Abstract
Introduction: Acute Exacerbations of Chronic Obstructive Pulmonary disease (AECOPD) due to Pseudomonas aeruginosa (PA) are associated with worse outcomes. PA antibiotic resistance is important to determine treatment.
Objectives: To study clinical characteristics and outcomes in patients with AECOPD due to PA based on their antibiotic resistance.
Methods: Prospective observational study including all patients with AECOPD due to PA admitted in a Respiratory ward in a tertiary hospital in Barcelona during 2013-2014. Resistant PA (PA-R) was defined when ≥1 class of antibiotics were resistant on the antibiogram.
Results: 401 patients with AECOPD were evaluated. Of them, 53 (13%) had a positive PA sputum culture. 82% were men, median age (± SD) 77 (±7) years old and FEV1 36 (±17) % of predicted. PA-R was isolated in 35 patients (66%).No differences in demographics, lung function and comorbidities among patients with PA-R and PA-sensible (PA-S) were found, except that patients with PA-R had received more prior oral steroids (80% vs 44%, p = 0.009) and antibiotics (65% vs 33%, p = 0.02)
PA persistence after adequate treatment was higher in the PA-R group (82% vs 50%, p = 0.04). However, patients with PA-R had lower 30-day and 90-day mortality when compared to patients with PA –S (3% vs 22%, p = 0.02, and 9% vs 33%, p= 0.02, respectively).
Conclusions: PA-R affects patients with severe COPD and previous use of steroids and antibiotics. Persistent PA-R strains were found in follow-up sputum samples. However, the presence of sensitive PA is associated with higher mortality. These results may reflect a contrast between acute infections caused by PA-S and chronic colonization with PA-R.
- Copyright ©ERS 2015
