title: Bacterial flora in the sputum and comorbidity in patients with acute exacerbations of COPD.
abstract: OBJECTIVE
  To determine in patients admitted with an acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) the association between the isolation of potential pathogens in a conventional sputum culture and comorbidities.
  
  
  METHODS
  The ESMI study is a multicenter observational study. Patients with AE-COPD admitted to the Internal Medicine departments of 70 hospitals were included. The clinical characteristics, treatments, and comorbidities were gathered. The results of conventional sputum cultures were recorded.
  
  
  RESULTS
  A total of 536 patients were included, of which 161 produced valid sputum and a potentially pathogenic microorganism was isolated from 88 subjects (16.4%). The isolation of Pseudomonas aeruginosa (30.7%) was associated with a greater severity of the lung disease (previous admissions [P= 0.026], dyspnea scale [P=0.047], post-broncodilator forced expiratory volume in 1 second (FEV1) [P=0.005], and the BODEx index [P=0.009]); also with higher prevalence of cor pulmonale (P=0.017), heart failure (P=0.048), and cerebrovascular disease (P=0.026). Streptococcus pneumoniae (26.1%) was associated with more comorbidity according to number of diseases (P=0.018); notably, peripheral artery disease (P=0.033), hypertension (P=0.029), dyslipidemia (P=0.039), osteoporosis (P=0.0001), and depression (P=0.005).
  
  
  CONCLUSIONS
  Patients with AE-COPD and P. aeruginosa present higher severity of COPD, while those with S. pneumoniae present greater comorbidity. The potentially pathogenic microorganism obtained in the sputum culture depends on the associated comorbidities.
authors.affiliation: Internal Medicine Department, Hospital de Mataró - CSDM, Universitat Autònoma de Barcelona, Mataró, Barcelona, Spain.
authors.forename: Ramon
authors.initials: R
authors.lastname: Boixeda
authors.affiliation: Internal Medicine Department, Hospital Mútua de Terrassa, Terrassa, Spain ; Universitat de Barcelona, Barcelona, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Almagro
authors.affiliation: Internal Medicine Department, Hospital Royo Villanova, Zaragoza, Zaragoza, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Díez-Manglano
authors.affiliation: Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Cabrera
authors.affiliation: Internal Medicine Department, Hospital Vall d'Hebrón, Barcelona, Barcelona, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Recio
authors.affiliation: Internal Medicine Department, Hospital Quirón San Camilo, Madrid, Madrid, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Martin-Garrido
authors.affiliation: Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Cátedra UAM-Lindel, Madrid, Spain.
authors.forename: Joan B
authors.initials: JB
authors.lastname: Soriano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007388:Internal Medicine; D008168:Lung / Q000382:microbiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011008:Pneumococcal Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology* / Q000503:physiopathology / Q000628:therapy; D011379:Prognosis; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology* / Q000503:physiopathology / Q000628:therapy; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification / Q000472:pathogenicity*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology* / Q000503:physiopathology / Q000628:therapy; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013183:Sputum / Q000382:microbiology*; D013296:Streptococcus pneumoniae / Q000302:isolation & purification / Q000472:pathogenicity*
keywords: chronic obstructive pulmonary disease; comorbidities; etiology of exacerbations; hospitalization; sputum culture