Pseudomonas aeruginosa in patients hospitalised for COPD exacerbation: a prospective study.
ABSTRACT Risk factors for Pseudomonas aeruginosa (PA) isolation in patients hospitalised for chronic obstructive pulmonary disease (COPD) exacerbation remain controversial. The aim of our study was to determine the incidence and risk factors for PA isolation in sputum at hospital admission in a prospective cohort of patients with acute exacerbation of COPD. We prospectively studied all patients with COPD exacerbation admitted to our hospital between June 2003 and September 2004. Suspected predictors of PA isolation were studied. Spirometry tests and 6-min walking tests were performed 1 month after the patients were discharged. High-resolution computed tomography (HRCT) was performed in a randomised manner in one out of every two patients to quantify the presence and extent of bronchiectasis. Patients were followed up during the following year for hospital re-admissions. A total of 188 patients were included, of whom 31 (16.5%) had PA in sputum at initial admission. The BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity) index (OR 2.18, CI 95% 1.26-3.78; p = 0.005), admissions in the previous year (OR 1.65, CI 95% 1.13-2.43; p = 0.005), systemic steroid treatment (OR 14.7, CI 95% 2.28-94.8; p = 0.01), and previous isolation of PA (OR 23.1, CI 95% 5.7-94.3; p<0.001) were associated with PA isolation. No relationship was seen between bronchiectasis in HRCT and antibiotic use in the previous 3 months. PA in sputum at hospital admission is more frequent in patients with poorer scoring on the BODE index, previous hospital admissions, oral corticosteroids and prior isolation of PA.
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ABSTRACT: Pseudomonas aeruginosa chronically infects patients with cystic fibrosis and is associated with greater morbidity. There has been limited progress on the clinical development of new antibiotics with novel modes of action. This review addresses some of the latest research developments on the exploitation of candidate adjuvant therapeutic agents that may act alongside conventional antibiotics as an alternative therapeutic strategy. After considering key mechanisms this opportunistic pathogen employs to control virulence, the progress of various strategies including the inhibition of quorum sensing, efflux pumps and lectins, and the use of iron chelators, bacteriophages, immunisation and immunotherapy is reviewed. Both therapeutic approaches in early development and clinical phase are discussed.European Respiratory Journal 06/2012; 40(4):1014-23. · 5.89 Impact Factor
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ABSTRACT: Objective: Respiratory tract infections (RTIs) are amongst the most common conditions encountered in our hospitals. The objectives of the study were to determine the frequency and antibiotic susceptibility pattern of various Gram nega-tive bacteria (GNB) isolated from sputum samples of patients with RTIs. Methods: A descriptive, cross sectional study was carried out at the department of Microbiology, Army Medical College. Patients were diagnosed as suffering from RTIs on the basis of clinical features, radiological and laboratory findings. Sputum samples from all admitted and outdoor patients that presented to the hospital with RTIs were collected using sterile plastic containers. Those that satisfied the criteria for inclusion were accepted and processed according to routine microbiological procedures. The cultures were identified and susceptibility patterns of the organisms noted. Results: Fifteen hundred and ninety six sputum samples were processed of which 549 (34.4%) yielded a positive patho-genic organism on culture with 327 (59.6%) yielding GNB. Of these Pseudomonas aeruginosa 105 (32.1%) was the most frequently isolated organism followed by Heamophilus influenzae 62 (19.0%), Klebsiella pneumoniae 54 (16.5%), Aci-netobacter 46 (14.1%) and E. coli 41 (12.5%). Piperacillin/tazobactam, meropenem and imipenem were among the most effective antibiotics.Journal of Microbiology and Infectious Diseases. 03/2013; 3(1):8-11.
European Respiratory Journal. 01/2005; 26(6).