Pathogen-directed Therapy in Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Martínez, Fernando J.

doi:10.1513/pats.200707-097th

Cited by 19 publications

(12 citation statements)

References 170 publications

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“…It has been estimated that approximately 40%–50% of AECOPD cases are due to bacterial infections 34. The precise contribution of bacterial infection is difficult to define because the airways of COPD patients may be chronically colonized 3,4. Acquisition of new strains of Haemophilus influenzae and Moraxella catarrhalis, rather than bacterial load, appears to be the most important factor in the pathogenesis of acute exacerbations 35.…”

Section: Discussionmentioning

confidence: 99%

“…Several meta-analyses support these recommendations to reduce mortality and treatment failures 2. Although purulent sputum and growth of a bacterial pathogen suggest infection, definitive causality with an AECOPD is difficult because patients may be chronically colonized 3,4. In addition, recent studies using molecular diagnostics indicate that a substantial proportion of AECOPD are associated with viral infection 5,6.…”

Section: Introductionmentioning

confidence: 99%

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Utility of serum procalcitonin values in patients with acute exacerbations of chronic obstructive pulmonary disease: a cautionary note

Falsey¹,

Becker²,

Swinburne³

et al. 2012

COPD

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BackgroundSerum procalcitonin levels have been used as a biomarker of invasive bacterial infection and recently have been advocated to guide antibiotic therapy in patients with chronic obstructive pulmonary disease (COPD). However, rigorous studies correlating procalcitonin levels with microbiologic data are lacking. Acute exacerbations of COPD (AECOPD) have been linked to viral and bacterial infection as well as noninfectious causes. Therefore, we evaluated procalcitonin as a predictor of viral versus bacterial infection in patients hospitalized with AECOPD with and without evidence of pneumonia.MethodsAdults hospitalized during the winter with symptoms consistent with AECOPD underwent extensive testing for viral, bacterial, and atypical pathogens. Serum procalcitonin levels were measured on day 1 (admission), day 2, and at one month. Clinical and laboratory features of subjects with viral and bacterial diagnoses were compared.ResultsIn total, 224 subjects with COPD were admitted for 240 respiratory illnesses. Of these, 56 had pneumonia and 184 had AECOPD alone. A microbiologic diagnosis was made in 76 (56%) of 134 illnesses with reliable bacteriology (26 viral infection, 29 bacterial infection, and 21 mixed viral bacterial infection). Mean procalcitonin levels were significantly higher in patients with pneumonia compared with AECOPD. However, discrimination between viral and bacterial infection using a 0.25 ng/mL threshold for bacterial infection in patients with AECOPD was poor.ConclusionProcalcitonin is useful in COPD patients for alerting clinicians to invasive bacterial infections such as pneumonia but it does not distinguish bacterial from viral and noninfectious causes of AECOPD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Utility of serum procalcitonin values in patients with acute exacerbations of chronic obstructive pulmonary disease: a cautionary note

Falsey¹,

Becker²,

Swinburne³

et al. 2012

COPD

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“…Many species of bacteria have been identified in the airways of patients with asthma or COPD (8,9,12,13). However, the role of bacteria in disease acute exacerbations as well as progression remains controversial (14,15). The common bacteria seen in asthma and COPD airways include, but are not limited to, Mycoplasma pneumoniae (Mp), nontypeable Haemophilus influenzae (NTHi), and Moraxella catarrhalis (12,13).…”

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confidence: 99%

Up-Regulation of MUC18 in Airway Epithelial Cells by IL-13

Simon

Martin²,

Smith³

et al. 2011

Am J Respir Cell Mol Biol

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Airway bacterial infections are a major problem in lung diseases, including asthma, chronic obstructive pulmonary disease (COPD), and cystic fibrosis. Increased Th2 cytokines, such as IL-13, are observed in lung diseases and may contribute to bacterial infections. How Th2 cytokines affect bacterial infection remains unknown. MUC18, an adhesion molecule shown to be involved in the pathogenesis of malignant melanoma, has been recently identified in airway epithelial cells of patients with COPD. We investigated MUC18 regulation by IL-13 and the role of MUC18 in bacterial adherence to epithelial cells. Human airway tissues, brushed bronchial epithelial cells from normal subjects and subjects with asthma, and epithelial cell lines (e.g., HEK293 cells) were used to study the regulation of MUC18 by IL-13 and the involvement of MUC18 in bacterial (e.g., Mycoplasma pneumoniae [Mp] and nontypeable Haemophilus influenzae [NTHi]) adherence to epithelial cells. Asthmatic bronchial epithelium expressed higher levels of MUC18 than normal bronchial epithelium. IL-13 increased MUC18 in cultured bronchial epithelial cells from normal subjects and particularly from subjects with asthma. IL-13-induced MUC18 expression may be modulated in part through transcription factor specificity protein 1. Overexpression of human MUC18 in HEK293 cells increased cellassociated Mp and NTHi levels. Moreover, MUC18 was shown to directly interact with Mp and NTHi. These results for the first time show that an allergic airway milieu (e.g., IL-13) increases MUC18 expression, which may contribute to increased bacterial infection/ colonization in asthma and other lung diseases.

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“…The precise contribution of bacterial infection is difficult to define because the airways of COPD patients may be chronically colonized [33,34]. Acquisition of new strains of Haemophilus influenzae and Moraxella catarrhalis, rather than bacterial load, appears to be the most important factor in the pathogenesis of acute exacerbations [35]. This factor has not been accounted for in AECOPD antibiotic trials and might explain the modest beneficial effects of antimicrobial treatments observed.…”

Section: Discussionmentioning

confidence: 99%

Measurement of Procalcitonin in acute exacerbation of COPD and its correlation to SpirometricIndices

Bhaskar¹,

Singh²,

Singh³

et al. 2018

IJRDPL

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Available online on:15.01.2018@http://ijrdpl.co m http://dx.doi.org/10.21276/ IJRDPL.227 8-0238.2017.6(6).2906-2912 ABSTRACT:Background: rational prescription of antibiotics in acute exacerbation of COPD (AECOPD) requires predictive markers. Acute phase reactants are capable of demonstrating the inflammation; however, they cannot be employed to make a difference between bacterial and non-bacterial causes of the inflammation. The bacterial infection plays an important role in the exacerbation of COPD patients. Recently, measurement of serum procalcitonin levels appears to be useful in order to minimize this problem. We aim to evaluate the prognostic and diagnostic. Methods & methods: 51 COPD patients with bacterial exacerbations, 47 patients without bacterial exacerbations, similar age and sex were included in the study. PCT levels in the serum samples were measured in all subjects. Results: Procalcitonin levels ranged from 0.01 to 12.03 ng/ml. Mean levels were 3.18±2.60 ng/ml in Group I and 0.23±0.39 ng/ml in Group II. Median values in Groups I and II were 2.98 and 0.09 ng/ml respectively. Statistically, there was a significant difference between two groups (p<0.001) with Group I showing a higher mean value as compared to Group II. A significant near strong correlation was observed between TLC levels and serum Proclacitonin levels (r=0.699; p<0.001). However, a weak negative and borderline significant correlation. Conclusions: This study found increased PCT serum levels among AECOPD patients and suggests a role for PCT in the predicting of the bacterial exacerbations and their needs for ventilator support. We recommend other large studies to au gment our findings.

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Pathogen-directed Therapy in Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Cited by 19 publications

References 170 publications

Utility of serum procalcitonin values in patients with acute exacerbations of chronic obstructive pulmonary disease: a cautionary note

Utility of serum procalcitonin values in patients with acute exacerbations of chronic obstructive pulmonary disease: a cautionary note

Up-Regulation of MUC18 in Airway Epithelial Cells by IL-13

Measurement of Procalcitonin in acute exacerbation of COPD and its correlation to SpirometricIndices

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