BACTERIOLOGICAL PROFILE OF PATIENTS WITH ACUTE EXACERBATION OF COPD

Dr. Abhishrut Pramod Jog 1 and Dr. Theresia Risa Davita 2 . 1. M.D. Medicine (Silchar Medical College & Hospital, Assam, India), Medical OfficerMedipoint Hospital, Pune, India. 2. M.D. (Pelita Harapan University, Indonesia), Medical Officer, PT Mondrian Clinic, Central Java, Indonesia. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

The data of such patients fulfilling the inclusion and exclusion criteria were collected on a structured proforma. Sputum samples were collected from all eligible patients for sputum culture and sensitivity testing. Processing and examination of the samples was done in the Department of Microbiology, Silchar Medical College and Hospital.
Inclusion Criteria:-All patients above 18 years of age, diagnosed with COPD, as per GOLD criteria presenting with acute exacerbation, were included in the study.
Exclusion Criteria:-All patients treated with antibiotics in the past 48 hours, known cases of malignancy or immunosuppression, tuberculosis, heart failure, pneumonia, asthma and unwilling patients, were excluded from the study.
Ethical Clearance:-Ethical clearance for the study was taken from the Ethical Committee of Silchar Medical College and Hospital, Silchar, Assam (Date of approval-13 th February 2015) Statistical Analysis:-The data were collected, compiled, tabulated and analyzed in terms of descriptive statistics using SPSS version 17.0 software. Continuous variables were presented as mean ± SD and categorical variables were expressed as frequencies and percentages. Categorical data between the groups were compared using Chi square test. A p-value < 0.05 was considered as statistically significant. Graphical and diagrammatic representations were made wherever felt necessary.
The following antibiotics were used in the antibiotic sensitivity testing.

Results & Observations:-
Out of the 114 cases, maximum number of cases were seen in the age groups of 56-65 years (42%). The next commonest age group was 66-75 years, with 20% of the cases. As many as 19% of the patients were between the ages of 46-55 years. Other 13% cases were above the age of 75 years. Mean age was 62.9 ±10.7 years.
All patients (100%) had dyspnoea on presentation. The next frequent presenting symptom was cough (95.6%). Increased sputum volume was seen in 68.4% patients. Chest pain was seen in 34.2% and fever in 34.5% of the cases. Out of the 114 patients, bacteria were detected in 80 patients on microscopy. Out of these 80 patients, Gram positive bacteria were seen in 32.5% cases whereas Gram negative bacteria were seen in 67.5% cases.
There was a statistically significant association between purulence of sputum and frequency of isolation of bacteria (p-value < 0.05).
351 Table 1:-Association between nature of sputum and frequency of isolation of bacteria   (Miravitlles et al, 2000).
The higher number of males in the study may be a result of a higher number of males engaging in tobacco smoking as compared to females. The Global Adult Tobacco Survey revealed that 47.9% Indian males and 20.3 % Indian females smoke tobacco (GATS, 2010).
The higher male prevalence in this study could also be a result of the greater financial independence, better disease awareness and the earlier seeking of medical attention of males in this part of the country.

3) OCCUPATION
The greater number of farmers in this study could be because this part of North-Eastern India primarily has agriculture based population.

3) BACTERIOLOGICAL PROFILE
In a study conducted in Kolkata, the commonest organism was found to be Klebsiella pneumoniae (33.33%). The next organisms found, in decreasing order of frequency were-Staphylococcus aureus (29.6%), Pseudomonas aeruginosa (19.05%), and 9.51% each for Escherichia coli and Acinetobacter species (Basu et al, 2013).
A 2012 study, found that Klebsiella pneumoniae isolates in their study were most sensitive to Meropenem (86%) and Piperacillin-Tazobactam (76%). Pseudomonas aueruginosa isolates were most sensitive to Meropenem (87%) and Amikacin (79%). Staphylococcus aureus showed highest sensitivity to Vancomycin (100%). Acinetobacter species was sensitive to Meropenem in 66% cases, which was one of the antibiotics it was most sensitive to (Surindar et al, 2012).
In another study from 2012, Pseudomonas aeruginosa was found to be highly sensitive to Levofloxacin (100%) and Amikacin (100%), similar to present study. Klebsiella pneumoniae was found to be sensitive to Amikacin (100%) and Levofloxacin (92%), correlating with the present study (Madhavi et al, 2012).
Narayangowda et al found that Pseudomonas aeruginosa showed high sensitivity to Piperacillin-Tazobactam and Amikacin, whereas Streptococcus pneumonia showed high sensitivity to Gentamycin and Amikacin (Narayanagowda et al, 2015).

5) PROPORTION OF MRSA
A study in 2015 found 28.5% of total Staphylococcus aureus isolates to be MRSA (Narayanagowda et al, 2015).

Conclusions:-
It is concluded from the present study that bacterial infection is a major cause of AECOPD. Gram negative bacteria are seen predominantly. Klebsiella pneumoniae is the commonest bacteria, precipitating AECOPD.
The other important organisms are Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter species and Streptococcus pneumoniae.

Sputum purulence is indicative of bacterial infection in majority of the cases
Antibiotics showing high activity against Gram negative organisms are Meropenem, Imipenem, Piperacillin-Tazobactam, Amikacin and Levofloxacin.

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Antibiotics showing high activity against Gram positive organisms are Vancomycin, Linezolid, Amikacin and Piperacillin-Tazobactam.