CLINICAL PROFILE AND MICROBIOLOGICAL SPECTRUM IN ACUTE EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

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. The study was conducted 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 presented with AECOPD 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 were done. The sputum specimens were collected using sterile containers and subjected to Gram’s stain, culture on blood agar.

Results:Out of90 patients admitted with AECOPD, 84 males. Only 54(60%) had infective exacerbation, among them 50 were males and mean age of was 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%). Gram negative isolates were sensitive to carbapenems (100%), CSE-1034 Antibiotic Adjuvant 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 were coloured sputum 48/54 (89%) followed by dyspnoea 44/54 (81%). The presence of pneumonia was only in 22%cases.

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.