Risk factors for multidrug-resistant pathogens in bronchiectasis exacerbations

Abstract

BackgroundNon-cystic fibrosis bronchiectasis is a chronic structural lung condition that courses with recurrent infectious exacerbations that lead to frequent antibiotic treatment making this population more susceptible to acquire pathogens with antibiotic resistance. We aimed to investigate risk factors associated with isolation of multidrug-resistant pathogens in bronchiectasis exacerbations.MethodsA prospective observational study was conducted in two tertiary-care hospitals, enrolling patients when first exacerbation appeared. Multidrug-resistance was determined according to European Centre of Diseases Prevention and Control classification.ResultsTwo hundred thirty three exacerbations were included and microorganisms were isolated in 159 episodes. Multidrug-resistant pathogens were found in 20.1% episodes: Pseudomonas aeruginosa (48.5%), methicillin-resistant Staphylococcus aureus (18.2%) and Extended spectrum betalactamase + Enterobacteriaceae (6.1%), and they were more frequent in exacerbations requiring hospitalization (24.5% vs. 10.2%, p: 0.016). Three independent multidrug-resistant risk factors were found: chronic renal disease (Odds ratio (OR), 7.60, 95% CI 1.92–30.09), hospitalization in the previous year (OR, 3.88 95% CI 1.37–11.02) and prior multidrug-resistant isolation (OR, 5.58, 95% CI 2.02–15.46). The proportion of multidrug-resistant in the 233 exacerbations was as follows: 3.9% in patients without risk factors, 12.6% in those with 1 factor and 53.6% if ≥2 risk factors.ConclusionsHospitalization in the previous year, chronic renal disease, and prior multidrug-resistant isolation are risk factors for identification multidrug-resistant pathogens in exacerbations. This information may assist clinicians in choosing empirical antibiotics in daily clinical practice.

Epidemiology and Antibiotic Susceptibility Patterns of Carbapenem Resistant Gram Negative Bacteria Isolated from Two Tertiary Care Hospitals in North Lebanon

“…The clinical microbiology laboratory has a crucial role in rapid detecting and reporting drug resistant bacteria to infectious disease specialists in order to choose appropriate antibiotic therapy. Multidrug resistant (MDR) bacteria such as carbapenem-resistant pathogens are difficult to treat even when appropriate initial antibiotic therapy is used because they require different treatment regimens to those usually recommended in guidelines [22]. Hence, reliable treatment of MDR pathogens should be based on drug susceptibility testing since only few antibiotics remain as last-resort agents.…”

Bronchiectasis Exacerbations: Clinical Relevance and Management

“…The most common isolated bacteria in the sputum cultures of patients with bronchiectasis exacerbations are Pseudomonas aeruginosa, Haemophilus influenzae, Enterobactericeae, Streptococcus pneumoniae, Staphylococcus aureus and Moraxella catarrhalis. However, it has been increasingly recognised, through clinical experience and limited evidence data that the same microorganisms are also isolated when the patient is clinically stable [30][31][32] . The challenge is clarifying why these patients exacerbate.…”

“…A major concern about long-term antibiotic (inhaled and oral) treatment is microbial resistance 19 . A prospective observational study by Menéndez et al 32 identified three independent risk factors associated with isolation of multidrug-resistant (MDR) pathogens in bronchiectasis exacerbations: chronic renal disease, prior MDR isolation and hospitalisation in the previous year. Notably, MDR isolation was more frequent in patients using inhaled antibiotics (34.4% versus 19.7%), but there was no statistically significant difference.…”

Systemic Inflammation during and after Bronchiectasis Exacerbations: Impact of Pseudomonas aeruginosa

“…Bronchiectasis is a chronic inflammatory structural respiratory disease associated with frequent exacerbations of varying severity [ 1 , 2 ]. In general, patients with advanced disease and a high bronchiectasis severity index (BSI) [ 3 ] or a high FACED (FEV1, age, chronic colonization, extension, dyspnea) [ 4 ] score have an average of two or more exacerbations per year [ 5 ], and Pseudomonas aeruginosa is the most frequent microorganism involved [ 6 ]. It has been clearly demonstrated that exacerbations lead to lung function deterioration [ 7 ], poor prognosis [ 3 ], and increased mortality [ 8 , 9 ].…”