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Bacteriological profile and antibiotic sensitivity pattern in chronic obstructive pulmonary disease patients

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Bacteriological profile and antibiotic sensitivity pattern in chronic obstructive pulmonary disease patients

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Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Bacteriological profile and antibiotic sensitivity
pattern in chronic obstructive pulmonary
disease patients
Bhavya Nayak, Sowmya Kharvi, Aneena Varghese and Arya MB
Chronic obstructive pulmonary disease (COPD) is a progressive chronic disease, which
is characterized by obstinate obstruction of airflow with an enhanced chronic inflam-
matory response in the airways and the lung to toxic elements or gases. COPD is a major
etiology of morbidity and one among the primary causes of the death globally. The
objective of this study is to analyze the bacteriological profile of the patients with COPD
and also to study their antimicrobial sensitivity pattern, which may help to scheme a
proper antibiotic treatment to the COPD patients, which will have a beneficial effect in
preventing the morbidity and mortality of the disease. A narrative review of the literature
was carried out after a bibliographical search on the database PubMed, Science Direct
and Scopus and active search lists of bibliographical references of articles selected up to
November 2019. According to various studies addressed, the causative agents in COPD
from both sputum and bronchoscopic samples are found to be Haemophilus influenza,
Streptococcus pneumoniae, and Moraxella catarrhalis. However, to conclude, the
bacterial flora in COPD varies with disease severity as Gram-negative organisms, such
as Pseudomonas aeruginosa are more commonly detected in patients with more severe
airflow obstruction in both stable COPD and in exacerbations.
Copyright ß2020 Wolters Kluwer Health, Inc. All rights reserved.
Reviews in Medical Microbiology 2021, 32:166168
Keywords: antimicrobial resistance, bacteriology, chronic obstructive
pulmonary disease, etiology
Introduction
Chronic obstructive pulmonary disease (COPD) is a
progressive chronic disease, which is characterized by
obstinate obstruction of airflow with an enhanced chronic
inflammatory response in the airways and the lung to toxic
elements or gases. COPD is a major etiology of morbidity
and one among the primary causes of the death globally. It
is the fourth leading etiology of death in the world and is
anticipated to bethe third most important etiology of death
worldwide by 2020 [1]. The major reason of exacerbations
(worsening) of COPD is the use of antibiotic, it has
significant influence on healthcare system at both primary
and tertiary care levels [2]. The role of bacterial infectionin
provocation of chronic bronchitis and the use of sputum
cultures and sensitivity to reach an etiological finding will
guide to obtain appropriate clinical management. Majority
of the Gram-negative strains will be sensitive to
quinolones, yet, it cannot be considered as the first option
for starting treatment as its frequent usage can lead to
emergence of the resistant strains [3].
Search strategy
The research resources available in Manipal academy of
Higher education was used extensively. A review of the
literature was carried out after a bibliographical search on
the database PubMed, Science Direct and Scopus, and
active search lists of bibliographical references of articles
selected up to November 2019. The literature search was
carried out using key words including ‘COPD’, ‘Chronic
Obstructive Pulmonary Disease’ AND ‘Bacterial load’,
‘Antibiotic sensitivity’.
Department of Medical Laboratory Technology, Manipal College of Health Professions, MAHE, Manipal, Karnataka; and Faculty
of Life and Allied Health Sciences, MS Ramaiah University of Applied Sciences, Bangalore, India.
Correspondence to Aneena Varghese, Assistant Professor, Department of Medical Laboratory Technology, Manipal College of
Health Professions, MAHE, Manipal, Karnataka, India.
Mobile: þ7090652115/þ95 26787947; e-mail: aneenavarghesep82@gmail.com; aneena.varghese@manipal.edu
Received: 14 December 2019; revised: 9 June 2020; accepted: 14 September 2020
DOI:10.1097/MRM.0000000000000254
166 ISSN 0954-139X Copyright Q2020 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Study selection
The original research articles that met the following
criteria were included in this review. Randomized
controlled trials and experimental studies that studied
the etiology of COPD to assess for the risk factors. Studies
on animals, case reports were excluded. We also did not
include those studies that did not give the proper etiology
of the infection, such as the predominant bacteria
identified. Non-English articles and articles whose full
text were not available were also excluded from the study.
Results
A total of 567 articles were retrieved from various
databases. When the titles and abstracts were reviewed for
relevance to the topic, 259 articles were excluded. Out of
95 articles selected, 43 articles were included after final
analysis of abstracts for very similar studies, quality of the
data analysis and availability of the full texts. Further
analysis of the whole content of each article could finally
select only 12 articles, which are eligible for the analysis.
The articles were excluded because of improper study
design and language other than English.
The objective of this study was to analyze the
bacteriological profile of the patients with COPD and
also to study their antimicrobial sensitivity pattern, which
may help to scheme a proper antibiotic treatment to the
COPD patients, which will have a beneficial effect in
preventing the morbidity and mortality of the disease.
In order to investigate the role of infection in COPD, an
understanding of the normal microbial flora in healthy
individuals is required. Most of the surfaces of the upper
respiratory tract (including nasal and oral passages,
nasopharynx and oropharynx) are colonized by bacteria
in healthy individuals. These organisms constitute the
normal flora of the respiratory tract and rarely etiology
disease. The nose is commonly colonized with predomi-
nantly Staphylococcus epidermidis and Cornyebacteria but
Staphylococcus aureus can also be present. The nasopharynx
is predominantly colonized with nonhemolytic and
alpha-hemolytic Streptococci and Neisseria Spp. with
occasional carriage of Streptococcus pneumoniae and
Haemophilus influenzae. Determining the prevalence of
bacteria in the lower respiratory tract has been proved
problematic because of the difficulty of obtaining lower
respiratory tract samples uncontaminated by upper airway
secretions [4]. The most common organisms cultured in
COPD from both sputum and bronchoscopic samples are
consistently H. influenzae,Strep. pneumoniae, and Moraxella
catarrhalis. However, the bacterial flora in COPD varies
with disease severity as Gram-negative organisms, such as
Pseudomonas aeruginosa are more commonly detected in
patients with more severe airflow obstruction in both
stable COPD and in exacerbations. Other organisms
detected less frequently include Haemophilus parainfluen-
zae and Staph. aureus [5–9].
Historically, the lungs have been considered sterile,
despite their continuity with the upper airways, proximity
to the gastrointestinal tract and continuous exposure to
the environment. Over the past decade, molecular
culture-independent techniques, initially developed in
the ecology field, have identified bacteria previously not
amenable to culture [18]. These techniques when
combined with advances in sequencing technologies
have produced a powerful tool for investigating the role of
bacteria in health and disease and have recently begun to
shed more light on the role of bacteria in COPD [10].
Therefore, both the presence and type of bacteria in the
airways in stable COPD are not static phenomena and
may be affected by factors, such as disease progression,
exacerbations and treatments including antibiotics and
inhaled corticosteroids. Conversely the presence of
bacteria can influence disease progression and exacerba-
tions in COPD patients [11] Table 1.
Discussion
In healthy individuals, bacteria are constantly inhaled but
infection does not develop as a result of sophisticated host
defenses. These include mechanical, such as tight
epithelial lining cells and mucociliary clearance, antimi-
crobial peptides, local immune responses, such as
secretory IgA, resident phagocytes, such as airway
macrophages, and acquired immune responses. The
widespread use of antibiotics in COPD exacerbations,
the evidence for this usage is surprisingly weak.
Antibiotic use has a number of adverse effects both in
terms of direct side effects for patients and effects on
antimicrobial resistance. With increasing use of self-
management plans for COPD patients and increasing
numbers of elderly patients with COPD, the prescribing
of antibiotics and the associated adverse effects are likely
to increase with current management strategies. The
validation of biomarkers and identification of clinical
characteristics that identify exacerbations likely to be
bacterial are urgently needed to guide rational antibiotic
prescribing in COPD. Recognition of the potential role
of bacteria in amplifying airways inflammation in stable
COPD has led to interest in treating bacterial infection
not only in exacerbations but also in stable patients. The
risk of development of antibiotic resistance is reduced if
either short courses or pulsed courses of antibiotics are
used. Antibiotic use has a number of adverse effects both
in terms of direct side effects for patients and effects on
antimicrobial resistance. With increasing use of self-
management plans for COPD patients and increasing
numbers of elderly patients with COPD, the prescribing
Bacteriological profile and antibiotic sensitivity Nayak et al. 167
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
of antibiotics and the associated adverse effects are likely
to increase with current management strategies. The
validation of biomarkers and identification of clinical
characteristics that identify exacerbations likely to be
bacterial are urgently needed to guide rational antibiotic
prescribing in COPD [12].
Acknowledgements
Conflicts of interest
There are no conflicts of interest.
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168 Reviews in Medical Microbiology 2021, Vol 32 No 3
Table 1. Bacteriological characterization in COPD patients.
Author Year Topic Organism isolated Conclusion
Madhavi S 2017 Bacterial etiology of acute
exacerbations of chronic
obstructive pulmonary
disease
H. influenzae, M. catarrhalis, Strep.
pneumoniae, P. aeruginosa
The complexity of the host– pathogen interaction
that determines the outcome of each encounter
between a potential respiratory pathogen and a
patient with COPD.
Beasley V 2012 Lung microbiology and
exacerbations in COPD
H. influenzae, Strep. pneumoniae,
M. catarrhalis, P. aeruginosa,
H. parainfluenzae, Staph. aureus
New diagnostic methods that can detect different
strains of the same bacterial species and reveal
the presence of bacteria not detected by culture
methods are likely to further advance our
understanding of the role of bacteria in COPD.
Engler K 2012 Colonization with
Pseudomonas aeruginosa
and antibiotic resistance
patterns in COPD patients
P. aeruginosa P. aeruginosa colonization increases in frequency
in severe COPD, although colonization may
occur in the early stages resistance to
ciprofloxacin, most frequently found in severe
COPD, may influence empiric antibiotic
treatment offered to patients in this context.
Murphy TF 2008 Pseudomonas aeruginosa in
chronic obstructive
pulmonary disease.
P. aeruginosa, H. influenzae, Strep.
pneumoniae, M. catarrhalis
Two distinct patterns of carriage by P. aeruginosa
were observed: short-term colonization
followed by clearance and long-term
persistence. Mucoid strains showed
persistence. Acquisition of P. aeruginosa is
associated with the occurrence of an
exacerbation.
Rodrigo
troyano
2018 Pseudomonas aeruginosa in
chronic obstructive
pulmonary disease
patients with frequent
hospitalized
exacerbations: a
prospective multicentre
Study
P. aeruginosa, H. influenzae, Strep.
pneumoniae, M. catarrhalis,
K. pneumoniae
The presence of P. aeruginosa was related to three
or more readmissions during the 1-year follow-
up and PA persisted in the sputum despite an
appropriate antibiotic treatment. This finding
suggested an important role of PA in the course
of the disease of COPD patients with frequently
hospitalized exacerbations.
Marin A 2010 Variability and effects of
bronchial colonisation in
patients with moderate
COPD
Haemophilus influenzae,
Haemophilus parainfluenzae,
Strep. pneumoniae, Moraxella
catarrhalis, Pseudomonas
aeruginosa, Enterobacteria and
Staph. aureus
The recovery of H. influenzae, P. aeruginosa and
Enterobacteria from bronchial secretions was
closely related to a neutrophilic response,
suggesting that the cellular inflammatory effects
of bronchial colonisation on moderate COPD
depend mainly on the presence of these PPMs.
COPD, chronic obstructive pulmonary disease.
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