BACTERIAL PATHOGENS ISOLATED IN SPUTUM CULTURE OF PATIENTS WITH ACUTE EXACERBATION OF COPD AND SENSITIVITY PATTERN OF THESE PATHOGENS
A. BRIEF RESUME OF THE INTENDED WORK:
1. Need for the study:
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and one of the principal causes of death worldwide. (1) Exacerbations of COPD have considerable impact on health care system at both primary and tertiary care levels as they are the major reason for antibiotic use and admissions; additionally, exacerbations lead to indirect costs because of days lost from work.(2) COPD affects 30% of patients seen in chest clinics and constitutes 1-25% of hospital admissions all over India.(3) The disease is also associated with working and social incapacity and has tendency to repeated exacerbations, both infective and non-infective. Cigarette smoking or inhalation of dust or fumes are important contributing factors. (4) The role of bacterial infection in exacerbations of COPD and the use of sputum cultures to reach an etiological diagnosis to guide clinical management are subjects of current debates.
The role of infection in exacerbationsof COPD remains controversial and incompletely understood. Although some investigators believe that bacteria are not important for patients with exacerbation, we disagree and believe that patients with at least two of the three cardinal symptoms of exacerbation should receive antibiotic therapy with an open-minded view of the area, we review the data, showing that bacteriologic studies, pathologic investigations, and clinical trials all support roles for bacteria and antibiotic therapy in this disease. Still, many questions remain, and future studies will be needed to better define the mechanisms of
bacterial invasion in the COPD patients and to develop effective vaccines to prevent exacerbations. In the meantime, we must
rely on antibiotic therapy, and we will need prospective studies to corroborate preliminary findings showing that different patients may require different therapies; thus, patient subsetting may be vital in the selection of antibiotic therapy for exacerbations of COPD.
2.Review of Literature: The precise role of bacteria remains controversial as determining the contribution of bacteria to exacerbations is difficult as COPD patients are often colonised with bacteria even when clinically stable. Studies using bronchoscopic sampling have isolated bacteria from 50% of patients during an exacerbation, but also from 25 -30% of stable patients. In 40% of COPD (5)exacerbations in which the three symptoms of increased dyspnoea, sputum purulence and sputum volume were present and there was a significant benefit of antibiotics over placebo(5).
A study conducted in KMC manipal from june2006 to december2006 shows that the most common organisms grown in significant counts were Klebsiella and Staphylococcus. Coagulasepositive Klebsiella was the pathogen in 11 patients and Staphylococcus coagulase positive in 8 patients. Diplococci , pneumonia and Haemophilus influenzae have been a prominent feature of most of the Western studies.
First, exacerbations likely lead to structural alterations in the lung and to permanently worsened airflow. Second, health status is adversely affected by exacerbations, and although the mechanisms are unclear, the effects are long lasting and may be irreversible(7)
Microbial pattern of acute infective exacerbation of COPD in a hospital based study done by n.arora , m k daga , et al in 80 patients at maulana azad medical college delhi showed isolation of stretp pneumonia(25.8%of cases), p.auroginosa in12%, klebsiella 10.3% staph aureus in 1.7%.
3.Objective of the Study: To know the bacteria predominantly causing the acute exacerbation of COPD by sputum culture and the anti biotic sensitivity pattern of these organisms
B. Materials and Methods:
1. Source of Data:It will be a prospective study comprising of patients diagnosed with AECOPD from A.J.INSTITUTE OF MEDICAL SCIENCES HOSPITAL MANGALORE
2. Method of the Collection of the Data:
Study Design: One year prospective study.
Sample size: 90
Sample: It is a hospital based study. Study is done on patients admitted with acute exacerbation of COPD wherein the sputum culture and sensitivity is sent prior to starting the anti biotic treatment
Place: A.J. Institute Of Medical Sciences , Mangalore
Duration: One year from December 2009 to November 2010.
Method: It was a prospective study comprising 90 cases diagnosed as having AECOPD admitted in hospital. History of smoking or immunization for H.influenzae or S.pneumoniae will be noted down for all patients.
Sputum samples (preferably two) will be collected for all patients after rinsing the mouth twice with plain water. Routine haematological investigations and chest radiography (PA view) will be done on the day of presentation.
Inclusion criteria: Patients will be diagnosed depending upon the presence of two of the following symptoms:
1. Increased cough
2. Increased purulence and/or volume of
expectorations
3. Increased severity of dyspnoea.
Exclusion criteria:
1. All cases who have evidence of pneumonia or bronchiectasis developed as a sequelae of other disease, clinically or on chest radiography (PA view)
2. Those patients who were already taking treatment in the hospital
Data analysis: Prospective study of commonly isolated bacteria in sputum of patients with aecopd and their antibiotic sensitivity pattern
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