Pathogens in COPD exacerbations identified by comprehensive real-time PCR plus older methods

Shimizu, Kenichiro; Yoshii, Yutaka; Morozumi, Miyuki; Chiba, Naoko; Ubukata, Kimiko; Uruga, Hironori; Hanada, Shigeo; Saito, Nayuta; Kadota, Tsukasa; Ito, Saburo; Wakui, Hiroshi; Takasaka, Naoki; Minagawa, Shunsuke; Kojima, Jun; Hara, Hiromichi; Numata, Takanori; Kawaishi, Makoto; Saito, Keisuke; Araya, Jun; Kaneko, Yoshiaki; Nakayama, Katsutoshi; Kishi, Kazuma; Kuwano, Kazuyoshi

doi:10.2147/copd.s82752

Cited by 41 publications

(42 citation statements)

References 27 publications

(33 reference statements)

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“…Comprehensive RT-PCR has been regarded as a method of choice for detection of the viruses in the respiratory specimens. [18] Combining real-time PCR with conventional methods improves the ability to detect infectious etiologies of COPD exacerbations including both bacteria and respiratory viruses and may emerge as the standard of care in facilities with capacity to do the testing. [18] Recently microarray-based etiology of AECOPD pathogens was carried out in 200 patients with AECOPD.…”

Section: Discussionmentioning

confidence: 99%

“…[18] Combining real-time PCR with conventional methods improves the ability to detect infectious etiologies of COPD exacerbations including both bacteria and respiratory viruses and may emerge as the standard of care in facilities with capacity to do the testing. [18] Recently microarray-based etiology of AECOPD pathogens was carried out in 200 patients with AECOPD. Human RSV (subtypes A and B) (40.5%), influenza virus (subtypes A, B, C) (11%), rhinovirus (8%) and human parainfluenza virus (subtypes A and B) (7.5%) were the commonest isolated strains.…”

Section: Discussionmentioning

confidence: 99%

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Respiratory viruses in acute exacerbations of chronic obstructive pulmonary disease

et al. 2017

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Objective:Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) cause significant morbidity, mortality, and an inexorable decline of lung function. Data from developed countries have shown viruses to be important causes of AECOPD, but data from developing countries like India are scant. We set out to determine the contribution of viruses in the causation of hospitalized patients with AECOPD.Methods:Twin nasopharyngeal/oropharyngeal swabs collected from 233 patients admitted with an acute AECOPD and tested for respiratory viruses including respiratory syncytial virus A and B, parainfluenza were (PIV) 1, 2, 3, and 4, human metapneumovirus (hMPV) A and B, influenza A and B, enterovirus, corona NL65, OC43, and 229E viruses, adenovirus 2 and 4, rhinovirus, and bocavirus, by duplex real time reverse-transcription polymerase chain reaction (qRT-PCR) using CDC approved primers and probes. Samples positive for influenza A were subtyped for A/H1N1pdm09 and A/H3N2 whereas influenza B samples were subtyped into B/Yamagata and B/Victoria subtypes, using primers and probes recommended by CDC, USA.Results:Respiratory viruses were detected in 46 (19.7%) cases, influenza A/H3N2 and rhinoviruses being the most common viruses detected. More than one virus was isolated in four cases consisting of hMPV-B + adeno-2 + Inf-B; rhino + H3N2, PIV-1 + rhino; and PIV-1+ hMPV-B in one case each. Ancillary supportive therapeutic measures included bronchodilators, antibiotics, steroids, and ventilation (noninvasive in 42 and invasive in 4). Antiviral therapy was instituted in influenza-positive patients. Three patients with A/H3N2 infection died during hospitalization.Conclusions:We conclude that respiratory viruses are important contributors to AECOPD in India. Our data calls for prompt investigation during an exacerbation for viruses to obviate inappropriate antibiotic use and institute antiviral therapy in viral disease amenable to antiviral therapy. Appropriate preventive strategies like influenza vaccination also need to be employed routinely.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Respiratory viruses in acute exacerbations of chronic obstructive pulmonary disease

et al. 2017

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“…Notably, we confirmed that the clinical efficacy ranged from 65.2% to 75.0% in a cohort with severe risk factors, and there were no severe adverse events. To date, the most significant causes of COPD exacerbations have been reported to be air pollution and respiratory tract infection, including infection by a virus (40%e60%) or by bacterium, such as H. influenzae, S. pneumoniae, or M. catarrhalis [25,26]. The causative pathogens were isolated from only 11 patients (37.9%) in this study.…”

Section: Discussionmentioning

confidence: 77%

Efficacy and safety of cefditoren pivoxil for exacerbations of chronic obstructive pulmonary disease: A prospective multicenter interventional study

Miyazaki

Fukushima

Hashiguchi

et al. 2019

Journal of Infection and Chemotherapy

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Oral antibiotic therapy for patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) usually involves an aminopenicillin with clavulanic acid, a macrolide, or a quinolone. To date, however, the clinical efficacy and safety of the oral cephalosporin cefditoren pivoxil has not been evaluated in Japanese patients with acute exacerbations of COPD. We conducted a prospective, multicenter, single arm, interventional study from January 2013 to March 2017 to determine the efficacy and safety of oral administration of 200 mg cefditoren pivoxil three times daily for 7 days in a cohort of 29 eligible patients from 15 hospitals. The mean age (SD) of participants was 73.1 (8.1) years and 28 had a smoking history (the mean [SD] of smoking index, 1426.7 [931.7]). The primary efficacy endpoint was clinical response (cure rate) at test of cure, which was set at 5e10 days after treatment ceased. Of the 23 patients finally analyzed, cure was achieved in 15 (65.2%), while 8 (34.8%) remained uncured. Previous experience of acute exacerbations significantly affected the cure rate: none of the three patients who had at least two prior exacerbations were cured, while 15 of the 20 patients with one or fewer prior exacerbations were cured (p ¼ 0.032). The microbiological eradication rate was 88.9% at test of cure. During treatment, mild pneumonia was reported as an adverse event in one patient (3.4%) but resolved within 10 days of Abbreviations: COPD, chronic obstructive pulmonary disease; CRP, C-reactive protein; EOT, end of treatment; FEV 1.0 , forced expiratory volume in 1 s; FVC, forced vital capacity; M, mucous; P, purulent; PM, purulent-mucous; TOC, test of cure; WBC, white blood cell. * All authors meet the ICMJE authorship criteria.

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“…Double bacterial growth pattern in the present study was as follows: Klebsiella pneumoniae with Pseudomonas aeruginosa in 4 cases, Klebsiella pneumoniae with Staphylococcus aureus in 2 cases, E. coli with coagulase negative Staphylococcus in 2 cases and Klebsiella pneumoniae with E. coli in 2 cases. Shimizu et al [32] observed in their study as S. pneumoniae in 8% AECOPD cases, H. influenzae 2% cases, double bacterial infection with Klebsiella pneumoniae and H. influenzae in 4% cases, and with P. aeruginosa and S. aureus in 2% cases. In a study done by Bari MR et al [31] out of the 90 sputum samples, double organisms like, Pseudomonas with Klebsiella in 2 cases and Pseudomonas with Acinetobacter in the 1 case were isolated.…”

Section: Discussionmentioning

confidence: 79%

Bacteriological Profile in Acute Exacerbation of Chronic Obstructive Lung Disease (AECOPD)

Saxena¹,

Ramnani²,

Shashwati³

et al. 2016

AIMDR

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Background: In COPD, acute exacerbation is the common problem during natural course. Studies of sputum samples using standard culture and molecular techniques have demonstrated that it is associated with increased prevalence of bacteria. Methods: 200 clinically diagnosed cases of AECOPD of age ≥45 years were recruited. Two sputum samples each were processed by conventional methods. Preparation of media, reagents, Gram staining, identification of culture isolates, different tests, including antibiotic sensitivity tests were carried out following standard laboratory. Results: The prevalence of AECOPD was more common in the age group of fifty six to sixty five years (43%) with ratio between male and female of 2.12:1. Klebsiella pneumonia was the predominant organism isolated in 42.55%, followed by Staphylococcus aureus in 28.73%, P. aeruginosa in 14.89%, E coli in 8.51%, CONS in 4.26% and S. pneumoniae in 1.06%. Gram negative bacteria were most sensitive to meropenem, imepenem, amikacin, followed by cefotaxime ceftriaxone, levofloxacin, Cefepime and aztreonam. Gram-positive bacterial isolates were most sensitive to linezolid (34.04%) followed by vancomycin (32.98%), cefoxitin (31.91%).Conclusion: Sputum culture is a good and simple diagnostic tool to study the etiology due to bacteria in AECOPD. Antibiogram helps in the formation of the correct treatment protocol, screening resistant pathogens and better drug for treatment, thereby helping to decrease the mortality and morbidity.

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Pathogens in COPD exacerbations identified by comprehensive real-time PCR plus older methods

Cited by 41 publications

References 27 publications

Respiratory viruses in acute exacerbations of chronic obstructive pulmonary disease

Respiratory viruses in acute exacerbations of chronic obstructive pulmonary disease

Efficacy and safety of cefditoren pivoxil for exacerbations of chronic obstructive pulmonary disease: A prospective multicenter interventional study

Bacteriological Profile in Acute Exacerbation of Chronic Obstructive Lung Disease (AECOPD)

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