Bacterial Patterns and Empiric Antibiotic Use in COPD Patients With Community-Acquired Pneumonia
Arch Bronconeumol. 2023 Feb;59(2):90-100.
doi: 10.1016/j.arbres.2022.09.005.
Epub 2022 Sep 22.
[Article in
English,
Spanish]
Authors
Sergi Pascual-Guardia
1
, Francesco Amati
2
, Judith Marin-Corral
3
, Stefano Aliberti
4
, Joaquim Gea
5
, Nilam J Soni
6
, Alejandro Rodriguez
7
, Oriol Sibila
8
, Francisco Sanz
9
, Giovanni Sotgiu
10
, Pedro J Marcos
11
, Ane Uranga
12
, Branislava Milenkovic
13
, Christian N Meyer
14
, Martin Kolditz
15
, Antonio R Anzueto
6
, Marcos I Restrepo
16
; GLIMP investigators
Affiliations
- 1 Respiratory Department, Hospital del Mar-IMIM, CEXS, UPF, CIBERES, BRN, Barcelona, Spain; Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA.
- 2 Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA; Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital, Respiratory Unit, Milan, Italy.
- 3 Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA; Critical Care Department, Hospital del Mar-IMIM, Critical Illness Research Group (GREPAC), Barcelona, Spain.
- 4 Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital, Respiratory Unit, Milan, Italy.
- 5 Respiratory Department, Hospital del Mar-IMIM, CEXS, UPF, CIBERES, BRN, Barcelona, Spain.
- 6 Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA; Section of Pulmonary & Critical Care Medicine, South Texas Veterans Health Care System, USA.
- 7 Critical Care Department, Hospital Universitari Joan XXIII, URV, CIBERES, Tarragona, Spain.
- 8 Respiratory Department, Hospital Clinic, CIBERES, BRN, Barcelona, Spain.
- 9 Pulmonology Department, Consorci Hospital General Universitari de Valencia, Valencia, Spain.
- 10 Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.
- 11 Servicio de Neumología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC) Sergas Universidade da Coruña (UDC), A Coruña, Spain.
- 12 Pulmonology Department, Hospital of Galdakao-Usansolo, Spain.
- 13 Clinic for Pulmonary Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
- 14 Department of Internal Medicine, Roskilde Hospital, Copenhagen University Hospital, Roskilde, Denmark.
- 15 Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany.
- 16 Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA; Section of Pulmonary & Critical Care Medicine, South Texas Veterans Health Care System, USA. Electronic address: restrepom@uthscsa.edu.
Abstract
Introduction:
Chronic obstructive pulmonary disease (COPD) is strongly associated with the development of community-acquired pneumonia (CAP). Limited data are available on risk factors for difficult to manage bacteria such as Pseudomonas aeruginosa in COPD patients with CAP. Our objective was to assess the microbiological patterns associated with risk factors that determine empiric antibiotic therapy in hospitalized COPD patients with CAP.
Methods:
We performed a secondary data analysis of an international, multicenter, observational, point-prevalence study involving hospitalized COPD patients with CAP from March to June 2015. After identifying the risk factors associated with different microorganisms, we developed a scoring system to guide decision-making about empiric anti-pseudomonal antibiotic therapy in this population.
Results:
We enrolled 689 hospitalized COPD patients with CAP with documented microbiological testing. The most frequent microorganisms isolated were Streptococcus pneumoniae (8%) and Gram-negative bacteria (8%), P. aeruginosa (7%) and Haemophilus influenzae (3%). We developed a scoring system incorporating the variables independently associated with P. aeruginosa that include a previous P. aeruginosa isolation or infection (OR 14.2 [95%CI 5.7-35.2]), hospitalization in the past 12 months (OR 3.7 [1.5-9.2]), and bronchiectasis (OR 3.2 [1.4-7.2]). Empiric anti-pseudomonal antibiotics were overutilized in COPD patients with CAP. The new scoring system has the potential to reduce empiric anti-pseudomonal antibiotic use from 54.1% to 6.2%.
Conclusions:
COPD patients with CAP present different microbiological profiles associated with unique risk factors. Anti-pseudomonal treatment is a critical decision when selecting empiric antibiotic therapy. We developed a COPD scoring system to guide decision-making about empiric anti-pseudomonal antibiotic therapy.
Keywords:
Anti-bacterial agents; Antibiotics; COPD; Pseudomonas; Risk factors.
Published by Elsevier España, S.L.U.
MeSH terms
-
Anti-Bacterial Agents / therapeutic use
-
Community-Acquired Infections* / drug therapy
-
Community-Acquired Infections* / epidemiology
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Humans
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Pneumonia* / epidemiology
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Pseudomonas aeruginosa
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Pulmonary Disease, Chronic Obstructive* / complications
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Pulmonary Disease, Chronic Obstructive* / drug therapy
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Pulmonary Disease, Chronic Obstructive* / epidemiology
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Streptococcus pneumoniae