Patterns of infections in chronic obstructive pulmonary disease exacerbations and its outcome in high dependency area, intensive care setting in a tertiary care hospital
COPD, infections, and invasive ventilation
Keywords:
Bi-level positive airway pressure, bronchoalveolar lavage, C-reactive protein, chronic obstructive pulmonary disease and acute exacerbations, Clinical and Laboratory Standards Institute, pharyngeal swabAbstract
Background and Objectives: Chronic obstructive pulmonary disease is a common problem in both developed and developing nations. It is directly linked with smoking. It is associated with frequent exacerbations and then hospitalizations. A large percent of Gross domestic product is spent on its management. We conducted a hospital-based study in such patients who got admitted with exacerbation, whether infective or noninfective, and who required invasive ventilation during management. Such kind of study has not been reported from our country so far. The aim of this study is to determine the prevalence, etiology, and sensitivity of infective exacerbations and its impact on the outcome with the use of invasive ventilation. Materials and Methods: We enrolled 150 admitted patients for the study and recorded their clinical and laboratory parameters. The respiratory specimen was obtained by different ways and sent for culture and drug sensitivity. The outcome was noted with the use of invasive ventilation, and prognostic values of different variables were ascertained. Results: The infective exacerbation was seen in 65% and organisms involved were Gram-negative bacteria, with a predominance of Acinetobacter in 35%, Klebsiella in 32%, Pseudomonas in 17.5%, and Escherichia coli in 5%. The number of hospitalization days of the 150 patients ranged from 5 to 40 days with a mean of 16.39 ± 11.45 days. The number of Intensive Care Unit days range was 0-25 days with a mean of 7.35 ± 7.9 days. The number of days of invasive ventilation range was 2-18 days with a mean of 3.28 ± 5.2. The number of days on Bi-level positive airway pressure ventilation (BiPAP) was between 2 and 22 with a mean of 6.15 ± 5.7 days. The outcome was significant between the survivors/nonsurvivors in terms of a number of days of invasive ventilation required (P < 0.004). Conclusion: There was higher mortality among patients admitted with multiorgan dysfunction and multiple infiltrates on chest X ray, and there was significant advantage in outcome on invasive ventilation.
References
Stockley RA. Neutrophils and the pathogenesis of COPD. Chest 2002;121 5 Suppl: 151S-5S.
Lopez AD, Murray CC. The global burden of disease, 1990-2020. Nat Med 1998;4:1241-3.
Seemungal TA, Donaldson GC, Paul EA, Bestall JC, Jeffries DJ, Wedzicha JA. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998;157(5 Pt 1):1418-22.
Pauwels R, Calverley P, Buist AS, Rennard S, Fukuchi Y, Stahl E, et al. COPD exacerbations: The importance of a standard definition. Respir Med 2004;98:99-107.
Connors AF Jr, Dawson NV, Thomas C, Harrell FE Jr, Desbiens N, Fulkerson WJ, et al. Outcomes following acute exacerbations of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understanding Prognosis and Preferences for Outcomes and Risks to Treatment). Am J Respir Crit Care Med 1996;154:959-67.
Ball P. Epidemiology and treatment of chronic bronchitis and its exacerbations. Chest 1995;108 2 Suppl: 43S-52S.
Sunyer J, Sáez M, Murillo C, Castellsague J, Martínez F, Antó JM. Air pollution and emergency room admissions for chronic obstructive pulmonary disease: A 5-year study. Am J Epidemiol 1993;137:701-5.
Carilli AD, Gohd RS, Gordon W. A virologic study of chronic bronchitis. N Engl J Med 1964;270:123-7.
Monto AS, Bryan ER. Susceptibility to rhinovirus infection in chronic bronchitis. Am Rev Respir Dis 1978;118:1101-3.
Smith CB, Golden CA, Kanner RE, Renzetti AD Jr. Association of viral and Mycoplasma pneumoniae infections with acute respiratory illness in patients with chronic obstructive pulmonary diseases. Am Rev Respir Dis 1980;121:225-32.
Greenberg SB, Allen M, Wilson J, Atmar RL. Respiratory viral infections in adults with and without chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000;162:167-73.
Wedzicha JA, Donaldson GC. Exacerbations of chronic obstructive pulmonary disease. Respir Care 2003;48:1204-13.
Stenhouse AC. Viral antibody levels and clinical status in acute exacerbations of chronic bronchitis: A controlled prospective study. Br Med J 1968;3:287-90.
Seemungal TA, Harper-Owen R, Bhowmik A, Jeffries DJ, Wedzicha JA. Detection of rhinovirus in induced sputum at exacerbation of chronic obstructive pulmonary disease. Eur Respir J 2000;16:677-83.
Nseir S, Di Pompeo C, Cavestri B, Jozefowicz E, Nyunga M, Soubrier S, et al. Multiple-drug-resistant bacteria in patients with severe acute exacerbation of chronic obstructive pulmonary disease: Prevalence, risk factors, and outcome. Crit Care Med 2006;34:2959-66.
Nicotra MB, Rivera M, Awe RJ. Antibiotic therapy of acute exacerbations of chronic bronchitis. A controlled study using tetracycline. Ann Intern Med 1982;97:18-21.
Sachs AP, Koëter GH, Groenier KH, van der Waaij D, Schiphuis J, Meyboom-de Jong B. Changes in symptoms, peak expiratory flow, and sputum flora during treatment with antibiotics of exacerbations in patients with chronic obstructive pulmonary disease in general practice. Thorax 1995;50:758-63.
Jindal SK, Aggarwal AN, Gupta D. A review of population studies from India to estimate national burden of chronic obstructive pulmonary disease and its association with smoking. Indian J Chest Dis Allied Sci 2001;43:139-47.
Torres A, Dorca J, Zalacaín R, Bello S, El-Ebiary M, Molinos L, et al. Community-acquired pneumonia in chronic obstructive pulmonary disease: A Spanish multicenter study. Am J Respir Crit Care Med 1996;154:1456-61.
Lieberman D, Lieberman D, Gelfer Y, Varshavsky R, Dvoskin B, Leinonen M, et al. Pneumonic vs nonpneumonic acute exacerbations of COPD. Chest 2002;122:1264-70.
Anthonisen NR, Manfreda J, Warren CP, Hershfield ES, Harding GK, Nelson NA. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 1987;106:196-204.
Gump DW, Phillips CA, Forsyth BR, McIntosh K, Lamborn KR, Stouch WH. Role of infection in chronic bronchitis. Am Rev Respir Dis 1976;113:465-74.
Lambert HP, Stern H. Infective factors in exacerbations of bronchitis and asthma. Br Med J 1972;3:323-7.
McHardy VU, Inglis JM, Calder MA, Crofton JW, Gregg I, Ryland DA, et al. A study of infective and other factors in exacerbations of chronic bronchitis. Br J Dis Chest 1980;74:228-38.
Monsó E, Ruiz J, Rosell A, Manterola J, Fiz J, Morera J, et al. Bacterial infection in chronic obstructive pulmonary disease. A study of stable and exacerbated outpatients using the protected specimen brush. Am J Respir Crit Care Med 1995;152(4 Pt 1):1316-20.
Fagon JY, Chastre J, Trouillet JL, Domart Y, Dombret MC, Bornet M, et al. Characterization of distal bronchial microflora during acute exacerbation of chronic bronchitis. Use of the protected specimen brush technique in 54 mechanically ventilated patients. Am Rev Respir Dis 1990;142:1004-8.
Pela R, Marchesani F, Agostinelli C, Staccioli D, Cecarini L, Bassotti C, et al. Airways microbial flora in COPD patients in stable clinical conditions and during exacerbations: A bronchoscopic investigation. Monaldi Arch Chest Dis 1998;53:262-7.
Soler N, Torres A, Ewig S, Gonzalez J, Celis R, El-Ebiary M, et al. Bronchial microbial patterns in severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation. Am J Respir Crit Care Med 1998;157(5 Pt 1):1498-505.
Martinez JA, Rodríguez E, Bastida T, Bugés J, Torres M. Quantitative study of the bronchial bacterial flora in acute exacerbations of chronic bronchitis. Chest 1994;105:976.
Nseir S, Di Pompeo C, Soubrier S, Cavestri B, Jozefowicz E, Saulnier F, et al. Impact of ventilator-associated pneumonia on outcome in patients with COPD. Chest 2005;128:1650-6.
Groenewegen KH, Schols AM, Wouters EF. Mortality and mortality-related factors after hospitalization for acute exacerbation of COPD. Chest 2003;124:459-67.
Patil SP, Krishnan JA, Lechtzin N, Diette GB. In-hospital mortality following acute exacerbations of chronic obstructive pulmonary disease. Arch Intern Med 2003;163:1180-6.
Soler-Cataluña JJ, Martínez-García MA, Román Sánchez P, Salcedo E, Navarro M, Ochando R. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax 2005;60:925-31.
Khilnani GC, Banga A, Sharma SK. Predictors of mortality of patients with acute respiratory failure secondary to chronic obstructive pulmonary disease admitted to an intensive care unit: A one year study. BMC Pulm Med 2004;4:12-8.
Schrier RW, Wang W. Acute renal failure and sepsis. N Engl J Med 2004;351:159-69.
Ai-Ping C, Lee KH, Lim TK. In-hospital and 5-year mortality of patients treated in the ICU for acute exacerbation of COPD: A retrospective study. Chest 2005;128:518-24.
Downloads
Published
How to Cite
Issue
Section
Downloads
License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
