Malvisi Lucio, Yarraguntla Aparna, Mortier Marie-Cécile, Osman Karen, Cleary David W, Sente Béatrice, Pascal Thierry G, Weynants Vincent, Clarke Stuart C, Taddei Laura, Wilkinson Tom M A, Devaster Jeanne-Marie, Devos Nathalie
GSK, Siena, Italy.
GSK, Wavre, Belgium.
Infect Dis (Lond). 2022 Nov;54(11):784-793. doi: 10.1080/23744235.2022.2092648. Epub 2022 Jul 6.
Bacterial infections are associated with acute exacerbations of chronic obstructive pulmonary disease (AECOPD), but the mechanism is incompletely understood.
In a COPD observational study (NCT01360398), sputum samples were collected monthly at the stable state and exacerbation. analyses of 1307 non-typeable (NTHi) isolates from 20 patients and 756 isolates from 38 patients in one year of follow-up were conducted by multilocus sequence typing (MLST). All isolates came from cultured sputum samples that were analyzed for bacterial species presence, apparition (infection not detected at the preceding visit), or acquisition (first-time infection), with the first study visit as a baseline. Strain apparition or new strain acquisition was analyzed by MLST. The odds ratio (OR) of experiencing an exacerbation stable state was estimated by conditional logistic regression modelling, stratified by patient.
The culture results confirmed a significant association with exacerbation only for NTHi species presence (OR 2.28; 95% confidence interval [CI]: 1.12-4.64) and strain apparition (OR 2.38; 95% CI: 1.08-5.27). For , although confidence intervals overlapped, the association with exacerbation for first-time species acquisition (OR 5.99; 2.75-13.02) appeared stronger than species presence (OR 3.67; 2.10-6.40), new strain acquisition (OR 2.94; 1.43-6.04), species apparition (OR 4.18; 2.29-7.63), and strain apparition (OR 2.78; 1.42-5.42). This may suggest that previous colonization may modify the risk of exacerbation associated with infection.
The results confirm that NTHi and infections are associated with AECOPD but suggest different dynamic mechanisms in triggering exacerbations.
细菌感染与慢性阻塞性肺疾病急性加重（AECOPD）相关，但机制尚不完全清楚。
在一项慢性阻塞性肺疾病观察性研究（NCT01360398）中，在稳定期和加重期每月收集痰液样本。通过多位点序列分型（MLST）对20例患者的1307株不可分型流感嗜血杆菌（NTHi）分离株和38例患者在一年随访中的756株肺炎链球菌分离株进行分析。所有分离株均来自培养的痰液样本，分析细菌种类的存在、新出现（在前次就诊时未检测到感染）或获得（首次感染）情况，以首次研究就诊作为基线。通过MLST分析菌株的新出现或新菌株的获得情况。通过条件逻辑回归模型估计在稳定期发生加重的比值比（OR），按患者分层。
培养结果证实，仅NTHi种类的存在（OR 2.28；95%置信区间[CI]：1.12 - 4.64）和菌株新出现（OR 2.38；95% CI：1.08 - 5.27）与加重显著相关。对于肺炎链球菌，尽管置信区间有重叠，但首次获得菌种（OR 5.99；2.75 - 13.02）与加重的关联似乎比菌种存在（OR 3.67；2.10 - 6.40）、新菌株获得（OR 2.94；1.43 - 6.04）、菌种新出现（OR 4.18；2.29 - 7.63）和菌株新出现（OR 2.78；1.42 - 5.42）更强。这可能表明先前的肺炎链球菌定植可能改变与肺炎链球菌感染相关的加重风险。
结果证实NTHi和肺炎链球菌感染与AECOPD相关，但提示在触发加重方面有不同的动态机制。
