ANTIBIOTIC TREATMENT AND BACTERIAL FLORA IN SPUTUM IN CHRONIC PULMONARY DISEASE EXACERBATIONS

Authors

  • Aurelia CRETU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Cristina Mihaela GHICIUC “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Elena Cristina MITROFAN The Railway Clinical Hospital, Iasi, Romania
  • Diana CIUBOTARIU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Ioana Maria HUNEA “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • B. HUZUM “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • C. MITROFAN Clinical Hospital of Pulmonary Diseases, Iasi, Romania

Abstract

Background and aims: A judicious use of antibiotics for Chronic Obstructive Pulmonary Disease (COPD) or asthma frequent exacerbation is a provocation for clinician. In this context, the aim of our study was to identify and describe the commonest bacterial pathogens and the preferred antibiotic for the treatment of the patients with recurrences for COPD and asthma exacerbations because this category of patients has worse health status and increased morbidity. Materials and methods: A retrospective study investigated patients with recurrent COPD or bronchial asthma, more than 2 exacerbations/year and at least one early re-admission, admitted in Iasi University Clinical Hospital of Pulmonary Diseases from North-East Romania, from 2014 to 2019.  Results: Only 33 patients were selected according to inclusion criteria. A small proportion of sputum culture identified the pathogen (20.35%) and most frequent were Streptococcus pneumoniae followed by Pseudomonas aeruginosa and Haemophilus influenzae. The bacteria identified were resistant to aminopenicillins and 1st - 3rd cephalosporins generation.  Quinolones (levofloxacin) and colistin were the preferred antibiogram-based therapy. Conclusions: COPD and asthma exacerbation can be a start to antibiotic stewardship because these patients are the most exposed to inappropriate antibiotic use, decompensations, increased hospital stay, increased treatment costs.

Author Biographies

  • Aurelia CRETU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

    “Elytis” Hospital Iasi, Romania/Pulmonary Diseases Department
    Clinical Hospital of Pulmonary Diseases, Iasi, Romania

  • Cristina Mihaela GHICIUC, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

    “Sf. Maria” Clinical Hospital for Children, Iasi, Romania

  • Ioana Maria HUNEA, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

    “Sf. Parascheva” Clinical Hospital of Infectious Diseases, Iasi, Romania

References

1. Viegi G, Maio S, Fasola S, Baldacci S. Global Burden of Chronic Respiratory Diseases. J Aerosol Med Pulm Drug Deliv 2020; 33(4): 171-177.
2. Eurostat. Statistics explained. Causes of death statistics. 2022. https://ec.europa.eu/ eurostat/statistics-explained/index.php?title= Causes_of_death_ statistics # Main_ causes_of_death_by_country_in_2019 (last accessed on February 202.
3. Eurostat. Statistics Explained. Respiratory Diseases Statistics. 2022. Https://Ec.Europa. Eu/Eurostat/Statistics-explained/Index.Php?Title=Respiratory_ Diseases _ Statistics # Deaths_From_Diseases _Of_The_Respiratory_ System (last accessed on February 2023).
4. Bouquet J, Tabor DE, Silver JS, et al. Microbial burden and viral exacerbations in a longitudinal multicenter COPD cohort. Respir Res 2020; 21: article 77.
5. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Manage-ment and Prevention of Chronic Obstructive Pulmonary Disease: 2023 Report. 2022. https://goldcopd.org/2023-gold-report-2/ (last accessed on February 2023).
6. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2023. Reports - Global Initiative for Asthma - GINA (ginasthma.org) (last accessed sept 2023).
7. Normansell R, Sayer B, Waterson S, Dennett EJ, Del Forno M, Dunleavy A. Antibiotics for Exacer-bations of Asthma (Review). Cochrane Database of Syst Rev 2018; 6: Cd002741.
8. Ritchie AI, Brill SE, Vlies BH, et al. Targeted Retreatment of Incompletely Recovered Chronic Ob-structive Pulmonary Disease Exacerbations with Ciprofloxacin a Double-Blind, Randomized, Placebo-controlled, Multicenter, Phase III Clinical Trial. Am J Respir Crit Care Med 2020; 202(4): 549-557.
9. Roberts MH, Clerisme-Beatyet E, Kozma CM, et al. A retrospective analysis to identify predictors of COPD-related rehospitalization. BMC Pulmonary Medicine 2016; 16: 68.
10. Serra-Picamala X, Romana R, Escarrabillb J, et al. Hospitalizations due to exacerbations of COPD: A big data perspective. Respiratory Medicine 2018; 145: 219-225.
11. Sanjay S, Aaron SD. Antibiotic Retreatment for Acute Exacerbations of Chronic Obstructive Pulmo-nary Disease. Am J Respir Crit Care Med 2020; 202(4): 481-482.
12. Suruki RY, Daugherty JB, Boudiafet N, Albers FC. The frequency of asthma exacerbations and healthcare utilization in patients with asthma from the UK and USA. BMC Pulmonary Medicine 2017; 17: 74.
13. Stefan MS, Shieh M-S, Spitzer KA, et al. Association of Antibiotic Treatment with Outcomes in Patients Hospitalized for an Asthma Exacerbation Treated with Systemic Corticosteroids. Jama Intern Med. 2019; 179(3): 333-339.
14. Stolbrink M, Amiry J, Blakey JD. Does antibiotic treatment duration affect the outcomes of exacerba-tions of asthma and COPD? A systematic review. Chronic Respiratory Disease 2018; 15(3): 225-240.
15. King PT, MacDonald M, Bardin PG. Bacteria in COPD; their potential role and treatment. Transl Respir Med. 2013; 1: 13.
16. Hilty M, Burke C, Pedro H et al. Disordered Microbial Communities in Asthmatic Airways. PLoS One 2010; 5(1): e8578.

Additional Files

Published

2023-12-21