|Title:||Sputum bacteriology in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease in Taiwan with an emphasis on Klebsiella pneumoniae and Pseudomonas aeruginosa||Authors:||Lin S.-H.
|Issue Date:||2007||Journal Volume:||12||Journal Issue:||1||Start page/Pages:||81-87||Source:||Respirology||Abstract:||
Background and objective: Bacterial infection is one of the major causes of acute exacerbation of COPD (AECOPD). This study was undertaken to investigate the microbiology of AECOPD. Methods: Medical records from 494 episodes of AECOPD in patients admitted to the National Taiwan University Hospital from January 2000 to June 2004 were reviewed. Severity of COPD was classified according to the 2003 Global Initiative for Chronic Obstructive Lung Disease guideline. Results: Potential pathogenic microorganisms were isolated from patients in 328 (66.4%) episodes of AECOPD. The predominant bacteria were Klebsiella pneumoniae (19.6%), Pseudomonas aeruginosa (16.8%) and Haemophilus influenzae (7.5%), followed by Acinetobacter baumannii (6.9%), Enterobacter species (6.1%) and Staphylococcus aureus (6.1%). The incidence of Streptococcus pneumoniae was 2.4%. Spirometry results obtained within 1 year of the exacerbation were available in 186 cases. K. pneumoniae was more frequently isolated in stage I COPD (39.1%) than stage II (16.6%), III (13.8%) and IV (9.4%). No glucose non-fermentative Gram-negative bacilli were isolated in stage I patients. Multivariate logistic regression analysis revealed that P. aeruginosa (odds ratio (OR) 3.19; 95% confidence interval (CI): 1.21-8.38), intubation (OR 14.81; 95% CI: 5.08-43.12) and age (OR 1.1; 95% CI: 1.03-1.17) were independent risk factors for mortality. Conclusions: Klebsiella pneumoniae and P. aeruginosa are the most common sputum pathogens in hospitalized patients with AECOPD in Taiwan, with the former being more commonly isolated from mild COPD and the latter associated with poor clinical outcome. These results should be considered when deciding which antibiotics should initially be used to treat patients with AECOPD. ? 2007 The Authors.
|ISSN:||1323-7799||DOI:||10.1111/j.1440-1843.2006.00999.x||SDG/Keyword:||amikacin; aminoglycoside antibiotic agent; antibiotic agent; aztreonam; beta lactam antibiotic; cefepime; cefpirome; ceftazidime; ciprofloxacin; gentamicin; imipenem; levofloxacin; meropenem; piperacillin plus tazobactam; quinoline derived antiinfective agent; timentin; Acinetobacter baumannii; aged; antibiotic sensitivity; article; bacteriology; bacterium identification; bacterium isolation; chronic obstructive lung disease; confidence interval; controlled study; disease association; disease classification; disease exacerbation; disease severity; endotracheal intubation; Enterobacter; female; forced expiratory volume; Gram negative bacterium; Haemophilus influenzae; hospital admission; hospital patient; human; infection rate; infection risk; Klebsiella pneumoniae; major clinical study; male; medical record; mortality; multivariate logistic regression analysis; practice guideline; priority journal; Pseudomonas aeruginosa; risk assessment; spirometry; sputum analysis; Staphylococcus aureus; university hospital; Aged; Female; Follow-Up Studies; Humans; Incidence; Inpatients; Klebsiella Infections; Klebsiella pneumoniae; Male; Prognosis; Pseudomonas aeruginosa; Pseudomonas Infections; Pulmonary Disease, Chronic Obstructive; Recurrence; Respiratory Tract Infections; Retrospective Studies; Risk Factors; Severity of Illness Index; Sputum; Survival Rate; Taiwan
|Appears in Collections:||醫學系|
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