Bacterial Patterns and Empiric Antibiotic Use in COPD Patients With Community-Acquired Pneumonia

• Sergi Pascual-Guardia ^[7] ; Francesco Amati ^[8] ; Judith Marin-Corral ^[8] ; Stefano Aliberti ^[9] ; Joaquim Gea ^[7] ; Nilam J. Soni ^[8] ; Alejandro Rodriguez ^[10] ; Oriol Sibila ^[11] ; Francisco Sanz ^[1] ; Giovanni Sotgiu ^[2] ; Pedro J. Marcos ^[3] ; Ane Uranga ^[12] ; Branislava Milenkovic ^[4] ; Christian N. Meyer ^[5] ; Martin Kolditz ^[6] ; Antonio R. Anzueto ^[8] ; Marcos I. Restrepo ^[8]
  1. [1] Hospital General Universitario de Valencia

     Hospital General Universitario de Valencia

     Valencia, España

     
  2. [2] University of Sassari

     University of Sassari

     Sassari, Italia

     
  3. [3] Instituto de Investigación Biomédica da Coruña

     Instituto de Investigación Biomédica da Coruña

     A Coruña, España

     
  4. [4] University of Belgrade

     University of Belgrade

     Serbia

     
  5. [5] Copenhagen University Hospital

     Copenhagen University Hospital

     Dinamarca

     
  6. [6] Dresden University of Technology

     Dresden University of Technology

     Kreisfreie Stadt Dresden, Alemania

     
  7. [7] Departamento de Respiratorio, Hospital del Mar-IMIM, CEXS, UPF, CIBERES, BRN, Barcelona, España
  8. [8] Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
  9. [9] Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital, Respiratory Unit, Milan, Italy
  10. [10] Servicio de Cuidados Críticos, Hospital Universitari Joan XXIII, URV, CIBERES, Tarragona, España
  11. [11] Departamento de Respiratorio, Hospital Clinic, CIBERES, BRN, Barcelona, España
  12. [12] Servicio de Neumología, Hospital de Galdakao-Usansolo, España

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• Localización: Archivos de bronconeumología: Organo oficial de la Sociedad Española de Neumología y Cirugía Torácica SEPAR y la Asociación Latinoamericana de Tórax ( ALAT ), ISSN 0300-2896, Vol. 59, Nº. 2 (February), 2023, págs. 90-100
• Idioma: inglés
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• Resumen

  • Introduction 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.

    Methods 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.

    Results 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%.

    Conclusions 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.