Does a single Pseudomonas aeruginosa isolation predict COPD mortality?

Boutou, Afroditi; Raste, Yogini; Alshafi, K.; Polkey, Michael I.; Hopkinson, Nicholas S

doi:10.1183/09031936.00023414

Cited by 14 publications

(19 citation statements)

References 10 publications

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“…Our finding that patients colonized with P. aeruginosa had poor outcome is consistent with that of Almagro et al [10], who found P. aeruginosa to be an independent prognostic marker of 3-year mortality in a prospective study of 181 patients hospitalized with COPD exacerbation. In contrast, Boutou et al [18] reported no association between P. aeruginosa and long-term survival in COPD outpatients in a smaller study (n ¼ 132); power issues may, at least in part, explain that negative finding. Colonization with P. aeruginosa plays an important role in the course of other chronic lung diseases, in particular cystic fibrosis [19].…”

Section: Discussionmentioning

confidence: 82%

Pseudomonas aeruginosa and risk of death and exacerbations in patients with chronic obstructive pulmonary disease: an observational cohort study of 22 053 patients

Eklöf

Sørensen

Ingebrigtsen

et al. 2020

Clinical Microbiology and Infection

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a b s t r a c tObjectives: The role of Pseudomonas aeruginosa in the long-term prognosis of chronic obstructive pulmonary disease (COPD) is unknown. The purpose of this study was to determine whether P. aeruginosa is associated with increased risk of exacerbations or death in patients with COPD. Methods: This is a multiregional epidemiological study based on complete data on COPD outpatients between 1 January 2010 and 31 October 2017 and corresponding microbiology and national register data. Time-dependent Cox proportional hazards models and propensity matching was used to estimate hospitalization-demanding exacerbations and death after 2 years, separately and in combination. Results: A total of 22 053 COPD outpatients were followed for a median of 1082 days (interquartilerange: 427e1862). P. aeruginosa was present in 905 (4.1%) patients. During 730 days of follow-up, P. aeruginosa strongly and independently predicted an increased risk of hospitalization for exacerbation or all-cause death (HR 2.8, 95%CI 2.2e3.6; p <0.0001) and all-cause death (HR 2.7, 95%CI 2.3e3.4; p <0.0001) in analyses adjusted for known and suspected confounders. The signal remained unchanged in unadjusted analyses as well as propensity-matched subgroup analyses. Among patients 'ever colonized' with P. aeruginosa, the incidence of hospital-demanding exacerbations doubled after the time of the first colonization. Conclusions: COPD patients in whom P. aeruginosa can be cultured from the airways had a markedly increased risk of exacerbations and death. It is still not clear whether this risk can be reduced by offering patients targeted antipseudomonal antibiotics. A randomized trial is currently recruiting patients to clarify this (ClinicalTrials.gov: NCT03262142).

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Section: Discussionmentioning

confidence: 82%

Pseudomonas aeruginosa and risk of death and exacerbations in patients with chronic obstructive pulmonary disease: an observational cohort study of 22 053 patients

Eklöf

Sørensen

Ingebrigtsen

et al. 2020

Clinical Microbiology and Infection

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“…There is a debate regarding the prognosis and mortality of stable COPD patients who are colonized by P. aeruginosa . 29 There is no clear evidence that antibiotics should be used in this condition. A prospective study showed that P. aeruginosa identification in patients with severe AECOPD was associated with a higher 3-year mortality rate.…”

Section: Discussionmentioning

confidence: 99%

<em>Pseudomonas aeruginosa</em> infection increases the readmission rate of COPD patients

Choi

Lee

et al. 2018

COPD

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IntroductionAcute exacerbation of COPD (AECOPD) leads to rapid deterioration of pulmonary function and quality of life. It is unclear whether the prognosis for AECOPD differs depending on the bacterium or virus identified. The purpose of this study is to determine whether readmission of patients with severe AECOPD varies according to the bacterium or virus identified.MethodsWe performed a retrospective review of medical records of 704 severe AECOPD events at Korea University Guro Hospital from January 2011 to May 2017. We divided events into two groups, one in which patients were readmitted within 30 days after discharge and the other in which there was no readmission.ResultsOf the 704 events, 65 were followed by readmission within 30 days. Before propensity score matching, the readmission group showed a higher rate of bacterial identification with no viral identification and a higher rate of identification with the Pseudomonas aeruginosa (P=0.003 and P=0.007, respectively). Using propensity score matching, the readmission group still showed a higher P. aeruginosa identification rate (P=0.030), but there was no significant difference in the rate of bacterial identification, with no viral identification (P=0.210). In multivariate analysis, the readmission group showed a higher P. aeruginosa identification rate than the no-readmission group (odds ratio, 4.749; 95% confidence interval, 1.296–17.041; P=0.019).ConclusionP. aeruginosa identification is associated with a higher readmission rate in AECOPD patients.

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“…73 Despite this, a nested case-control study comparing mortality showed no difference in relation to Pseudomonas status in stable COPD; however, in AECOPD, recent work has reaffirmed this organism's association with higher COPD mortality rates. 25,74 Finally, chronic C. pneumoniae infection in COPD has been brought to light by a number of observational studies. Through its induction of a cytokine response (TNF-α, IL-1β, IL-6 and IFN-α), airway inflammation and critical airway remodelling ensue.…”

Section: Bacterial Infection and Colonizationmentioning

confidence: 99%

The role of acute and chronic respiratory colonization and infections in the pathogenesis of COPD

et al. 2017

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COPD is a major global concern, increasingly so in the context of ageing populations. The role of infections in disease pathogenesis and progression is known to be important, yet the mechanisms involved remain to be fully elucidated. While COPD pathogens such as Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae are strongly associated with acute exacerbations of COPD (AECOPD), the clinical relevance of these pathogens in stable COPD patients remains unclear. Immune responses in stable and colonized COPD patients are comparable to those detected in AECOPD, supporting a role for chronic colonization in COPD pathogenesis through perpetuation of deleterious immune responses. Advances in molecular diagnostics and metagenomics now allow the assessment of microbe-COPD interactions with unprecedented personalization and precision, revealing changes in microbiota associated with the COPD disease state. As microbial changes associated with AECOPD, disease severity and therapeutic intervention become apparent, a renewed focus has been placed on the microbiology of COPD and the characterization of the lung microbiome in both its acute and chronic states. Characterization of bacterial, viral and fungal microbiota as part of the lung microbiome has the potential to reveal previously unrecognized prognostic markers of COPD that predict disease outcome or infection susceptibility. Addressing such knowledge gaps will ultimately lead to a more complete understanding of the microbe-host interplay in COPD. This will permit clearer distinctions between acute and chronic infections and more granular patient stratification that will enable better management of these features and of COPD.

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Does a single Pseudomonas aeruginosa isolation predict COPD mortality?

Cited by 14 publications

References 10 publications

Pseudomonas aeruginosa and risk of death and exacerbations in patients with chronic obstructive pulmonary disease: an observational cohort study of 22 053 patients

Pseudomonas aeruginosa and risk of death and exacerbations in patients with chronic obstructive pulmonary disease: an observational cohort study of 22 053 patients

<em>Pseudomonas aeruginosa</em> infection increases the readmission rate of COPD patients

The role of acute and chronic respiratory colonization and infections in the pathogenesis of COPD

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