-04-17 Impact factor: 9.410