BACTERIAL ETIOLOGY AND ANTIBIOTIC SUSCEPTIBILITY IN ACUTE EXACERBATIONS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Main Article Content
Keywords
Acute Exacerbation of Chronic Obstructive Pulmonary Disease; Bacterial Pathogens; Antibiotic Susceptibility; Multidrug Resistance
Abstract
Exacerbations of chronic obstructive pulmonary disease are acute conditions that increase the rate of hospitalization and are accompanied by both clinical decline and high mortality. Bacterial infections are the most central in causing these exacerbations and antimicrobial resistance is increasing thus making effective treatment plans harder.
Objective: To identify the bacterial pathogens that cause the acute exacerbation of chronic obstructive pulmonary disease and assess their pattern of antibiotic susceptibility, which can be used to guide evidence based antimicrobial choice.
Duration and place of study: This study was conducted at KVSS Site Hospital Karachi from October 2024 to October 2025
Methodology: The study was an observational one that involved 120 patients aged 40 years and above who were diagnosed with acute exacerbation of chronic obstructive pulmonary disease and who were not in any way exposed to antibiotic treatment in the recent past. The sputum samples that were of high quality were subjected to Gram staining and bacterium culture. Testing of the antibiotic susceptibility was conducted according to the guidelines of the Clinical and Laboratory Standards Institute, by implementing the method of the Kirby Bauer disc diffusion.
Results: The microbial growth was found to be significant in 90 sputum samples which comprised 75 percent of the study population. The dominant ones were gram negative with 84.4 percent of the isolates. Klebsiella pneumoniae (32.2 percent) and Pseudomonas aeruginosa (26.7 percent) were the most common isolated pathogens. Streptococcus pneumoniae (11.1 percent) and Haemophilus influenzae (10 percent) were also frequently found amongst Gram positive bacteria. The bacterial isolates were found to have multidrug resistance in 41.1 percent of the isolates and Pseudomonas aeruginosa and Acinetobacter baumannii had the highest rate of resistance.
Conclusion: The most predominant pathogen in acute exacerbation of chronic obstructive pulmonary disease is gram negative bacteria with high levels of multidrug resistance. Regular sputum culture and antibiotic susceptibility testing are imperative to inform a specific antimicrobial treatment, enhance clinical results, and reduce the development of antimicrobial resistance.
References
2. GOLD. Global strategy for the diagnosis, management, and prevention of COPD. 2024 report.
3. Seemungal TA, Donaldson GC, Paul EA, Bestall JC, Jeffries DJ, Wedzicha JA. Effect of exacerbation on quality of life in patients with COPD. Am J Respir Crit Care Med. 1998;157(5):1418-22.
4. Soler-Cataluña JJ, Martínez-García MA, Román Sánchez P, Salcedo E, Navarro M, Ochando R. Severe acute exacerbations and mortality in patients with COPD. Thorax. 2005;60(11):925-31.
5. Sethi S, Murphy TF. Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N Engl J Med. 2008;359(22):2355-65.
6. Wilkinson TM, Hurst JR, Perera WR, Wilks M, Donaldson GC, Wedzicha JA. Effect of interactions between lower airway bacterial and rhinoviral infection in exacerbations of COPD. Chest. 2006;129(2):317-24.
7. Patel IS, Seemungal TA, Wilks M, Lloyd-Owen SJ, Donaldson GC, Wedzicha JA. Relationship between bacterial colonisation and the frequency, character, and severity of COPD exacerbations. Thorax. 2002;57(9):759-64.
8. Miravitlles M, Anzueto A. Antibiotic prophylaxis in COPD. Chest. 2013;144(6):1937-47.
9. Rosell A, Monsó E, Soler N, Torres F, Angrill J, Riise G, et al. Microbiologic determinants of exacerbation in chronic obstructive pulmonary disease. Arch Intern Med. 2005;165(8):891-7.
10. Eller J, Ede A, Schaberg T, Niederman MS, Mauch H, Lode H. Infective exacerbations of chronic bronchitis. Chest. 1998;113(6):1542-8.
11. Ko FW, Ip M, Chan PK, Chan MC, To KW, Ng SS, et al. Bacterial infection in acute exacerbation of COPD in Hong Kong. Respirology. 2007;12(5):724-31.
12. Anthonisen NR, Manfreda J, Warren CP, Hershfield ES, Harding GK, Nelson NA. Antibiotic therapy in exacerbations of COPD. Ann Intern Med. 1987;106(2):196-204.
13. Ventola CL. The antibiotic resistance crisis. Pharm Ther. 2015;40(4):277-83.
14. Falagas ME, Koletsi PK, Bliziotis IA. The diversity of definitions of multidrug resistant organisms. Clin Microbiol Infect. 2006;12(7):682-3.
15. Monsó E, Ruiz J, Rosell A, Manterola J, Fiz J, Morera J, et al. Bacterial infection in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1995;152(4):1316-20.
16. Sethi S, Murphy TF. Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N Engl J Med. 2008;359(22):2355-65.
17. Eller J, Ede A, Schaberg T, Niederman MS, Mauch H, Lode H. Infective exacerbations of chronic bronchitis. Chest. 1998;113(6):1542-8.
18. Rosell A, Monsó E, Soler N, Torres F, Angrill J, Riise G, et al. Microbiologic determinants of exacerbation in chronic obstructive pulmonary disease. Arch Intern Med. 2005;165(8):891-7.
19. Falagas ME, Koletsi PK, Bliziotis IA. The diversity of definitions of multidrug resistant organisms and their impact on healthcare associated infections. Clin Microbiol Infect. 2006;12(7):682-3.
20. Ko FW, Ip M, Chan PK, Chan MC, To KW, Ng SS, et al. Bacterial infection in acute exacerbation of COPD in Hong Kong. Respirology. 2007;12(5):724-31
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Syeda Bizat uz Zahra
Consultant Pulmonologist, KVSS Site Hospital Karachi Pakistan.
Darakhshan Talat Siddiqui
Consultant Pulmonologist, Shed Foundation Hospital Karachi Pakistan.
Nasira Sohail
Consultant Physician Medicine, Sindh Government Lyari General Hospital and SMBBMC Lyari Karachi Pakistan.
Maria Ismail
Consultant Pulmonologist, Alkhidmat Hospital Karachi.
Sana Nasir
Pulmonologist, Landhi Social Security Hospital, Karachi Pakistan.
Areeba Hasan
Senior Registrar Pulmonology, Liaquat National Hospital and Medical College Karachi Pakistan.
