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title:Clinical Profile and Microbiological Spectrum in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Author:Waseem Javid, Majid Abbas Khawaja

Keywords:Chronic obstructive pulmonary disease; MDR strains; Infective exacerbations; Microbiological spectrum

Type:Original Article

Abstract:"Background: Exacerbations are a prominent feature of the natural history of COPD, Microbiological spectrum of acute exacerbations of COPD patients, which is most often infectious and related to a viral and/or bacterial infection remains debatable. Objective: To know the clinical profile and Microbiological Spectrum in Acute Exacerbations of chronic obstructive pulmonary disease. Methodology: In this cohort prospective study 90 COPD patients who presented with AECOPD in KD medical college, U.P were enrolled to determine the incidence of infective exacerbations, their respective microbiological spectrum ,antibiotic sensitivity, incidence of MDR cases and management with antibiotic stewardship. Study period was between March 2018 to March 2019. A detailed history and examination was done. The sputum specimens were collected using sterile containers and subjected to Gram’s stain, culture on blood agar. Results: Out of 90 patients admitted with AECOPD, 84 males and 6 females. Only 54(60%) had infective exacerbation, 50 males and 4 females with a mean age of 62 years. Sputum culture showed Gram negative bacilli in 25.9%, Gram positive Cocci in 11.1%, one or two isolates in 37% ,Mixed flora in 33% and no growth in isolates 29.7%. The commonest organism was Klebsiella pneumonia 6 (11.5%) followed by pseudomonas aeruginosa 4 (7.4%). The drug sensitivity revealed that gram negative isolates were sensitive to carbapenems (100%), CSE-1034 A novel Antibiotic Adjuvent Entity( AEE-100%), followed by amino-glycosides. MDR strains were found in 28.6% of the gram negative organisms and 7.4% of total cases. The most common symptoms was colored sputum 48/54 (89%) followed by dyspnea 44/54 (81%). Increased TLC was not predominant in most cases in our study. The presence of pneumonia was only in 12/54 cases representing 22%. Conclusion: Gram negative bacteria were more frequently isolated in our study. Early antibiotic therapy based on culture and sensitivity with Antibiotic stewardship in the form of Right Drug, Right dose, Descalation as per culture -sensitivity with appropriate duration, should be started to reduce increasing burden of MDR and ESBL strains. "

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