Aydemir Yusuf, Aydemir Özlem, Kalem Fatma
Department of Respiratory Medicine, Sakarya University, Sakarya, Turkey.
Department of Microbiology, Sakarya University, Sakarya, Turkey.
Int J Chron Obstruct Pulmon Dis. 2014 Sep 27;9:1045-51. doi: 10.2147/COPD.S70620. eCollection 2014.
Acute exacerbations, which are a significant cause of mortality and morbidity, adversely affect chronic obstructive pulmonary disease (COPD) prognosis by accelerating loss of lung function. It is important to know the microorganisms that commonly cause exacerbations in the patient groups classified according to clinical and functional characteristics for fast and accurate treatment of acute exacerbations.
The last Global Initiative for Chronic Obstructive Lung Disease (GOLD) publication recommended a new staging system containing obstruction degree, frequency of exacerbations, and quality of life questionnaires. This study is designed to analyze the relationship between the bacteria isolated in acute exacerbations and new GOLD stages.
Potentially pathogenic bacteria (PPB) isolation with culture and polymerase chain reaction methods were obtained from 114 acute exacerbation COPD patients, classified into A, B, C, and D groups by analyzing the forced expiratory volume in 1 second (FEV1) value, COPD Assessment Test (CAT) score, and exacerbation frequency according to the new GOLD staging system.
There was a significant correlation between exacerbation frequency and PPB isolation (P=0.002). There was no relationship between GOLD stage, FEV1, and CAT score with PPB isolation. The isolated bacteria diversity and mixed infection frequency were higher in the GOLD stage D group. Pseudomonas aeruginosa, Escherichia coli, and Acinetobacter baumannii were isolated only from D group patients.
Bacterial infection may cause an acute exacerbation equally in each stage for COPD. The difference in bacterial etiology is more related to exacerbation frequency than FEV1 and CAT scores for an acute exacerbation. Determining exacerbation frequency is significant for treatment success in empirical antibiotic selection.
急性加重是导致死亡率和发病率的重要原因，通过加速肺功能丧失对慢性阻塞性肺疾病（COPD）的预后产生不利影响。了解根据临床和功能特征分类的患者群体中常见的引起急性加重的微生物，对于快速准确地治疗急性加重至关重要。
慢性阻塞性肺疾病全球倡议（GOLD）的最新出版物推荐了一种新的分期系统，该系统包含阻塞程度、急性加重频率和生活质量问卷。本研究旨在分析急性加重期分离出的细菌与新的GOLD分期之间的关系。
采用培养和聚合酶链反应方法，从114例COPD急性加重患者中分离潜在致病菌（PPB），根据新的GOLD分期系统，通过分析1秒用力呼气量（FEV1）值、COPD评估测试（CAT）评分和急性加重频率，将患者分为A、B、C和D组。
急性加重频率与PPB分离之间存在显著相关性（P = 0.002）。GOLD分期、FEV1和CAT评分与PPB分离之间无相关性。GOLD D期组分离出的细菌多样性和混合感染频率更高。铜绿假单胞菌、大肠埃希菌和鲍曼不动杆菌仅从D组患者中分离出。
细菌感染在COPD的每个阶段都可能同样导致急性加重。细菌病因的差异与急性加重频率的关系比与FEV1和CAT评分的关系更大。确定急性加重频率对于经验性抗生素选择的治疗成功具有重要意义。
