Effectiveness of empirical anti-pseudomonal antibiotics for recurrent COPD exacerbation: a multicenter retrospective cohort study

Akihiro Shiroshita,Shinya Matsushita,Kenya Sato,Masahiro Ohgiya,Hiroshi Shiba,Chigusa Shirakawa,Yuya Kimura,Yuki Kataoka,Keisuke Tomii,Chisato Miyakoshi,Shunta Tsutsumi

doi:10.1038/s41598-021-99640-y

Abstract

Although frequent chronic obstructive pulmonary disease (COPD) exacerbation has been associated with the isolation of Pseudomonas aeruginosa (PA) in sputum cultures, it remains unknown whether the empirical use of anti-pseudomonal antibiotics can improve outcomes in patients with frequent COPD exacerbations. This multicenter retrospective cohort study evaluated whether the empirical use of anti-pseudomonal antibiotics improves the length of the hospital stay in patients with recurrent COPD exacerbation (≥ 2 admissions from April 1, 2008 to July 31, 2020). For statistical analysis, a log-linked Gamma model was used. Parameters were estimated using a generalized estimating equation model with an exchangeable correlation structure accounting for repeated observations from a single patient. Covariates included age, body mass index, home oxygen therapy use, respiratory rate, heart rate, oxygen use on admission, mental status, systemic steroid use, activities of daily living, and the number of recurrences. Hospital-specific effects were specified as fixed effects. In total, 344 patients and 965 observations of recurrent COPD exacerbations were selected. Anti-pseudomonal antibiotics were used in 173 patients (18%). The estimated change in the length of the hospital stay between anti-pseudomonal and non-anti-pseudomonal antibiotics groups was 0.039 days [95% confidence interval; − 0.083, 0.162]. Anti-pseudomonal antibiotics could not shorten the length of the hospital stay.

Highlights

Frequent chronic obstructive pulmonary disease (COPD) exacerbation has been associated with the isolation of Pseudomonas aeruginosa (PA) in sputum cultures, it remains unknown whether the empirical use of anti-pseudomonal antibiotics can improve outcomes in patients with frequent COPD exacerbations
For patients with frequent exacerbations, anti-pseudomonal antibiotic use should be considered, as frequent COPD exacerbations have been reported as associated with the isolation of Pseudomonas aeruginosa (PA)[9]
The validation study conducted across four hospitals revealed that patient selection for recurrent COPD exacerbation using the ICD-10 code resulted in 6 of 108 false positives

Summary

Introduction

Frequent chronic obstructive pulmonary disease (COPD) exacerbation has been associated with the isolation of Pseudomonas aeruginosa (PA) in sputum cultures, it remains unknown whether the empirical use of anti-pseudomonal antibiotics can improve outcomes in patients with frequent COPD exacerbations. This multicenter retrospective cohort study evaluated whether the empirical use of anti-pseudomonal antibiotics improves the length of the hospital stay in patients with recurrent COPD exacerbation (≥ 2 admissions from April 1, 2008 to July 31, 2020). For patients with frequent exacerbations, anti-pseudomonal antibiotic use should be considered, as frequent COPD exacerbations have been reported as associated with the isolation of Pseudomonas aeruginosa (PA)[9] It is unclear whether empirical treatment for PA can improve outcomes in patients with frequent COPD e xacerbations[10]. We hypothesized that anti-pseudomonal antibiotics would improve the length of the hospital stay in patients with frequent COPD exacerbation

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