Bacteriological Profile and Antibiotic Susceptibility Patterns in Acute Exacerbations of COPD Among Hospitalized Patients
Keywords:
Respiratory Diseases, AECOPD, Sputum Bacterial Profile, Antibiotic Resistant PatternAbstract
BackgroundAcute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) are critical events, often triggered by bacterial infections. The bacteriological profile and antibiotic susceptibility patterns are highly region-specific and evolve over time, necessitating local surveillance to guide effective empirical therapy. Objective: To determine the sputum bacteriological profile in hospitalized patients with acute exacerbation of COPD. MethodologyA prospective cross-sectional study was conducted on 240 hospitalized patients who met the GOLD criteria for AECOPD and were enrolled. Demographic and clinical data were collected. Sputum samples were obtained for culture and antibiotic susceptibility testing, which was performed using the Kirby-Bauer disk diffusion method. ResultsResults showed that the mean age of participants was 61.4 ± 10.2 years, with a male predominance (76.7%). Sputum culture was positive in 118 patients (49.2%). Streptococcus pneumoniae (28.8%) was the most common single isolate, but Gram-negative bacteria collectively predominated, led by Escherichia coli (16.9%) and Klebsiella pneumoniae (12.7%). Culture positivity showed a strong, significant association with purulent sputum (94.5%), severe GOLD grade (76.7%), and hypoxemia at presentation (SpO?<80%; 80.0%). Antibiotic susceptibility revealed high resistance in Gram-negative isolates to ceftriaxone (15-30%) and fluoroquinolones (20-45%), while carbapenems and polymyxins remained highly effective. ConclusionThe bacteriology of AECOPD in our region is characterized by a high prevalence of multidrug-resistant Gram-negative bacilli. Clinical markers, such as sputum purulence and hypoxemia, can help identify patients with a high probability of bacterial infection. The documented resistance patterns necessitate an urgent revision of empirical antibiotic guidelines, favoring carbapenems over cephalosporins and fluoroquinolones in cases of severe infection.References
Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (2024 report). [Internet]. 2024. Available from URL: https://goldcopd.org/2024-gold-report/.
Wedzicha JA, Seemungal TA. COPD exacerbations: defining their cause and prevention. Lancet. 2007;370(9589):786-96. DOI:10.1016/S0140-6736(07)61382-8.
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;173(10):1114-21. DOI:10.1164/rccm.200506-859OC.
Sethi S, Murphy TF. Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N Engl J Med. 2008;359(22):2355-65. DOI:10.1056/NEJMra0800353.
Miravitlles M, Espinosa C, Fernández-Laso E, Martos JA, Maldonado JA, Gallego M. Relationship between bacterial flora in sputum and functional impairment in patients with acute exacerbations of COPD. Chest. 1999;116(1):40-6. DOI:10.1378/chest.116.1.40.
García-Vidal C, Almagro P, Romaní V, Rodríguez-Carballeira M, Cuchi E, Canales L, et al. Pseudomonas aeruginosa in patients hospitalised for COPD exacerbation: a prospective study. Eur Respir J. 2009;34(5):1072-8. DOI:10.1183/09031936.00003309.
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(2):196-204. DOI:10.7326/0003-4819-106-2-196.
World Health Organization. Antimicrobial resistance [Internet]. 2021. Available from URL: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance.
Dimopoulos G, Siempos II, Korbila IP, Manta KG, Falagas ME. Comparison of first-line with second-line antibiotics for acute exacerbations of chronic obstructive pulmonary disease: a meta-analysis of randomized controlled trials. Chest. 2007;132(2):447-55. DOI:10.1378/chest.06-2212.
Llor C, Moragas A, Hernández S, Bayona C, Miravitlles M. Efficacy of antibiotic therapy for acute exacerbations of mild to moderate COPD. Am J Respir Crit Care Med. 2012;186(8):716-23. DOI:10.1164/rccm.201206-0996OC.
Sapey E, Stockley RA. COPD exacerbations . 2: aetiology. Thorax. 2006;61(3):250-8. DOI:10.1136/thx.2005.041822.
MacIntyre N, Huang Y. Acute exacerbations and respiratory failure in chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2008;5(4):530-5. DOI: 10.1513/pats.200707-088ET.
Baron EJ, Miller JM, Weinstein MP, Richter SS, Gilligan PH, Thomson RB Jr, et al. A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2013 recommendations by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis. 2013;57(4):e22-e121. DOI:10.1093/cid/cit278.
Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing. 33rd ed. CLSI supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute; 2023.
Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2024 Report. Available from URL: https://goldcopd.org/2024-gold-report/.
Sharma P, Narula S, Sharma K, Kumar N, Lohchab K, Kumar N. Sputum bacteriology and antibiotic sensitivity pattern in COPD exacerbation in India. Egypt J Chest Dis Tuberc. 2017;66:593-7. DOI:10.1016/j.ejcdt.2017.08.003.
Chawla K, Mukhopadhay C, Majumdar M, Bairy I. Bacteriological profile and their antibiogram from cases of acute exacerbations of chronic obstructive pulmonary disease: a hospital based study. J Clin Diagn Res. 2008;2(1):612-6.
Saeed NK, Kambal AM, El-Khizzi NA. Antimicrobial-resistant bacteria in a general intensive care unit in Saudi Arabia. Saudi Med J. 2010;31(12):1341-9.
Iqbal MZ, Shahzad S, Latif SM, Mubarik A, Fatima N, Arshad S, Aamir R, Shoukat MA, Ilyas MA, Sher F. Prescription pattern of antibiotics and infection control among outpatients presented at the different community pharmacies in lahore, Pakistan. Med Sci. 2024;28:e29ms3327. DOI: 10.54905/disssi.v28i146.e29ms3327.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Pakistan Journal of Chest Medicine
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
