Bacterial and Fungal Profile of Acute Exacerbation of Chronic Obstructive Pulmonary Disease

BACKGROUND AND OBJECTIVE: Acute exacerbation of Chronic obstructive Pulmonary disease (AECOPD) is defined as a sustained worsening of the patient’s condition, from the stable state in the patient’s baseline dyspnoea and cough or sputum or both and beyond normal day to day variation ,that is acute in onset and necessitates a change in regular medication in a patient with underlying COPD as per Gold guidelines ..It leads to significant increase in morbidity and mortality in COPD patients. Bacteria are responsible for 60% of exacerbation. The aim of our study was to determine the bacterial and fungal isolates in AECOPD and Stable COPD patients with special reference to antibiotic susceptibility and their resistance pattern from hospital data. SETTINGS AND DESIGN: It was a Cross sectional study carried out at the Institute of Microbiology, Madras Medical College in association with Departments of Internal Medicine, Thoracic Medicine, Intensive Medicare Care Unit at Rajiv Gandhi Government General Hospital, Chennai from October 2013 to September 2014. MATERIALS AND METHODS: The Study population consisted of 150 in patients presenting with signs and symptom of AECOPD and 50 stable COPD out patients .All the respiratory samples were subjected to direct gram staining , culture ,biochemical reactions and the isolates were identified ac-cording to standard techniques. Antibiotic sensitivity was done by Kirby-Bauer method according to CLSI standards. RESULTS: COPD was common in age group of sixty to seventy one. Both AECOPD and Stable COPD patients had male predominance .Tobacco smoking was strongly associated with study group. Respiratory failure 8% was the most common complication. Positive bacteriological culture was obtained in 70.6% of cases. Mixed infection among AECOPD patients was found in 3.8% of culture positive cases. Sputum purulence was significantly correlated with the culture positivity. The commonest organism in the respiratory samples in AECOPD patients were Gram negative bacteria 74.5% as compared to Gram positive bacteria 21.6.Among Gram negative organisms Klebsiella pneumoniae 33.3% was the most commonly and significantly isolated organism followed by Pseudomonas aeruginosa. In stable COPD patients only 19% Klebsiella pneumoniae was isolated. Non fermenters were significantly isolated in Severe type and Staphylococcus aureus from Moderate type. Klebsiella pneumoniae showed Multi drug resistance (MDR) of 29.7%. The prevalence of Carbapenemase production in Klebsiella pneumoniae was 28.5%. This implies that Klebsiella pneumoniae was one of the important drug resistant pathogen isolated among AECOPD patients. Presence of MRSA and ESBL isolates were higher in Moderate AECOPD patients (66.6%, 66.6%, respectively) than in severe group (33.3%, 33.3%). Penicillin resistant Streptococcus pneumoniae, Imipenem resistance, Carbapenamase producing isolates, Amp C producing strain were significantly higher in severe AECOPD patients MDR pathogens were present both in moderate and severe type of COPD. Haemophilus influenzae and Fungus were not isolated. CONCLUSION: The bacterial etiology of AECOPD is different in India from what has been shown in western studies..To conclude Gram negative bacteria were more frequently isolated in our patients, antimicrobial treatment should be started early depending on the antimicrobial sensitivity results, in the wake of an increasing rate of isolation of resistant organisms