Acute exacerbations of chronic obstructive pulmonary disease: etiological bacterial pathogens and antibiotic resistance in Upper Egypt

Previous data on etiologic bacteria in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in Upper Egypt are limited. The aim of this study was to identify the causative bacteria in AECOPD and to determine the antibiotic resistance patterns for AECOPD in Upper Egypt. The study design was a prospective one and was conducted in a University Hospital. Patients who were admitted in Assiut University Hospital with AECOPD were prospectively enrolled. Sputum specimens were investigated using culture. Susceptibilities of the isolated bacterial strains to different antibiotics were determined using the disk diffusion method. During 18 months, 156 patients who experienced 218 AECOPD were enrolled. A significant bacterial growth was found in 77% of patients during 81% of exacerbations. The most commonly detected bacteria were Haemophilus influenzae (18%), Streptococcus pneumoniae (15%), and Klebsiella pneumoniae ( 14%). The majority of the isolated strains showed high resistance rates to most groups of antibiotics; 63% of the isolated strains were multidrug resistant, 29% were extensively drug resistant, and 5% were pandrug resistant. High resistance rates were observed against penicillins and cephalosporins, moderate rates against fluoroquinolones, and lowest rates against the carbapenems. All gram-positive bacteria were sensitive to linezolid. Increased severity of chronic obstructive pulmonary disease was related to increased prevalence of antibiotic resistance. The predominant bacterial pathogens for AECOPD in Upper Egypt are H. influenzae, S. pneumoniae , and K. pneumoniae . Bacterial resistance rates were the highest against penicillins and cephalosporins, moderate against fluoroquinolones, and least against carbapenems. Increased severity of chronic obstructive pulmonary disease is related to an increased prevalence of antibiotic resistance.