Abstract
BackgroundPatients with severe chronic obstructive pulmonary disease (COPD) are at increased risk of infection by P. aeruginosa. The specific role of bronchiectasis in both infection and chronic colonization by this microorganism in COPD, however, remains ill defined.To evaluate the prevalence and risk factors for P. aeruginosa recovery from sputum in outpatients with severe COPD, characterizing P. aeruginosa isolates by pulsed-field gel electrophoresis (PFGE) and focusing on the influence of bronchiectasis on chronic colonization in these patients.MethodsA case-cohort study of 118 patients with severe COPD attended at a Respiratory Day Unit for an acute infectious exacerbation and followed up over one year. High-resolution CT scans were performed during stability for bronchiectasis assessment and sputum cultures were obtained during exacerbation and stability in all patients. P. aeruginosa isolates were genotyped by PFGE. Determinants of the recovery of P. aeruginosa in sputum and chronic colonization by this microorganism were assessed by multivariate analysis.ResultsP. aeruginosa was isolated from 41 of the 118 patients studied (34.7%). Five of these 41 patients (12.2%) with P. aeruginosa recovery fulfilled criteria for chronic colonization. In the multivariate analysis, the extent of bronchiectasis (OR 9.8, 95% CI: 1.7 to 54.8) and the number of antibiotic courses (OR 1.7, 95% CI: 1.1 to 2.5) were independently associated with an increased risk of P. aeruginosa isolation. Chronic colonization was unrelated to the presence of bronchiectasis (p=0.75). In patients with chronic colonization the isolates of P. aeruginosa retrieved corresponded to the same clones during the follow-up, and most of the multidrug resistant isolates (19/21) were harbored by these patients.ConclusionsThe main risk factors for P. aeruginosa isolation in severe COPD were the extent of bronchiectasis and exposure to antibiotics. Over 10% of these patients fulfilled criteria for chronic colonization by P. aeruginosa and showed clonal persistence, independently of the presence of bronchiectasis.
Highlights
Patients with severe chronic obstructive pulmonary disease (COPD) are at increased risk of infection by P. aeruginosa
Exclusion criteria: patients previously diagnosed with bronchiectasis in view of symptoms and chest X-rays, patients
Our study showed a high prevalence of P. aeruginosa isolation in a cohort of severe COPD patients
Summary
Patients with severe chronic obstructive pulmonary disease (COPD) are at increased risk of infection by P. aeruginosa. To evaluate the prevalence and risk factors for P. aeruginosa recovery from sputum in outpatients with severe COPD, characterizing P. aeruginosa isolates by pulsed-field gel electrophoresis (PFGE) and focusing on the influence of bronchiectasis on chronic colonization in these patients. Infectious exacerbations are the most important cause of hospital admission and mortality in severe chronic obstructive pulmonary disease (COPD) [1,2]. P. aeruginosa infection in COPD has been related to risk factors such as previous hospital admissions and use of oral corticosteroids or antibiotics [6,7,8,9] but the importance of these individual determinants has not been elucidated. The relationship between chronic colonization by P. aeruginosa, the pattern of clonal carriage and bronchiectasis has not been evaluated to date
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