COPD patients harbouring Pseudomonas Aeruginosa face high risk of hospitalisation

Patients with chronic obstructive pulmonary disease (COPD) who test positive for Pseudomonas aeruginosa have a worse prognosis than COPD patients without this germ [1].

Pseudomonas aeruginosa is a bacterium usually not found in COPD patients. According to a previous study, pathogens frequently found in sputum of patients with COPD exacerbations include Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae, Klebsiella pneumoniae, and Escherichia coli[2].

Dr Josefin Eklöf (Copenhagen University Hospital) presented the results of a multiregional epidemiological study, which assessed the role of P. aeruginosa in 22,053 COPD outpatients. Samples from the lower respiratory tract (e.g. sputum, tracheal secretion, bronchial secretion, and bronchial alveolar lavage) were examined for the presence of P. aeruginosa. The germ could be identified in 905 patients (4.1%) of the total cohort. All study participants were followed for a median time of 1,082 days, and hospitalisation for exacerbation and all-cause mortality were compared between patients with and without P. aeruginosa.

Compared with the patients who did not harbour P. aeruginosa, those with P. aeruginosa had a significant higher risk for exacerbation or all-cause death. Of the COPD patients with P. aeruginosa, 80% were hospitalised compared with 48% of patients without P. aeruginosa (P<0.0001). The difference between the groups with regard to all-cause mortality was also striking: 22% in patients positive for P. aeruginosa compared with 18% in P. aeruginosa-negative patients (P<0.0001). These results were robust even after adjusting for well-known confounders.

The authors conclude that P. aeruginosa is associated with substantially worsened long-term prognosis in COPD. They advocate a randomised controlled trial to conclude whether targeted antibiotic interventions can improve the prognosis of this high-risk group of COPD patients.

1. 
   
   1. Eklöf J, et al. PA2887, ERS 2019, 29 Sept-2 Oct, Madrid, Spain.
   2. Vesna Cukic. Mater Sociomed 2013;25(4):226-9.

Posted on 28 November 201916 March 2021