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Category: Volume 06 Issue 08 August 2018
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Title: Bacterial Flora in Sputum and Antibiotic Sensitivity in Exacerbations of Bronchiectasis

Authors: Muhammed Aslam, Manoj D K, Rajani M, Achuthan V

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i8.65

Abstract

Background: The present study aimed to identify Bacterial Flora in Sputum during exacerbations of Bronchiectasis and to assess the antibiotic sensitivity pattern of isolated organisms.

Materials and Methods: A Cross-sectional observational study was done in the Pulmonary Medicine ward of a tertiary care teaching hospital in Kerala for a period of one year. Sputum samples from 52 patients with exacerbation of bronchiectasis were subjected to bacterial culture and antibiotic sensitivity.

Results: This study yielded pathogenic bacterial growth in 76.9 % samples. Gram negative organisms were predominant (87.5%). Three commonest organisms identified were Pseudomonas aeruginosa in 30.8% cases, Klebsiella in 21.2% cases and Acinetobacter in 9.6 % cases. Commonest gram positive bacteria were Streptococcus Pneumoniae (60%). Modified Ziehl-Neelsen stain for acid fast bacilli was negative in all cases. Pseudomonas aeruginosa was 100% sensitive to Imipenem (p value <0.05) and ciprofloxacin (p value <0.05).Sensitivity of pseudomonas aeruginosa to Piperacillin-tazobactam was 85.7% (p value <0.05). The sensitivity to commonly used antipseudomonal cephalosporin ceftazidime was only 42.8% (p value = 0.0265).60% cases of Acinetobacter group (p value <0.05) died during the hospital stay.

Conclusion: The commonest organisms causing exacerbatioin of bronchiectasis in our study were gram negative organisms. The commonest isolate was Pseudomonas aeruginosa followed by Klebsiella. Initial empirical antibiotic therapy in severe bronchiectasis exacerbation canbe started with a combination of Piperacillin-tazobactam with Quinolones. Imipenem or Meropenem can be used as second line drugs.

Keywords: Bronchiectasis; Exacerbations ;Bacterial etiology; Antibiotic sensitivity.

References

  1. Barker AF. Bronchiectasis. N Engl J Med.2002; 346:1383–1393.
  2. Cohen M, Sahn SA. Bronchiectasis in systemic diseases. Chest 1999; 116:1063–1074.
  3. Ellis DA, Thornley PE, Wightman AJ, et al. Present outlook in bronchiectasis: clinical and social study and review of factors influencing prognosis. Thorax .1981; 36:659–664.
  4. Murray M. P., Turnbull K., Mac Quarrie S., Hill A. T. Assessing response to treatment of exacerbations of bronchiectasis in adults. Eur Respir J .2009; 33: 312-318.
  5. Nicotra MB. Bronchiectasis. Semin RespirInfec .1994; 9:31-40.
  6. Diana Bilton, MD; Noreen Henig, MD FCCP, Brian Morrisey, Mark Gotfried. Addition of inhaled tobramycine to ciprofloxacin for acute exacerbations pseudomonas aeruginosa infection in adult bronchiectasis. Chest; 2006; 130: 1503-1510.
  7. Chang AB, Bilton D. Exacerbations in cystic fibrosis: 4 – Noncystic fibrosis bronchiectasis. Thorax 2008; 63: 269–276.
  8. Barker AF, Bardana EJ; Bronchiectasis: update of an orphan disease, Am Rev Respir Dis .1988; 137 ;969-978.
  9. ReidM. Reductionin bronchial subdivision in bronchiectasis. Thorax .1950; 5:233-247.
  10. Abdullah Al-Mobeireek, Abdulmageed Kambal et al..Pseudomonas aeruginosa in hospitalized patients with infective exacerbations of bronchiectasis: Clinical and research implications. Annals of Saudi Medicine, Vol.18,No.5,1998;469-471.
  11. Onen ZP, Gulbay BE, Sen E, et al; Analysis of the factors related to mortality in patients with bronchiectasis. Respir Med.2007 Jul;101(7):1390-7. Epub 2007 Mar 19.
  12. Finklea JD, Khan G, Thomas S et al. Predictors of mortality in hospitalized patients with acute exacerbation of bronchiectasis. Respir Med 2010; 104:816–21.
  13. Kecelj P., Music E., Tomic V., Kosnik M., Erzen R.The microbiological isolates in patients with non-CF bronchiectasis in stable clinical situation and in disease exacerbation. 17th European Congress of Clinical Microbiology and Infectious Diseases. Abstract number:
  14. Eugenios Metaxas, EvagelosBalis et al. Microbiological Factors Associated With Colonization and Exacerbations in Patients With Bronchiectasis. 2011;140 (4_MeetingAbstracts):456A-456A. doi:10.1378/chest.1116989.
  15. W.T. Tsang, W-M. Chan et al. Comparative study on the efficacy of levofloxacin and ceftazidime in acute exacerbation of bronchiectasis .EurRespir J .1999; 14: 1206-1209.
  16. Chan TH, Ho SS, Lai CK, et al. Comparison of oral ciprofloxacin and amoxycillin in treating infective exacerbations of bronchiectasis in Hong Kong. Chemotherapy 1996;42:150–156.
  17. Chan CH, Ho AK, Chan RC, et al. Mycobacteria as a cause of infective exacerbation in bronchiectasis. Postgrad Med J 1992;68:896–9.
  18. Wickremasinghe M, Ozerovitch LJ, Davies G, et al. Non-tuberculous mycobacteria in patients with bronchiectasis. Thorax 2005;60:1045–51.
  19. Säynäjäkangas O, Keistinen T, Tuuponen T, Kivelä SL. Bronchiectasis in Finland: trends in hospital treatment. Respir Med. 1997;91 (7):395–398. 

Corresponding Author

Dr Muhammed Aslam

Assistant Professor, Dept. of Pulmonary Medicine, DM Wayanad Institute of Medical Sciences, Wayanad, Kerala, India

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