Sputum bacterial profile and antibiotics sensitivity pattern in acute exacerbation of chronic obstructive pulmonary disease

Abstract

Background: Constant microbiologic screening of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is vital to control the possible alteration of pathogens, as well as their antibiotic resistance.Objective: to identify sputum bacterial profile and antibiotics sensitivity in patients with AECOPD aiming to adjust antibiotics use and reduce antibiotics resistance. Methodology:This cross-sectional study was conducted on 100 patients with AECOPD. The total and differential leucocytic count, spirometric-indices, sputum gram stain, sputum semi-quantitative culture using colony forming unit (CFU) were done for all patients. Additionally, assessments of the sensitivity of the isolated pathogenic bacterial species were done for 25 antibiotics by disk diffusion method.Results: by sputum semi-quantitative culture 28% of the studied patients have non-pathogenic bacterial growth (i.e., growth of normal flora) and 72% have pathogenic bacterial growth. Among those with pathogenic bacterial growth the isolated bacterial species in descending order were klebsiella (40.3%), staphylococcus aureus (19.4%), pseudomonas (12.5%), streptococcal pneumoniae, E. coli (8.3% each), acinetobacter (6.9%), citrobacter (2.8%) and enterobacter (1.4%). The most predictive factors for bacterial etiology in AECOPD in descending orders were decreased blood eosinophils % (B = -0.16), increased blood neutrophils % (B = 0.04), increased blood lymphocytes (B = 0.02), and lower FEV 1 % (B = -0.01). Levofloxacin was the most sensitive antibiotics (91.7%), followed by amikacin (88.9%), ciprofloxacin (87.5%) and gentamycin (87.5%) then imipenem (81.7%) and ofloxacin (76.4%). On the other hand, linezolid and vancomycin were the most resistant antibiotics (95.8% each), followed by clindamycin and cefotaxime (91.7% each) then colistin sulphate and tetracycline (90.3% each). Conclusion:Gram-negative bacterial species especially klebsiella was the most prevalent organism's in AECOPD. The isolated bacterial species were sensitive mainly to quinolones, gentamycin, amikacin, and imipenem, while it was mainly resistant to clindamycin, cefotaxime, colistin sulphate, tetracycline.