Impact of Bacteriology on Outcome of Infective Exacerbation of Chronic Obstructive Pulmonary Disease in a Tertiary Care Hospital of Eastern India

Introduction Respiratory tract infection is a common precipitating factor of acute exacerbation of chronic obstructive pulmonary disease (AE-COPD). Early diagnosis and prompt treatment, with knowledge of the local bacteriological profile and antibiogram, are likely to reduce the case fatality rate during empirical treatment of AE-COPD. Aims and objectives: The present study aimed to determine the influence of respiratory tract bacterial infection on the treatment outcomes of infective exacerbations of COPD. This study is likely to provide local data from Eastern India regarding clinical, radiological, and microbiological presentation of patients with AE-COPD. Materials and methods: A cross-sectional observational study was conducted over a period of 12 months on 50 admitted AE-COPD patients. Clinical examination, followed by laboratory investigations, including blood tests, chest radiology, electrocardiogram, arterial blood gas analysis, and sputum and blood bacteriology, was done. Results: Sputum culture was positive in 41 (82%) patients, while blood culture was positive in only 12 (24%) patients. In sputum, gram-negative bacteria were more common (63.41%), of which the most common was Pseudomonas aeruginosa (13 cases, 26%). The association between sputum C/S and outcome was not significant, whereas the association between blood C/S and outcome was significant (41.7%). All-cause mortality was 10%. Conclusion: A previous severe episode of AE-COPD appears to predict a high probability of respiratory failure in subsequent episodes. Gram-negative bacteria, such as Pseudomonas and Escherichia coli , were the most common bacterial isolates in sputum and blood, respectively. The presence of invasive pneumonia and chest infiltrates showed a significant association with outcome. Polymyxin B was sensitive to most organisms, including Pseudomonas .