Clinical Factors Associated with a Shorter or Longer Course of Antibiotic Treatment in Patients with Exacerbations of Bronchiectasis: A Prospective Cohort Study

Abstract

Background: Bronchiectasis exacerbations are often treated with prolonged antibiotic use, even though there is limited evidence for this approach. We therefore aimed to investigate the baseline clinical and microbiological findings associated with long courses of antibiotic treatment in exacerbated bronchiectasis patients. Methods: This was a bi-centric prospective observational study of bronchiectasis exacerbated adults. We compared groups receiving short (≤14 days) and long (15–21 days) courses of antibiotic treatment. Results: We enrolled 191 patients (mean age 72 (63, 79) years; 108 (56.5%) females), of whom 132 (69%) and 59 (31%) received short and long courses of antibiotics, respectively. Multivariable logistic regression of the baseline variables showed that long-term oxygen therapy (LTOT), moderate–severe exacerbations, and microbiological isolation of Pseudomonas aeruginosa were associated with long courses of antibiotic therapy. When we excluded patients with a diagnosis of community-acquired pneumonia (n = 49), in the model we found that an etiology of P. aeruginosa remained as factor associated with longer antibiotic treatment, with a moderate and a severe FACED score and the presence of arrhythmia as comorbidity at baseline. Conclusions: Decisions about the duration of antibiotic therapy should be guided by clinical and microbiological assessments of patients with infective exacerbations.

Hospitalizations for Community-Acquired and Non-Ventilator-Associated Hospital-Acquired Pneumonia in Spain: Influence of the Presence of Bronchiectasis. A Retrospective Database Study

“…The presence of BQ could lead to more frequent failures of initial empirical antibiotic therapy and more days of intravenous treatment, thus increasing hospital stay and associated costs. Regarding this point, a study by Scioscia et al has seen how the microbiological isolation of P. aeruginosa is associated with the need for a longer cycle of antibiotic therapy even during exacerbations of BQ [36].…”

Lung microbiome: new insights into bronchiectasis’ outcome

“…The outcomes are still unknown, the treatment focuses on treating the aggravation. The optimal duration of antibiotic treatment for bronchiectasis exacerbations has not been systematically studied, 14 days’ therapy being extrapolated from the treatment cystic fibrosis ( Scioscia et al., 2019 ).Therefore, it is critical to study the clinical aspects, pathogenesis and treatment of bronchiectasis, as well as the pulmonary microbiome and its various properties, to better understand the correlation between these two entities.…”