Respiratory Department, Hospital Joan March, Carretera Palma-Soller km 12,5, 07110 Bunyola, Balearic Island, Spain.
Respir Med. 2010 Jun;104(6):840-8. doi: 10.1016/j.rmed.2009.12.010. Epub 2010 Jan 27.
A subgroup of patients with chronic obstructive pulmonary disease require frequent hospitalization because of exacerbations of the disease. We hypothesized that airway infection by non-usual pathogens is a major factor driving hospitalization needs in these patients.
Open cohort study of 116 COPD patients who had been hospitalized at least twice during the last 12 months. Patients were followed for an average of 21 months.
Clinical data, forced spirometry and 6min walking distance were determined, and the BODE index was calculated, at the time of inclusion in the study. During follow-up, sputum culture was obtained during exacerbations, and hospitalization and mortality were collected every two months. Mean age was 71 yrs, and 94% of patients were male. Main findings show that: 1) not all patients had severe disease according to either the degree of airflow limitation or the BODE index; 2) non-usual pathogens, mainly Pseudomonas aeruginosa, other gram-negative non-fermentative rods and Enterobacteriaceae, were isolated among 71.1% of the sputum obtained during exacerbations; and, 3) these pathogens were associated with poor prognosis and frequent hospitalization.
Airway infection by non-usual pathogens appears to be a key driver of frequent hospitalizations and mortality in COPD.
慢性阻塞性肺疾病（COPD）患者中有一部分亚群因疾病加重而需要频繁住院治疗。我们假设，非典型病原体引起的气道感染是导致这些患者住院需求的主要因素。
1）描述每年需要 > 或 =2 次住院治疗的 COPD 患者队列的临床和功能特征；2）前瞻性确定他们在加重期的微生物学模式；3）分析几个临床、功能和微生物学变量对住院和死亡率的预后价值。
这是一项开放队列研究，纳入了 116 名在过去 12 个月内至少住院两次的 COPD 患者。患者平均随访 21 个月。
在研究纳入时，确定了临床数据、用力肺活量和 6 分钟步行距离，并计算了 BODE 指数。在随访期间，在加重期采集痰培养，并每两个月收集一次住院和死亡情况。患者的平均年龄为 71 岁，94%为男性。主要发现如下：1）并非所有患者根据气流受限程度或 BODE 指数都有严重疾病；2）在加重期获得的痰标本中，有 71.1%分离出非典型病原体，主要是铜绿假单胞菌、其他革兰氏阴性非发酵菌和肠杆菌科；3）这些病原体与不良预后和频繁住院相关。
非典型病原体引起的气道感染似乎是 COPD 患者频繁住院和死亡的关键驱动因素。
