title: Prevalence and outcome of severe chronic obstructive pulmonary disease exacerbations caused by multidrug-resistant bacteria.
abstract: OBJECTIVE
  A bacterial cause is found in about half of all severe chronic obstructive pulmonary disease exacerbations. The aim of this review is to discuss recent findings regarding prevalence, risk factors and outcome of severe chronic obstructive pulmonary disease exacerbations caused by multidrug-resistant bacteria.
  
  
  RESULTS
  According to the results of recent studies, multidrug-resistant bacteria represented a large proportion of bacteria isolated in chronic obstructive pulmonary disease exacerbations. Prior antibiotic treatment, prior endotracheal intubation, long-term inhaled or systemic corticosteroid use and severe impairment of lung function were identified as risk factors for severe chronic obstructive pulmonary disease exacerbations related to multidrug-resistant bacteria. Although the mortality rate was higher in patients with multidrug-resistant bacteria as compared with patients with other bacteria, multidrug resistance was not independently associated with mortality in these patients. Multidrug-resistant bacteria were, however, significantly associated with inappropriate initial antibiotic treatment. Higher rates of subsequent ventilator-associated pneumonia and mortality were found in patients with severe chronic obstructive pulmonary disease exacerbation who received inappropriate initial antibiotic treatment when compared with those who received appropriate treatment.
  
  
  CONCLUSIONS
  Further studies should determine whether administration of broad-spectrum antibiotic treatment could improve the outcome of patients with severe chronic obstructive pulmonary disease exacerbation caused by multidrug-resistant bacteria.
authors.affiliation: Intensive Care Unit, Calmette Hospital, University Hospital of Lille, Lille, France. s-nseir@chru-lille.fr
authors.forename: Saad
authors.initials: S
authors.lastname: Nseir
authors.forename: Florence
authors.initials: F
authors.lastname: Ader
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D053717:Pneumonia, Ventilator-Associated / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D015995:Prevalence; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D012008:Recurrence; D012720:Severity of Illness Index
chemical_list: D000890:Anti-Infective Agents