title: Real-life data on antibiotic prescription and sputum culture diagnostics in acute exacerbations of COPD in primary care.
abstract: BACKGROUND
  Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are generally treated with optimization of bronchodilation therapy and a course of oral corticosteroids, mostly without antibiotics. The Dutch guidelines recommend prudent use of antibiotics, with amoxicillin or doxycycline as first choice. Here we evaluate adherence to these guidelines with regard to antibiotic prescription in AECOPD in primary care and the use of sputum cultures.
  
  
  METHODS
  We retrospectively analyzed a longitudinal cohort of patients in three primary care practices in the north-eastern region of the Netherlands from 2009 to 2013 (n=36,172 subjects) participating in the Registration Network Groningen. Antibiotics prescribed for AECOPD -10/+28 days from the start date of corticosteroid courses were evaluated. In addition, we assessed regional data on the susceptibility of respiratory pathogens from COPD patients.
  
  
  RESULTS
  We identified 1,297 patients with COPD. Of these, 616 experienced one or more exacerbations, resulting in a total of 1,558 exacerbations, for which 1,594 antibiotic courses were prescribed. The recommended antibiotics doxycycline and amoxicillin accounted for 56% of the prescribed antibiotics overall and for 35% in subsequent antibiotic courses. The alternative choices were not based on culture results because only in 67 AECOPD events (2.9%) sputum samples were taken. Regional data including 3,638 sputum samples showed that pathogens relevant in AECOPD were detected in 19% of cultures.
  
  
  CONCLUSIONS
  Our study shows that guidelines regarding the prescription of antibiotics are poorly followed, particularly in recurrent exacerbations. Sputum cultures were performed in a small minority of cases. Performing sputum diagnostics in patients with early treatment failure or a repeated exacerbation when antibiotic treatment is started may further rationalize antibiotic treatment.
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: Bathoorn
authors.affiliation: Department of Primary Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Feikje
authors.initials: F
authors.lastname: Groenhof
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Ron
authors.initials: R
authors.lastname: Hendrix
authors.affiliation: Department of Primary Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Medical Microbiology, Certe - Laboratory for Infectious Diseases, Groningen, the Netherlands.
authors.forename: Thys
authors.initials: T
authors.lastname: van der Molen
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Bhanu
authors.initials: B
authors.lastname: Sinha
authors.affiliation: GRIAC Research Institute, Groningen, University of Groningen, University Medical Center Groningen, the Netherlands.
authors.forename: Huib Am
authors.initials: HA
authors.lastname: Kerstjens
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Alex W
authors.initials: AW
authors.lastname: Friedrich
authors.affiliation: Department of Primary Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Medical Microbiology, Certe - Laboratory for Infectious Diseases, Groningen, the Netherlands.
authors.forename: Janwillem Wh
authors.initials: JW
authors.lastname: Kocks
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001431:Bacteriological Techniques; D001993:Bronchodilator Agents / Q000627:therapeutic use; D000066491:Clinical Decision-Making; D018450:Disease Progression; D004318:Doxycycline / Q000627:therapeutic use; D011307:Drug Prescriptions; D004359:Drug Therapy, Combination; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000382:microbiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013183:Sputum / Q000382:microbiology*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D001993:Bronchodilator Agents; D000658:Amoxicillin; D004318:Doxycycline
keywords: COPD; antimicrobial stewardship; bacteria; exacerbation; sputum cultures