Antimicrobial therapy of chronic obstructive pulmonary disease exacerbations in a multidisciplinary hospital

Abstract

Objective. To study the real practice of management of patients with COPD exacerbations on the example of a single hospital. Materials and Methods. During the retrospective descriptive study the data of medical records of 219 patients with COPD were processed, the profile of the studied patients with distribution by phenotypes and determination of the Charlson comorbidity index was compiled and analyzed. StatPlus 7.0 program was used for statistical analysis. Results. According to GOLD guidelines, the majority of patients were in category D (93.2%). Bacteriologic examination of respiratory specimens was done in 127 (57.9%) patients. The microbiological results indicated a high probability of contamination of the majority of samples with oral microflora. Empiric antibacterial therapy was given to 215 (98.2%) patients. In 191 (88.8%) patients, antibiotics were used in monotherapy, and in 24 patients (11.2%) – in combinations. The most frequently used antimicrobials were fluoroquinolones – levofloxacin (34.3%) and ciprofloxacin (43.6%). Cephalosporins of III and IV generations were used much less frequently (2.5 to 7%). There was a weak direct statistically significant association between CRP level and the use of combination antibiotic therapy (V = 0.14, p = 0.047). The purulent sputum had a more pronounced influence on the choice of antibiotic combinations (V = 0.257, p < 0.001). Modification of empirical initial therapy was required in 37 (17.2%) patients. Conclusions. Microbiological results in our study indicate that the majority of respiratory samples were contaminated with oral microflora during the collection of clinical material. The antibiotic therapy prescribed in most cases corresponded to current clinical recommendations, the combined antibiotic therapy was most characteristic of purulent sputum character.