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Original Article
Available online 12 November 2022
Bacterial Patterns and Empiric Antibiotic Use in COPD Patients With Community-Acquired Pneumonia
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Sergi Pascual-Guardiaa,b, Francesco Amatib,c, Judith Marin-Corralb,d, Stefano Alibertic, Joaquim Geaa, Nilam J. Sonib,e, Alejandro Rodriguezf, Oriol Sibilag, Francisco Sanzh, Giovanni Sotgiui, Pedro J. Marcosj, Ane Urangak, Branislava Milenkovicl, Christian N. Meyerm, Martin Kolditzn, Antonio R. Anzuetob,e, Marcos I. Restrepob,e,
Corresponding author
restrepom@uthscsa.edu

Corresponding author.
, on behalf of the GLIMP investigators 1
a Respiratory Department, Hospital del Mar-IMIM, CEXS, UPF, CIBERES, BRN, Barcelona, Spain
b Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
c Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital, Respiratory Unit, Milan, Italy
d Critical Care Department, Hospital del Mar-IMIM, Critical Illness Research Group (GREPAC), Barcelona, Spain
e Section of Pulmonary & Critical Care Medicine, South Texas Veterans Health Care System, USA
f Critical Care Department, Hospital Universitari Joan XXIII, URV, CIBERES, Tarragona, Spain
g Respiratory Department, Hospital Clinic, CIBERES, BRN, Barcelona, Spain
h Pulmonology Department, Consorci Hospital General Universitari de Valencia, Valencia, Spain
i Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
j Servicio de Neumología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC) Sergas Universidade da Coruña (UDC), A Coruña, Spain
k Pulmonology Department, Hospital of Galdakao-Usansolo, Spain
l Clinic for Pulmonary Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
m Department of Internal Medicine, Roskilde Hospital, Copenhagen University Hospital, Roskilde, Denmark
n Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
Received 25 May 2022. Accepted 09 September 2022
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Abstract
Introduction

Chronic obstructive pulmonary disease (COPD) is strongly associated with the development of community-acquired pneumonia (CAP). Limited data are available on risk factors for difficult to manage bacteria such as Pseudomonas aeruginosa in COPD patients with CAP. Our objective was to assess the microbiological patterns associated with risk factors that determine empiric antibiotic therapy in hospitalized COPD patients with CAP.

Methods

We performed a secondary data analysis of an international, multicenter, observational, point-prevalence study involving hospitalized COPD patients with CAP from March to June 2015. After identifying the risk factors associated with different microorganisms, we developed a scoring system to guide decision-making about empiric anti-pseudomonal antibiotic therapy in this population.

Results

We enrolled 689 hospitalized COPD patients with CAP with documented microbiological testing. The most frequent microorganisms isolated were Streptococcus pneumoniae (8%) and Gram-negative bacteria (8%), P. aeruginosa (7%) and Haemophilus influenzae (3%). We developed a scoring system incorporating the variables independently associated with P. aeruginosa that include a previous P. aeruginosa isolation or infection (OR 14.2 [95%CI 5.7–35.2]), hospitalization in the past 12 months (OR 3.7 [1.5–9.2]), and bronchiectasis (OR 3.2 [1.4–7.2]). Empiric anti-pseudomonal antibiotics were overutilized in COPD patients with CAP. The new scoring system has the potential to reduce empiric anti-pseudomonal antibiotic use from 54.1% to 6.2%.

Conclusions

COPD patients with CAP present different microbiological profiles associated with unique risk factors. Anti-pseudomonal treatment is a critical decision when selecting empiric antibiotic therapy. We developed a COPD scoring system to guide decision-making about empiric anti-pseudomonal antibiotic therapy.

Keywords:
COPD
Pseudomonas
Risk factors
Anti-bacterial agents
Antibiotics
Abbreviations:
CAP
COPD
CT
FEV1
FVC
GLIMP
GNB
MRSA
OR
PAS-COPD
SPP

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