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Pseudomonas aeruginosa isolates in severe chronic obstructive pulmonary disease: characterization and risk factors

Miguel Gallego1, Xavier Pomares, Mateu Espasa

  • 1Department of Respiratory Medicine, Hospital de Sabadell, Institut Universitari Parc Taulí-UAB, Sabadell, Spain. mgallego@tauli.cat.

BMC Pulmonary Medicine
|June 27, 2014
PubMed
Abstract

Insights

In severe chronic obstructive pulmonary disease (COPD), bronchiectasis and antibiotic use increase Pseudomonas aeruginosa infection risk. Over 10% of patients experience chronic P. aeruginosa colonization, independent of bronchiectasis.

Area of Science:

  • Pulmonology
  • Infectious Diseases
  • Microbiology

Background:

  • Patients with severe chronic obstructive pulmonary disease (COPD) face a higher risk of Pseudomonas aeruginosa infections.
  • The role of bronchiectasis in P. aeruginosa infection and chronic colonization in COPD is not well understood.

Purpose of the Study:

  • To determine the prevalence and risk factors for P. aeruginosa recovery from sputum in severe COPD outpatients.
  • To characterize P. aeruginosa isolates using pulsed-field gel electrophoresis (PFGE).
  • To investigate the influence of bronchiectasis on chronic P. aeruginosa colonization.

Main Methods:

  • A case-cohort study involving 118 severe COPD patients followed for one year.
  • High-resolution CT scans for bronchiectasis assessment and sputum cultures during exacerbation and stability.
  • P. aeruginosa isolates were genotyped by PFGE, and risk factors were analyzed using multivariate analysis.

Main Results:

  • P. aeruginosa was isolated in 34.7% of patients; 12.2% met criteria for chronic colonization.
  • The extent of bronchiectasis (OR 9.8) and antibiotic courses (OR 1.7) were independent risk factors for P. aeruginosa isolation.
  • Chronic colonization was not associated with bronchiectasis, but isolates showed clonal persistence and harbored multidrug-resistant strains.

Conclusions:

  • Bronchiectasis extent and antibiotic exposure are key risk factors for P. aeruginosa isolation in severe COPD.
  • Over 10% of severe COPD patients experience chronic P. aeruginosa colonization with clonal persistence.
  • Chronic colonization by P. aeruginosa occurs independently of bronchiectasis in this patient group.

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