title: Bacteria associated with acute exacerbations of chronic obstructive pulmonary disease requiring mechanical ventilation and antimicrobial management in Respiratory Care Unit of Central Chest Institute of Thailand.
abstract: OBJECTIVE
  To investigate the role of bacterial infection, antimicrobial sensitivity and antibiotics usage in severe acute exacerbations of COPD requiring mechanical ventilation in the respiratory care unit of the central chest institute of Thailand.
  
  
  METHODS
  All data were analyzed from medical records of 38 patients admitted in RCU of CCIT during 1 November 2008-31 August 2011 with severe acute exacerbations of COPD requiring mechanical ventilation. The tracheobronchial aspirates specimens were collected for Gram stain, quantitative culture and sensitivities testing. The sera were tested for antibodies to Chlamydophila pneumoniae and Mycoplasma pneumoniae with the immunofluorescence test.
  
  
  RESULTS
  Bacterial pathogens were isolated by quantitative culture from 18 of 38 patients (47.3%). Gram-negative bacilli were the predominant organisms. K. pneumoniae was the predominant isolates 7 cases (18.4%) followed by H. influenzae 3 cases and P. aeruginosa 3 cases (7.9% each). A single pathogen was isolated from 12 patients (31.6%), two pathogens were isolated from 5 patients (13.2%) and three pathogens from 1 patient (2.6%). Serological samples were positive for Chlamydophila pneumoniae in 5 (13.2%) cases. 1 of these patients had coinfection with Acinetobacter baumannii. In the RCU, 33 (86.8%) patients were empirically treated with antibiotic. Ceftriaxone was the most commonly used antibiotic.
  
  
  CONCLUSIONS
  57.8% (22/38 cases) of the patients with severe exacerbations in COPD requiring mechanical ventilation caused by bacterial infection, Gram-negative bacilli were the predominant organism with a resistance to commonly used antibiotics of K. pneumoniae, P. aeruginosa, S. aureus, E. coli, A. baumannii, P. mirabilis, S. dysgalactiae and S. pneumoniae. 13.2% of the patients had serological evidence of Chlamydophila pneumoniae infection.
authors.affiliation: Division of Medicine, Central Chest Institute of Thailand, Nonthaburi, Thailand. sirasiripataravanit@gmail.com
authors.forename: Sudarat
authors.initials: S
authors.lastname: Siripataravanit
authors.forename: Ransiya
authors.initials: R
authors.lastname: Phaicharoen
authors.forename: Sumol
authors.initials: S
authors.lastname: Termsetcharoen
authors.forename: Nuchchara
authors.initials: N
authors.lastname: Klangprapun
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects* / Q000302:isolation & purification / Q000472:pathogenicity; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy; D015897:Comorbidity; D019468:Disease Management; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008826:Microbial Sensitivity Tests / Q000379:methods; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy; D012121:Respiration, Artificial / Q000379:methods*; D012124:Respiratory Care Units / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D013785:Thailand / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents