[Antimicrobial treatment of patients with severe acute exacerbation of COPD]

Chronic obstructive lung disease (COPD) is a leading cause of death worldwide. In patients with acute exacerbations admitted to an intensive care unit (ICU), potentially pathogenic microorganisms can be found in approximately 50%, with Haemophilus influenzae and Streptococcus pneumoniae as the leading strains, followed by enterobacteria and Pseudomonas aeruginosa. Viruses can also be detected in a large proportion of patients. The indication for antimicrobial treatment of acutely exacerbated COPD is still controversial but recommended by guidelines for all patients admitted to an ICU. Appropriate agents for an empiric initial treatment are penicillins + betalactamase inhibitor, 2(nd) and 3(rd) generation cephalosporins, carbapenems, and quinolones. Antimicrobial treatment should be adjusted according to the results of microbial investigation of sputum or endotracheal aspirate.