Citation Information :
Naved A, Ali SA, Ahmedi U, Quadri SM, Butool K, Sultana Q. Sputum Culture and Antibiogram in Infective Acute Exacerbation of Chronic Obstructive Pulmonary Disease in a Tertiary Care Hospital in India. Indian J Chest Dis Allied Sci 2018; 60 (1):13-18.
Background: Infections are the common cause of death in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).
Methods: A prospective cohort study was conducted on 100 patients with AECOPD in a tertiary care hospital in Hyderabad city in South India. Sputum culture of 100 patients was evaluated for the presence of Gram-positive and Gram-negative micro-organisms. Sensitivity and resistance patterns of the micro-organisms against commonly used antibiotics were also investigated.
Results: During the period October 2015 to April 2016, 67% of the patients had sputum culture positive for the presence of pathogenic micro-organisms. Pathogens, most commonly, isolated were Gram-negative organisms like Klebsiella oxytoca (13%), followed by Klebsiella species (11%) and Klebsiella pneumoniae (10%). Amikacin was found to be the most effective antibiotic against all micro-organisms. A significantly higher proportion of organisms were pathogenic compared to non-pathogenic organisms (p=0.0014). Among pathogenic organisms, a significantly higher proportion of Gram-positive organisms were found compared to Gram-negative organisms (p=0.0180). Pathogenic microorganisms showed a high resistance rate to commonly used antibiotics. Except few strains of Klebsiella, Pseudomonas and Streptococcus, overall 62.9% strains were sensitive to doxycycline.
Conclusions: Our observations suggest that doxycycline can be used as an empirical antibiotic in the treatment of AECOPD.
Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: updated 2005: Available at: www.goldcopd.org. Accessed on February 23, 2018.
Miravitlles M, Mayordomo C, Artes M, Sanchez-Agudo L, Nicolau F, Segu JL, on behalf of the EOLO Group. Treatment of chronic obstructive pulmonary disease and its exacerbations in general practice. Respir Med 1999;93:173–9.
Burrows B, Earle RH. Course and prognosis of chronic obstructive lung disease: a prospective study of 200 patients. N Engl J Med 1969;280:397–404.
Rosell A, Monso E, Soler N, Angrill J, Riise G, Zalacaín R, et al. Microbiologic determinants of exacerbation in chronic obstructive pulmonary disease. Arch Intern Med 2005;165:891–7.
Sheti S, Evans N, Grant BJ, Murphy TF. New strains of bacteria and exacerbations of chronic obstructive pulmonary disease. N Engl J Med 2002;347:465–71.
Murphy TF, Brauer AL, Eschberger K, Lobbins P, Grove L, Cai X, et al. Pseudomonas aeruginosa in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2008;177:853–60.
Sheti S, Murphy T. Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N Engl J Med 2008;359:2355–65.
Ball P. Epidemiology and treatment of chronic bronchitis and its exacerbations. Chest 1995;108:43S–52S.
Haas H, Morris JF, Samson S, Kilbourn JP, Kim PJ. Bacterial flora of the respiratory tract in chronic bronchitis: comparison of transtracheal, fiberbronchoscopic and oropharyngeal sampling methods. Am Rev Respir Dis 1977;116:41–7.
Cabello H, Torres A, Celis R, El-Ebiary M, Puig de la Bellacasa J, Xaubet A, et al. Bacterial colonization of distal airways in healthy subjects and chronic lung diseases: a bronchoscopic study. Eur Respir J 1997;10:1137–44.
Performance standards for antimicrobial susceptibility testing. National Committee for Clinical Laboratory Standards 2013;33:27.
Chawla K, Mukhopadhay C, Majumdar M, Bairy I. Bacteriological profile and their antibiogram from cases of acute exacerbations of chronic obstructive pulmonary disease: a hospital based study. J Clini Diagn Res 2008;2:612–6.
Basu S, Mukherjee S, Samanta A. Epidemiological study of bacterial microbiology in aecopd patients of Kolkata. Asian J Pharma Clin Res 2013;6:112–6 .
Erkan L, Uzun O, Findik S, Katar D, Sanic A, Atici AG. Role of bacteria in acute exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2008;3:463–7.
Beaty CD, Grayston JT, Wang SP, Kuo CC, Reto CS, Martin TR. Chlamydia pneumoniae, strain TWAR, infection in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 1991;144:1408–10.
Karnak D, Beng Sun S, Beder S, Kayacan O. Chlamydia pneumoniae infection and acute exacerbation of chronic obstructive pulmonary disease (COPD). Respir Med 2001;95:811–6.
Mogulkoc N, Karakurt S, Isalska B, Bayindir U, Celikel T, Korten V, et al. Acute purulant exacerbations of chronic obstructive pulmonary disease and Chlamydia pneumonia infection. Am J Respir Crit Care Med 1999;160:349–53.
Verkooyen RP, Van Lent NA, Mousavi Joulandan SA, Snijder RJ, Van Den Bosch JM, Van Heldens HP, et al. Diagnosis of Chlamydia pneumoniae infection in patients chronic obstructive pulmonary disease by micro-immunofluorescence and ELISA. J Med Microbiol 1997;46:959–64.
Miravitlles M, Espinosa C, Fernandez-Laso E, Martos JA, Maldonado JA, Gallego M, et al. Relationship between bacterial flora in sputum and functional impairment in patients with acute exacerbations of COPD. Chest 1999;116:40–6.
Papi A, Bellettato CM, Braccioni F, Romagnoli M, Casolari P, Caramori G, et al. Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations. Am J Respir Crit Care Med 2006;173:1114–21.
McManus TE, Marley AM, Baxter N, Christie SN, O'Neill HJ, Elborn JS, et al. Respiratory viral infection in exacerbations of COPD. Respir Med 2008;102:1575–80.
Murphy TF, Brauer AL, Schiffmacher AT, Sethi S. Persistent colonization by Haemophilus influenzae in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2004;170:266–72.
Ko Fanny WS, Ng Tony KC, Li Thomas ST, Fok Joan PC, Chan Michael CH, Wu Alan KL, et al. Sputum bacteriology in patients with acute exacerbations of COPD in Hong Kong. Respir Med 2005;99:454–60.
Kumar S, Megha V, Singh AV, Mehta S, Jad B, Bareja R. Bacteriological profile of sputum and their antibiogram in cases of acute exacerbation of COPD from a rural tertiary care hospital. J Adv Res Biol Sci 2012;4:115–9.
Shashibhushan BL, Nagaraja C, Arun BJ, Nagaraj N. Bacteriological profile and antibiotic sensitivity pattern in sputum culture of chronic obstructive pulmonary disease patients. Int J Adv Med 2016;3:671–4.
Bathoorn E, Groenhof F, Hendrix R, van der Molen T, Sinha B, Kerstjens HAM, et al. Real-life data on antibiotic prescription and sputum culture diagnostics in acute exacerbations of COPD in primary care. Int J Chron Obstruct Pulmon Dis 2017;12:285–90.
ElFeky DS, Elmandory HM, Galal M, Hakim MA. Sputum bacteriology in patients with acute exacerbation of chronic obstructive pulmonary disease. Int J Curr Microbiol App 2016;5:289–305.