Pseudomonas aeruginosa resistance patterns and clinical outcomes in hospitalized exacerbations of COPD.
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) due to Pseudomonas aeruginosa (PA) are associated with worse outcomes. PA antibiotic resistance is important to determine treatment and may influence clinical outcomes. The aim was to study clinical characteristics and outcomes in patients with AECOPD associated with PA based on their antibiotic resistance.



This was a prospective observational study including all patients with AECOPD and positive PA sputum culture admitted in a respiratory ward in a tertiary hospital in Barcelona during 2013-2014. PA was defined as resistant (PA-R) when the antibiogram showed ≥1 resistance.



Four hundred one patients with AECOPD were evaluated. Of them, 54 (13%) had a positive PA sputum culture. Eighty-two per cent were men, median age was 77 (SD 7) years old and FEV1 was less than 36% (SD 17) of predicted value. PA-R was isolated in 35 patients (66%), and PA-sensitive (PA-S) was isolated in 18 (34%) patients. No differences were found in demographics, lung function and comorbidities among groups. PA-R patients were more likely exposed to prior oral corticosteroids (77% vs 44%, P = 0.03) and antibiotics (77% vs 31%, P = 0.01), respectively. AECOPD patients associated with PA-S were more likely to die at 30 days (odds ratio 13.53, 95% confidence interval: 1.14-69.56, P = 0.03) and 90 days (odds ratio 7.09, 95% confidence interval: 1.33-37.89, P = 0.02), respectively.



Pseudomonas aeruginosa-resistant affects patients with severe AECOPD and previous use of corticosteroids and antibiotics. The presence of PA-S is associated with higher mortality. These results may suggest increased virulence in PA-S strains causing acute infections.
Respiratory Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.|Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
Ana
A
Rodrigo-Troyano
Respiratory Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.|Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
Guillermo
G
Suarez-Cuartin
Respiratory Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.|Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
Meritxell
M
Peiró
Respiratory Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.|Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
Silvia
S
Barril
Respiratory Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.|Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
Diego
D
Castillo
Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.|Microbiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Ferran
F
Sanchez-Reus
Respiratory Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.|Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
Vicente
V
Plaza
South Texas Veterans Health Care System and University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
Marcos I
MI
Restrepo
Tayside Respiratory Research Group, University of Dundee, Dundee, UK.
James D
JD
Chalmers
Respiratory Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain. osibila@santpau.cat.|Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain. osibila@santpau.cat.
Oriol
O
Sibila
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004352:Drug Resistance, Microbial; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011446:Prospective Studies; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000302:isolation & purification; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013183:Sputum / Q000382:microbiology; D000067251:Symptom Flare Up
D000900:Anti-Bacterial Agents
COPD; Pseudomonas aeruginosa; exacerbation