title: Determinants of bacteriological outcomes in exacerbations of chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  Changes in sputum microbiology following antibiotic treatment of acute exacerbations of chronic obstructive pulmonary disease (AECOPD), including patterns of bacteriological relapse and superinfection are not well understood. Sputum microbiology at exacerbation is not routinely performed, but pathogen presence and species are determinants of outcomes. Therefore, we determined whether baseline clinical factors could predict the presence of bacterial pathogens at exacerbation. Bacterial eradication at end of treatment (EOT) is associated with clinical resolution of exacerbation. We determined the clinical, microbiological and therapeutic factors that were associated with bacteriological eradication in AECOPD at EOT and in the following 8 weeks.
  
  
  METHODS
  Sputum bacteriological outcomes (i.e., eradication, persistence, superinfection, reinfection) from AECOPD patients (N = 1352) who were randomized to receive moxifloxacin or amoxicillin/clavulanate in the MAESTRAL study were compared. Independent predictors of bacterial presence in sputum at exacerbation and determinants for bacteriological eradication were analyzed by logistic regression and receiver operating characteristic (ROC) analyses.
  
  
  RESULTS
  Significantly greater bacteriological eradication with moxifloxacin was mainly driven by superior Haemophilus influenzae eradication (P = 0.002, EOT). Baseline clinical factors were a weak predictor of the presence of pathogens in sputum (AUCROC = 0.593). On multivariate analysis, poorer bacterial eradication was associated with antibiotic resistance (P = 0.0001), systemic steroid use (P = 0.0024) and presence of P. aeruginosa (P = 0.0282).
  
  
  CONCLUSIONS
  Since clinical prediction of bacterial presence in sputum at AECOPD is poor, sputum microbiological analysis should be considered for guiding antibiotic therapy in moderate-to-severe AECOPD, particularly in those who received concomitant systemic corticosteroids or are at risk for infection with antibiotic-resistant bacteria.
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Medicine, University at Buffalo, State University of New York, Buffalo, NY, USA. ssethi@buffalo.edu.|VA Medical Research, 151, 3495 Bailey Avenue, Buffalo, NY, 14215, USA. ssethi@buffalo.edu.
authors.forename: S
authors.initials: S
authors.lastname: Sethi
authors.affiliation: South Texas Veterans Health Care System, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: A
authors.initials: A
authors.lastname: Anzueto
authors.affiliation: Pneumology Department, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Miravitlles
authors.affiliation: Bayer HealthCare, Loos, France.
authors.forename: P
authors.initials: P
authors.lastname: Arvis
authors.affiliation: Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA.
authors.forename: J
authors.initials: J
authors.lastname: Alder
authors.affiliation: Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA.
authors.forename: D
authors.initials: D
authors.lastname: Haverstock
authors.affiliation: Bayer Inc., Toronto, ON, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Trajanovic
authors.affiliation: Host Defence Unit, Royal Brompton Hospital, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Wilson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D004311:Double-Blind Method; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077266:Moxifloxacin; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000382:microbiology*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D013183:Sputum / Q000382:microbiology*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D019980:Amoxicillin-Potassium Clavulanate Combination; D000077266:Moxifloxacin
keywords: Bacteriological outcomes; Beta-lactams; Exacerbation of chronic obstructive pulmonary disease; Fluoroquinolones; Risk factors; Systemic corticosteroids