Respiratory Department, Hospital del Mar-IMIM, CEXS, UPF, CIBERES, BRN, Barcelona, Spain; Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA.
Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA; Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital, Respiratory Unit, Milan, Italy.
Arch Bronconeumol. 2023 Feb;59(2):90-100. doi: 10.1016/j.arbres.2022.09.005. Epub 2022 Sep 22.
Chronic obstructive pulmonary disease (COPD) is strongly associated with the development of community-acquired pneumonia (CAP). Limited data are available on risk factors for difficult to manage bacteria such as Pseudomonas aeruginosa in COPD patients with CAP. Our objective was to assess the microbiological patterns associated with risk factors that determine empiric antibiotic therapy in hospitalized COPD patients with CAP.
We performed a secondary data analysis of an international, multicenter, observational, point-prevalence study involving hospitalized COPD patients with CAP from March to June 2015. After identifying the risk factors associated with different microorganisms, we developed a scoring system to guide decision-making about empiric anti-pseudomonal antibiotic therapy in this population.
We enrolled 689 hospitalized COPD patients with CAP with documented microbiological testing. The most frequent microorganisms isolated were Streptococcus pneumoniae (8%) and Gram-negative bacteria (8%), P. aeruginosa (7%) and Haemophilus influenzae (3%). We developed a scoring system incorporating the variables independently associated with P. aeruginosa that include a previous P. aeruginosa isolation or infection (OR 14.2 [95%CI 5.7-35.2]), hospitalization in the past 12 months (OR 3.7 [1.5-9.2]), and bronchiectasis (OR 3.2 [1.4-7.2]). Empiric anti-pseudomonal antibiotics were overutilized in COPD patients with CAP. The new scoring system has the potential to reduce empiric anti-pseudomonal antibiotic use from 54.1% to 6.2%.
COPD patients with CAP present different microbiological profiles associated with unique risk factors. Anti-pseudomonal treatment is a critical decision when selecting empiric antibiotic therapy. We developed a COPD scoring system to guide decision-making about empiric anti-pseudomonal antibiotic therapy.
慢性阻塞性肺疾病（COPD）与社区获得性肺炎（CAP）的发生密切相关。关于 COPD 合并 CAP 患者中难以处理的细菌（如铜绿假单胞菌）的危险因素的数据有限。我们的目的是评估与决定 CAP 合并 COPD 患者经验性抗生素治疗相关的微生物学模式和危险因素。
我们对 2015 年 3 月至 6 月期间参与国际多中心观察性时点患病率研究的住院 COPD 合并 CAP 患者进行了二次数据分析。在确定与不同微生物相关的危险因素后，我们开发了一个评分系统，以指导该人群中针对抗假单胞菌经验性抗生素治疗的决策。
我们纳入了 689 例住院 COPD 合并 CAP 患者，他们均进行了微生物学检测。最常分离到的微生物为肺炎链球菌（8%）和革兰氏阴性菌（8%）、铜绿假单胞菌（7%）和流感嗜血杆菌（3%）。我们开发了一个评分系统，其中包含与铜绿假单胞菌独立相关的变量，包括既往铜绿假单胞菌分离或感染（OR 14.2[95%CI 5.7-35.2]）、过去 12 个月内住院（OR 3.7[1.5-9.2]）和支气管扩张（OR 3.2[1.4-7.2]）。经验性抗假单胞菌抗生素在 COPD 合并 CAP 患者中过度使用。新的评分系统有可能将经验性抗假单胞菌抗生素的使用从 54.1%降低到 6.2%。
CAP 合并 COPD 患者存在不同的微生物学特征，与独特的危险因素相关。抗假单胞菌治疗是选择经验性抗生素治疗的关键决策。我们开发了 COPD 评分系统，以指导 CAP 合并 COPD 患者经验性抗假单胞菌抗生素治疗的决策。
