Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski, Gospodin Iliev
ISSN: 1312 773X (Online)
Issue: 2015, vol. 21, issue 2
Subject Area: Medicine - Pulmonology
Pages: 770-774
DOI: 10.5272/jimab.2015212.770
Published online: 30 April 2015

J of IMAB 2015 Apr-Jun;21(2):770-774
SPUTUM ISOLATES FROM AMBULATORY PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE – FREQUENT PATHOGENS AND ANTIBIOTIC RESISTANCE.
Pavlina T. Glogovska1Corresponding Autor, Zlatina I. Ivanova1, Tsania P. Popova2, Plamen S. Pavlov1, Yavor J. Ivanov1, Nikolai A. Yanev1, Nikolai H. Kyuchukov1.
1) Clinic of Pneumonology and Phthisiatry, University Hospital, Pleven, Bulgaria
2) Clinic of Internal diseases, University Hospital, Pleven, Bulgaria.

ABSTRACT:
Purpose: The clinical aspects of antibiotic resistance (ABR) of patients in ambulatory practice with chronic obstructive pulmonary disease (COPD) are not investigated thoroughly. The aim of the present study is to find the most frequent respiratory pathogens of ambulatory COPD patients and to evaluate the resistance of their isolates to tested antibiotics.
Material/Methods: For 3 year period 249 COPD patients from Pulmonary Ambulatory Practice in Pleven were retrospectively studied. Data were collected from medical documents. The sputum samples from the ambulatory COPD patients were tested via direct microscopy and on culture medium. The ABR of the isolates was tested.
Results: Pathogens were isolated from 71 (28.5%) out of 249 sputum samples from COPD ambulatory patients. Most frequent isolates, we found were:  Pseudomonas aeruginosa- 5.22%, Hemophilus influenzae - 4.82%, Klebsiella pneumoniae - 4.42% and Esherichia coli - 3.61%. A significant correlation was found between ABR and the results from lung function testing. In patients with forced expiratory volume per 1 second - FEV1< 50%, antibiotic resistant isolates were found more frequently (χ2 =7.59, p=0.0059). Similar correlation was found among smokers. Resistant isolates were found more often among smoker than in non-smokers (χ2 = 5.01, p= 0.0252).
Conclusions: The regular microbiological testing of sputum samples, including in ambulatory practice, with determination of most frequent isolates and their ABR would be helpful for the good clinical practice..

Key words: antibiotic resistance, ambulatory, COPD, sputum, isolates,

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Please cite this article in PubMed Style or AMA (American Medical Association) Style:
Glogovska PT, Ivanova ZI, Popova TP, Pavlov PS, Ivanov YJ, Yanev NA, Kyuchukov NH. Sputum isolates from ambulatory patients with chronic obstructive pulmonary disease – frequent pathogens and antibiotic resistance. J of IMAB. 2015 Jan-Mar;21(2):770-774.
doi: http://dx.doi.org/10.5272/jimab.2015212.770

Correspondence to: Dr Pavlina Glogovska, Clinic of Pneumonology and phtisiatry, UMHAT “D-r G. Stranski”; 81, General Vladimir Vazov str., Pleven, Bulgaria; E-mail: pglogovska@gmail.com

REFERENCES:
1. Garau J. Why do we need to eradicate pathogens in respiratory tract infections? Int J Infect Dis. 2003 Mar;7(Suppl 1):S5-12. [PubMed]
2. Monso 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 Oct;152(4 Pt 1):1316-1320. [PubMed]
3. Miravittles M, Niederman M. Lectures in Respiratory Tract Infections: Acute Exacerbations of Chronic Bronchitis. London: Science Press Ltd, 2004: p.7-8.
4. Todorova I, Savov E. Microbiological aspects of the inflammation in COPD. InSpiro. 2013; 1 (21):20-22 [in Bulgarian]
5. Murphy T. The Many Faces of Pseudomonas aeruginosa in Chronic Obstructive Pulmonary Disease.  Clin Infect Dis. 2008 Dec 15;47(12):1534–6. [PubMed] [CrossRef]
6. Sethi S. Chronic bronchial infection/colonisation: aetiology and mechanisms. Chapter 4. Eur Respir Monogr. 2013; 60:34–45.
7. Garmendia J, Morey P, Bengoechea J. A Impact of cigarette smoke exposure on host–bacterial pathogen interactions. Eur Respir J. 2012 Feb;39(2):467–477. [PubMed] [CrossRef]
8. Sykes A, Mallia P, Johnston SL. Diagnosis of Pathogens in Exacerbations of Chronic Obstructive Pulmonary Disease. Proc Am Thorac Soc. 2007 Dec;4(8):642–646. [PubMed] [CrossRef].
9. Matkovic Z, Tudoric N, Miravitlles M. Impact of chronic bronchial infection on the lungs and beyond. Chapter 5. Eur Respir Monogr. 2013; 60:46–57.
10.  Lin SH, Kuo PH, Hsueh PR, Yang PC, Kuo SH. Sputum bacteriology in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease in Taiwan with an emphasis on Klebsiella pneumoniae and Pseudomonas aeruginosa. Respirology. 2007 Jan;12(1):81–87. [PubMed] [ target="_blank"CrossRef]
11. von Baum H, Welte T, Marre R, Suttorp N, Ewig S; CAPNETZ study group. Community-acquired pneumonia through Enterobacteriaceae and Pseudomonas aeruginosa: diagnosis, incidence and predictors. Eur Respir J. 2010 Mar;35(3):598–605. [PubMed] [CrossRef]
12. Ortiz-Ruiz G, Vetter N, Isaacs R, Carides A, Woods GL, Friedland I. Ertapenem versus ceftriaxone for the treatment of community-acquired pneumonia in adults: combined analysis of two multicentre randomized, double-blind studies. J Antimicrob Chemother. 2004 Jun;53 Suppl 2:ii59-66. [PubMed] [CrossRef]
13. 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 Apr 25;165(8):891-897. [CrossRef]
14. Кostov K. editor. COPD– in searching of identity. Second edition, ISBN: 978-619-90243-2-4, 2014; pp. 58-66. [in Bulgarian]
15. Miravitlles M, Marin A, Monso E, Vila S, de la Roza C, Hervas R, et al. Colour of sputum is a marker for bacterial colonisation in chronic obstructive pulmonary disease. Respir Res.2010 May 14;11:58. [PubMed] [CrossRef]
16. Papi A, Bellettato CM, Braccioni F, Romagnoli M, Casolari P, Caramori G, et al. Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations. Am J Respir Crit Care Med. 2006 May 15;173(10):1114-21. [PubMed] [CrossRef]
17. Han MK, Agusti A, Calverley P, Celli B, Criner G, Curtis J, et al. Chronic Obstructive Pulmonary Disease Phenotypes: the future of COPD. Am J Respir Crit Care Med. 2010 Sep 1;182(5):598–604. [PubMed] [CrossRef]
18. Boersma WG. Antibiotics in acute exacerbations of COPD: the good, the bad and the ugly. Eur Respir J. 2012 Jul;40(1):1–3. [PubMed] [CrossRef]
19. Stratev V. Oxidative stress and COPD. InSpiro. 2010; 3(11):48-50. [in Bulgarian]
20. Zalacain R,  Sobradillo V, Amilibia J, Barron J, Achotegui V, Pijoan JI, et al. Predisposing factors to bacterial colonization in chronic obstructive pulmonary disease. Eur Respir J. 1999 Feb;13(2):343-348. [PubMed] [CrossRef]
21. Marin А, Monso Е,  Garcia-Nuñez M, Sauleda J, Noguera A, Ponse J, et al. Variability and effects of bronchial colonisation in patients with moderate COPD. Eur Respir J. 2010 Feb;35(2): 295–302. [PubMed] [CrossRef].
22. Beasley V,  Joshi P, Singanayagam A, Molyneaux PL, Johnston SL, Mallia P. Lung microbiology and exacerbations in COPD. Int J Chron Obstruct Pulmon Dis. 2012; 7:555–569. [PubMed] [CrossRef].

Received: 29 October 2014
Published online: 30 April 2015

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