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Cao Y, Chen X, Shu L, Shi L, Wu M, Wang X, Deng K, Wei J, Yan J, Feng G. Analysis of the correlation between BMI and respiratory tract microbiota in acute exacerbation of COPD. Front Cell Infect Microbiol 2023; 13:1161203. [PMID: 37180432 PMCID: PMC10166817 DOI: 10.3389/fcimb.2023.1161203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/07/2023] [Indexed: 05/16/2023] Open
Abstract
Objective To investigate the distribution differences in the respiratory tract microbiota of AECOPD patients in different BMI groups and explore its guiding value for treatment. Methods Sputum samples of thirty-eight AECOPD patients were collected. The patients were divided into low, normal and high BMI group. The sputum microbiota was sequenced by 16S rRNA detection technology, and the distribution of sputum microbiota was compared. Rarefaction curve, α-diversity, principal coordinate analysis (PCoA) and measurement of sputum microbiota abundance in each group were performed and analyzed by bioinformatics methods. Results 1. The rarefaction curve in each BMI group reached a plateau. No significant differences were observed in the OTU total number or α-diversity index of microbiota in each group. PCoA showed significant differences in the distance matrix of sputum microbiota between the three groups, which was calculated by the Binary Jaccard and the Bray Curtis algorithm. 2. At the phylum level, most of the microbiota were Proteobacteria, Bacteroidetes Firmicutes, Actinobacteria, and Fusobacteria. At the genus level, most were Streptococcus, Prevotella, Haemophilus, Neisseria and Bacteroides. 3. At the phylum level, the abundance of Proteobacteria in the low group was significantly higher than that in normal and high BMI groups, the abundances of Firmicutes in the low and normal groups were significantly lower than that in high BMI groups. At the genus level, the abundance of Haemophilus in the low group was significantly higher than that in high BMI group, and the abundances of Streptococcus in the low and normal BMI groups were significantly lower than that in the high BMI group. Conclusions 1. The sputum microbiota of AECOPD patients in different BMI groups covered almost all microbiota, and BMI had no significant association with total number of respiratory tract microbiota or α-diversity in AECOPD patients. However, there was a significant difference in the PCoA between different BMI groups. 2. The microbiota structure of AECOPD patients differed in different BMI groups. Gram-negative bacteria (G-) in the respiratory tract of patients predominated in the low BMI group, while gram-positive bacteria (G+) predominated in the high BMI group.
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Affiliation(s)
- Yang Cao
- Department of Respiratory Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaolin Chen
- Department of Respiratory Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lei Shu
- Department of Respiratory Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lei Shi
- Department of Respiratory Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Mingjing Wu
- Department of Respiratory Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xueli Wang
- Department of Respiratory Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Kaili Deng
- Department of Respiratory Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jing Wei
- Department of Respiratory Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jiaxin Yan
- Department of Respiratory Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ganzhu Feng
- Department of Respiratory Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Respiratory Medicine, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Sivakumaran S, Alsallakh MA, Lyons RA, Quint JK, Davies GA. Estimating the contribution of respiratory pathogens to acute exacerbations of COPD using routine data. J Infect 2023; 86:233-238. [PMID: 36706962 DOI: 10.1016/j.jinf.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/28/2022] [Accepted: 01/11/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To characterise microbiology testing and results associated with emergency admissions for acute exacerbation of COPD (AECOPD), and determine the accuracy of ICD-10 codes in retrospectively identifying laboratory-confirmed respiratory pathogens in this setting. METHODS Using person-level data from the Secure Anonymised Information Linkage Databank in Wales, we extracted emergency admissions for COPD from 1/12/2016 to 30/11/2018 and undertook linkage of admissions data to microbiology data to identify laboratory-confirmed infection. We further used these data to assess the accuracy of pathogen-specific ICD-10 codes. RESULTS We analysed data from 15,950 people who had 25,715 emergency admissions for COPD over the two-year period. 99.5% of admissions could be linked to a laboratory test within 7 days of admission date. Sputum was collected in 5,013 (19.5%) of admissions, and respiratory virus testing in 1,219 (4.7%). Where respiratory virus testing was undertaken, 46.7% returned any positive result. Influenza was the virus most frequently detected, in 21.5% of admissions where testing was conducted. ICD-10 codes exhibited low sensitivity in detecting laboratory-confirmed respiratory pathogens. CONCLUSIONS In people admitted to hospital with AECOPD, increased testing for respiratory viruses could enable more effective antibiotic stewardship and isolation of cases. Linkage with microbiology data achieves more accurate and reliable case definitions.
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Affiliation(s)
- Shanya Sivakumaran
- Population Data Science, Swansea University Medical School, Swansea, UK.
| | | | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Gwyneth A Davies
- Population Data Science, Swansea University Medical School, Swansea, UK
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3
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Sanavro S, van der Worp H, Jansen D, Stoffelen J, Schers H, Postma M, Koning P, de Boer M, Janus G, Blanker MH. Impact of digital interdisciplinary consultation on secondary care referrals by general practitioners: a protocol for a stepped-wedge cluster randomised controlled trial. BMJ Open 2022; 12:e060222. [PMID: 36456003 PMCID: PMC9716832 DOI: 10.1136/bmjopen-2021-060222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Optimal collaboration between general practice and hospital care is crucial to maintain affordable and sustainable access to healthcare for the entire population. General practitioners (GPs) are the gatekeepers to specialist care and patients will visit hospitals mostly only after referral. However, a substantial part of these referrals may be inappropriate, as communication between GPs and medical specialists can be challenging and referring patients may be the most obvious action for a GP to perform.A new digital platform (Prisma) connects GPs and specialists in interdisciplinary groups and facilitates asynchronous, accessible and fast teleconsultation within the group. No previous research has been done to evaluate the impact of this new platform on the referral rates to the hospital. METHODS AND ANALYSIS A stepped-wedge randomised controlled trial (RCT) will be performed in Zwolle region in the Netherlands to analyse the effect of introduction of the platform on rate of inappropriate referrals to orthopaedic surgery. In four steps, GPs in the region will be given access to the platform. GPs will be part of the control condition until randomisation to the intervention. According to our sample size calculation, we need to include 18 practices with 1008 patients presenting with hip and knee symptoms. Routine care data of hospital registrations will be analysed to calculate the rate of inappropriate referrals (primary outcome). Secondary outcome are costs, primary and secondary care workload, posted cases and user satisfaction. Alongside this quantitative analysis, we will evaluate patient experience, facilitators and barriers for use of the platform. ETHICS AND DISSEMINATION The medical ethics review board of University Medical Center Groningen (UMCG), the Netherlands (METc-number: 2021/288) has confirmed that the Medical Research Involving Human Subjects Act (WMO) does not apply to the process evaluation because the study does not involve randomisation of patients or different medical treatments (letter number: M21.275351). TRIAL REGISTRATION NUMBER NL9704.
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Affiliation(s)
- Sanne Sanavro
- Department General Practice and Elderly Care Medicine, University of Groningen, University medical center groningen, Groningen, The Netherlands
| | - Henk van der Worp
- Department General Practice and Elderly Care Medicine, University of Groningen, University medical center groningen, Groningen, The Netherlands
| | - Danielle Jansen
- Department General Practice and Elderly Care Medicine, University of Groningen, University medical center groningen, Groningen, The Netherlands
| | | | - Henk Schers
- Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands
| | - Maarten Postma
- Pharmacoepidemiology and Pharmacoeconomics, University of Groningen, Groningen, The Netherlands
| | - Paul Koning
- Siilo Holding BV, Amsterdam, The Netherlands
| | - Michiel de Boer
- Department General Practice and Elderly Care Medicine, University of Groningen, University medical center groningen, Groningen, The Netherlands
- Health Sciences, Section Methodology and Applied Statistics, UMCG, Groningen, The Netherlands
| | - Guus Janus
- Department of Orthopaedic surgery, Isala hospital and Isala movement clinic, Zwolle, The Netherlands
| | - Marco H Blanker
- Department General Practice and Elderly Care Medicine, University of Groningen, University medical center groningen, Groningen, The Netherlands
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Meeraus WH, DeBarmore BM, Mullerova H, Fahy WA, Benson VS. Terms and Definitions Used to Describe Recurrence, Treatment Failure and Recovery of Acute Exacerbations of COPD: A Systematic Review of Observational Studies. Int J Chron Obstruct Pulmon Dis 2022; 16:3487-3502. [PMID: 34992357 PMCID: PMC8713707 DOI: 10.2147/copd.s335742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/23/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) are important clinical events, with many patients experiencing multiple AECOPDs annually. The terms used in the literature to define recurring AECOPD events are inconsistent and may impact the ability to describe the true burden of these events. We undertook a systematic review to identify and summarize terms and definitions used in observational studies to describe AECOPD-related events occurring after an initial AECOPD (hereafter “subsequent AECOPD”). Methods PubMed was searched (2000–2019) for observational studies on subsequent AECOPD events using broad search strings for “COPD”, “exacerbation”, and “subsequent exacerbation events”. Only English-language studies were included. Small studies (n<50) and studies focusing on hospital re-admission only were excluded. Extracted data were analyzed descriptively to generate a narrative summary, using a thematic approach to group studies utilizing similar terms for subsequent AECOPD. Results Forty-seven studies were included. No single, distinct terms or definitions were used to define and identify multiple occurrences of AECOPDs, though most (46) studies used one or more of four clustered terms and definitions: reapse (n = 13), recurrence/re-exacerbation (n = 11), treatment failure (n = 12) and non-recovery/time to recovery (n = 16). Heterogeneity was observed within and between the four clusters with respect to study setting, starting point for observing subsequent AECOPDs, time frame to identify a subsequent AECOPD (except for studies using “time to recovery”), and basis for identifying a subsequent exacerbation. Conclusion Our review demonstrates that subsequent AECOPDs (including events such as relapse, recurrence/re-exacerbation, treatment failure, non-recovery/time to recovery) are ill-defined in the observational study literature, emphasizing the need to reach consensus on precise and objective definitions (for example, when one AECOPD ends and another begins). Use of standardized terminology and definitions may aid comparability between, and synthesis of, studies, thus improving the understanding of the natural history and burden of exacerbations in COPD patients.
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Affiliation(s)
- Wilhelmine H Meeraus
- Epidemiology - Value Evidence and Outcomes, Global Medical R&D, GlaxoSmithKline, Brentford, UK
| | - Bailey M DeBarmore
- Epidemiology - Value Evidence and Outcomes, Global Medical R&D, GlaxoSmithKline, Raleigh, NC, USA
| | - Hana Mullerova
- Epidemiology - Value Evidence and Outcomes, Global Medical R&D, GlaxoSmithKline, Brentford, UK
| | - William A Fahy
- Discovery Medicine, Research and Development, GlaxoSmithKline, Stevenage, UK
| | - Victoria S Benson
- Epidemiology - Value Evidence and Outcomes, Global Medical R&D, GlaxoSmithKline, Brentford, UK
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5
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Ye YP, Zhao H, Kang T, Zhao LH, Li N, Chen J, Peng XX. Optimal cut-off value of serum procalcitonin in predicting bacterial infection induced acute exacerbation in chronic obstructive pulmonary disease: A prospective observational study. Chron Respir Dis 2022; 19:14799731221108516. [PMID: 35830291 PMCID: PMC9284202 DOI: 10.1177/14799731221108516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To explore the optimal cut-off value of serum procalcitonin (PCT) level in
predicting bacterial infection in hospitalized patients with acute
exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods 204 hospitalized patients with AECOPD were enrolled in this study. Their
diagnoses and treatments followed routine protocols in Fu-Xing Hospital
affiliated to Capital Medical University, Beijing, China. Extra blood
samples were taken for serum PCT level testing and the results were blinded
to the treating physicians. On discharge, clinical data were collected and
the treating physicians made comprehensive analyses to determine whether the
AECOPD were triggered by respiratory tract bacterial infection or
non-bacterial causes according to the “new diagnostic criteria” defined in
this study. In the AECOPD patients with bacterial infection, treating
physicians decided whether they had bacterial pneumonia based on imaging
studies. Receiver operating characteristic curve (ROC) was used to analyze
the accuracy of serum PCT level in predicting bacterial infection. Results In the 173 AECOPD patients who did not have pneumonia, 115 had evidences of
bacterial infection while 58 did not. The median PCT levels were 0.1(0.08,
0.18) ng/ml and 0.07 (0.05, 0.08) ng/ml for each group, which were
statistically different. The proposed optimal cut-off value of serum PCT
level in predicting bacterial infection was 0.08 ng/mL according to this
study, with a sensitivity of 81%, specificity of 67% and area under the ROC
curve (AUC) of 0.794. There were 31 AECOPD patients diagnosed with
pneumonia, their median PCT level was 0.23 ng/mL. Conclusions The serum PCT levels slightly increased in the majority of hospitalized
patients with AECOPD compared with reference range. When PCT level was
≥0.08 ng/mL, AECOPD was more likely to be caused by bacterial infection. A
significantly elevated PCT levels may indicate combination of AECOPD and
bacterial pneumonia.
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Affiliation(s)
- Yan-Ping Ye
- Department of Respiratory Medicine, Fu-Xing Hospital, 12517Capital Medical University, Beijing, China
| | - Hang Zhao
- Department of Respiratory Medicine, Fu-Xing Hospital, 12517Capital Medical University, Beijing, China
| | - Tao Kang
- Department of Laboratory Medicine, Fu-Xing Hospital, 12517Capital Medical University, Beijing, China
| | - Li-Hua Zhao
- Department of Respiratory Medicine, Fu-Xing Hospital, 12517Capital Medical University, Beijing, China
| | - Ning Li
- Department of Respiratory Medicine, Fu-Xing Hospital, 12517Capital Medical University, Beijing, China
| | - Jing Chen
- Department of Respiratory Medicine, Fu-Xing Hospital, 12517Capital Medical University, Beijing, China
| | - Xiao-Xia Peng
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, 12517Capital Medical University, National Center for Children's Health, Beijing, China
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Abramavicius S, Stundziene A, Jankauskaite L, Vitkauskiene A, Kowalski IM, Wojtkiewicz J, Stankevicius E. Novel approach towards antimicrobial chemotherapy optimization in lower respiratory tract infections in children: An observational study. Medicine (Baltimore) 2021; 100:e26585. [PMID: 34596107 PMCID: PMC8483859 DOI: 10.1097/md.0000000000026585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/19/2021] [Indexed: 01/05/2023] Open
Abstract
The use of local antibiogram in guiding clinical decisions is an integral part of the antimicrobial stewardship program. Conventional antibiograms are not disease-specific, ignore the distribution of microorganisms, obscure the in-vitro efficacy interrelationships, and have limited use in polymicrobial infections.We aimed to develop an in-house empiric, disease-specific, antimicrobial prescription auxiliary for the treatment of hospitalized pediatric pneumonia patients and to present the methods which help to choose the first and the second line antimicrobial therapy, while accounting for cost and safety aspects.A retrospective single center observational study was conducted on bronchoscopy obtained sputum culture. Analysis of probabilities, variance minimization, Boolean network modeling, and dominance analysis were applied to analyze antibiogram data. The Kirby-Bauer disk diffusion method was used to test the susceptibility of all isolates. Final optimization analysis included local drug acquisition cost (standardized to price per DDD) and safety profile.Data of 145 pediatric patients hospitalized with pneumonia with 218 isolates over 5 years was collected. A combination of statistical methods such as probabilities of drug efficacy, variance minimization, Boolean network modeling, and dominance analysis can help to choose the optimal first-line and the second-line antimicrobial treatment and optimize patient care. This research reveals that ampicillin is the optimal choice as the first-line drug and piperacillin-tazobactam is the second-line antimicrobial drug if the first one is not effective, while accounting for cost and safety aspects.The paper proposes a new methodology to adapt empiric antimicrobial therapy recommendations based on real world data and accout for costs and risk of adverse events.
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Affiliation(s)
| | - Alina Stundziene
- School of Economics and Business, Kaunas University of Technology
| | | | - Astra Vitkauskiene
- Department of Laboratory medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Joanna Wojtkiewicz
- Department of Pathophysiology, School of Medicine, University of Warmia and Mazury, Olsztyn, Poland
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Cantón R. [Current microbiological aspects of community respiratory infection beyond COVID-19]. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2021; 34:81-92. [PMID: 33749214 PMCID: PMC8019468 DOI: 10.37201/req/049.2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 03/21/2021] [Indexed: 12/22/2022]
Abstract
From a microbiological point of view, both empirical and targeted antimicrobial treatment in respiratory infection is based on the sensitivity profile of isolated microorganisms and the possible resistance mechanisms that they may present. The latter may vary in different geographic areas according to prescription profiles and vaccination programs. Beta-lactam antibiotics, fluoroquinolones, and macrolides are the most commonly used antimicrobials during the exacerbations of chronic obstructive pulmonary disease and community-acquired pneumonia. In their prescription, different aspects such as intrinsic activity, bactericidal effect or their ability to prevent the development of resistance must be taken into account. The latter is related to the PK/PD parameters, the mutant prevention concentration and the so-called selection window. More recently, the potential ecological impact has grown in importance, not only on the intestinal microbiota, but also on the respiratory one. Maintaining the state of eubiosis requires the use of antimicrobials with a low profile of action on anaerobic bacteria. With their use, the resilience of the bacterial populations belonging to the microbiota, the state of resistance of colonization and the collateral damage related to the emergence of resistance to the antimicrobials in pathogens causing the infections and in the bacterial populations integrating the microbiota.
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Affiliation(s)
- R Cantón
- Rafael Cantón. Servicio de Microbiología. Hospital Universitario Ramón y Cajal e Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS). Madrid. Spain.
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Wang Y, Bos JH, Boezen HM, Alffenaar JWC, van Boven JFM, Schuiling-Veninga CCM, Wilffert B, Hak E. Influence of age on real-life effects of doxycycline for acute exacerbations among COPD outpatients: a population-based cohort study. BMJ Open Respir Res 2020; 7:e000535. [PMID: 32075781 PMCID: PMC7047485 DOI: 10.1136/bmjresp-2019-000535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/29/2020] [Accepted: 02/01/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Although bacteria contribute significantly to acute exacerbations of chronic obstructive pulmonary disease (AECOPD), the added value of antibiotics remains controversial, especially in outpatient settings. Age may affect antibiotic effectiveness, but real-world evidence is lacking. We aimed to assess the influence of age on the effectiveness of doxycycline for AECOPD. METHODS A retrospective cohort study among outpatients with the first recorded AECOPD treated with oral corticosteroids was conducted using a large pharmacy dispensing database. The primary outcome was treatment failure within 15-31 days after treatment start. Secondary outcome was time to second exacerbation. All analyses were stratified by age groups. RESULTS We identified 6300 outpatients with the first AECOPD. 2261 (36%) received doxycycline and 4039 (64%) did not receive any antibiotic (reference group). Overall, there was no difference in treatment failure (adjusted OR: 0.97, 95% CI: 0.84 to 1.12) between two groups. Similarly, no difference in treatment failure was observed in younger groups. However, in patients with advanced age (≥75 years), treatment failure was significantly reduced by doxycycline compared with reference (16% vs 20%, adjusted OR: 0.77, 95% CI: 0.62 to 0.97). Overall, median time to second exacerbation was 169 days (95% CI: 158 to 182 days) in doxycycline group compared with 180 days (95% CI: 169 to 191 days) in reference group (adjusted HR: 1.06, 95% CI: 0.99 to 1.12). Although in older patients there was a trend within 3 months towards longer time of next exacerbation by doxycycline, it did not achieve statistical significance. CONCLUSIONS Our findings showed short-term treatment benefit of doxycycline added to oral corticosteroids for chronic obstructive pulmonary disease patients with advanced age. This value remains unclear for persons aged under 75 years in current primary care. Long-term preventive benefits of doxycycline for the next exacerbation were not observed, irrespective of age.
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Affiliation(s)
- Yuanyuan Wang
- Department of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Jens H Bos
- Department of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - H Marike Boezen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of General Practice & Elderly Care Medicine, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan-Willem C Alffenaar
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J F M van Boven
- Department of General Practice & Elderly Care Medicine, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Catharina C M Schuiling-Veninga
- Department of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Bob Wilffert
- Department of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Department of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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9
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Ernst P, Dahl M, Chateau D, Daneman N, Quail J, Sketris IS, Fisher A, Zhang J, Bugden S. Comparative Effectiveness Of Fluoroquinolone Antibiotic Use In Uncomplicated Acute Exacerbations Of COPD: A Multi-Cohort Study. Int J Chron Obstruct Pulmon Dis 2019; 14:2939-2946. [PMID: 31908442 PMCID: PMC6927224 DOI: 10.2147/copd.s226324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/31/2019] [Indexed: 12/29/2022] Open
Abstract
Purpose Fluoroquinolone antibiotics are associated with rare, but severe adverse events. They are frequently used for the treatment of acute exacerbations of COPD (AECOPD). While their effectiveness in severe exacerbations requiring hospitalisation has been well documented, the potential benefit in the ambulatory setting is less clear, especially in uncomplicated patients with COPD. Patients and characteristics We carried out a retrospective cohort study using health care databases from six Canadian provinces in subjects visiting their physician for uncomplicated COPD. Subjects dispensed either a quinolone or other antibiotics were compared using inverse probability of treatment weights with high dimensional propensity scores on 30-day outcomes, including repeat visits, hospitalisation for AECOPD and subsequent antibiotic prescription. Results from each province were combined by random effects meta-analysis. Results We identified 286,866 AECOPD events among 203,642 unique individuals. The frequency of fluoroquinolone use, mostly levofloxacin and moxifloxacin, varied by province and ranged from 8% to 32% of AECOPD antibiotic prescriptions. The risk of a repeat ambulatory care visit was increased among patients who were dispensed a fluoroquinolone compared with other antibiotics (OR 1.32, 95% CI 1.27-1.36). The risk of a hospitalisation for AECOPD was also higher with fluoroquinolones (OR 1.52, 95% CI 1.33-1.74). There was no difference in subsequent antibiotic prescriptions (OR 1.00, 95% CI 0.94-1.07). Conclusion There is no apparent benefit in short-term outcomes with fluoroquinolones as compared to other antibiotics for the ambulatory treatment of AECOPD in uncomplicated patients. These findings support current recommendations that fluoroquinolones be reserved for AECOPD in patients with recurrent exacerbations, significant co-morbidity or requiring hospitalisation.
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Affiliation(s)
- Pierre Ernst
- Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Matthew Dahl
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dan Chateau
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nick Daneman
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada.,Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jacqueline Quail
- Health Quality Council, Saskatoon, Saskatchewan, Canada.,Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ingrid S Sketris
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anat Fisher
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jianguo Zhang
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shawn Bugden
- School of Pharmacy, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada.,College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Blakeborough L, Watson JS. The importance of obtaining a sputum sample and how it can aid diagnosis and treatment. ACTA ACUST UNITED AC 2019; 28:295-298. [PMID: 30907645 DOI: 10.12968/bjon.2019.28.5.295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Respiratory disease has a major impact on the NHS and continues to be a growing problem as each year passes. However, through improving diagnosis and management of respiratory disease the problem could be lessened. Taking a sputum sample is common practice within respiratory medicine especially for patients with chronic obstructive pulmonary disease (COPD) and helps to diagnose, confirm infection and offer correct treatment. It is important that the multidisciplinary team are aware of how to appropriately obtain sputum samples and when to request them. It is important as a respiratory health professional to understand the patient's usual sputum history including colour, amount and viscosity. Antibiotic stewardship aims to reduce antibiotic resistance through offering the most appropriate antibiotics for those with a bacterial infection and to discourage antibiotic prescribing for those that have not. This should result in better patient outcomes and lower healthcare costs.
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Affiliation(s)
- Leanne Blakeborough
- Advanced Nurse Practitioner Course (Masters Level) with Anglia Ruskin University and Community Respiratory Nurse Specialist, Chelmsford
| | - Jane S Watson
- Senior Lecturer in Community Nursing, Anglia Ruskin University, Chelmsford
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González Del Castillo J, Candel FJ, de la Fuente J, Gordo F, Martín-Sánchez FJ, Menéndez R, Mujal A, Barberán J. [Integral approach to the acute exacerbation of chronic obstructive pulmonary disease]. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2018; 31:461-484. [PMID: 30284414 PMCID: PMC6194861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 09/04/2018] [Indexed: 11/12/2022]
Abstract
Chronic obstructive pulmonary disease is a set of clinical processes that have in common a chronic and progressive obstruction to airflow, with episodes of exacerbation. These exacerbations are more frequent and severe over time, deteriorating the lung function. The main cause of exacerbations is bacterial infection. There are multiple guidelines and documents that statement the management of this pathology. However, they focus primarily on the treatment during the stable phase. This document addresses the problem of acute exacerbation due to an infection from a multidisciplinary perspective, focusing on the integral approach to the process, and including etiology, microbiological studies, resistance to antimicrobials, risk stratification and initial empirical therapeutic management (antibiotic and concomitant). In addition, it includes an approach to more complex aspects such as the management of special populations (elderly and immunosuppressed) or therapeutic failure. Finally, more controversial topics such as prophylaxis of infection or palliative treatment are specifically discussed.
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Affiliation(s)
- J González Del Castillo
- Juan González del Castillo, Servicio de Urgencias. Hospital Clínico San Carlos. Calle Profesor Martín-Lagos s/n, 28040 Madrid. Spain.
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Lewis K, Morgan M, Jenkins DR. Slowing Progression of Airway Diseases by Smoking Cessation and Reducing Infections. EUROPEAN MEDICAL JOURNAL 2018. [DOI: 10.33590/emj/10310522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The prevalence of respiratory diseases, including asthma and chronic obstructive pulmonary disease, has increased in recent decades, placing a significant burden on healthcare systems and economies around the world. As these diseases are largely incurable, the aim of treatment is to control symptoms and improve quality of life. Aside from stopping smoking and reducing biomass fuel exposure, arguably the most effective strategy in the long-term management of chronic respiratory diseases is the prevention or control of respiratory infections via vaccines and antimicrobial agents. By preventing these infections or reducing exposure to some of the major risk factors, we can reduce further lung damage in these patients, thereby slowing disease progression. This review looks at maintaining long-term respiratory health in patients with asthma and chronic obstructive pulmonary disease, primarily through smoking cessation, reducing exposure to allergens and air pollutants, and infection control.
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Affiliation(s)
- Keir Lewis
- Swansea University, Swansea, UK; Hywel Dda University Health Board, UK
| | - Mike Morgan
- Department of Respiratory Medicine, Allergy and Thoracic Surgery, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK; University of Leicester, Leicester, UK
| | - David R. Jenkins
- University of Leicester, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester, UK
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van Geffen WH, Kerstjens HA. Static and dynamic hyperinflation during severe acute exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2018; 13:1269-1277. [PMID: 29713160 PMCID: PMC5912369 DOI: 10.2147/copd.s154878] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Static hyperinflation is known to be increased during moderate acute exacerbations of chronic obstructive pulmonary disease (COPD) (AECOPD), but few data exist in patients with severe exacerbations of COPD. The role of dynamic hyperinflation during exacerbations is unclear. Methods In a prospective, observational cohort study, we recruited patients admitted to hospital for AECOPD. The following measurements were performed upon admission and again after resolution (stable state) at least 42 days later: inspiratory capacity (IC), body plethysmography, dynamic hyperinflation by metronome-paced IC measurement, health-related quality of life and dyspnea. Results Forty COPD patients were included of whom 28 attended follow-up. The IC was low at admission (2.05±0.11 L) and increased again during resolution by 15.6%±23.1% or 0.28±0.08 L (mean ± standard error of the mean, p<0.01). Testing of metronome-paced changes in IC was feasible, and it decreased by 0.74±0.06 L at admission, similarly to at stable state. Clinical COPD Questionnaire score was 3.7±0.2 at admission and improved by 1.7±0.2 points (p<0.01), and the Borg dyspnea score improved by 2.2±0.5 points from 4.4±0.4 at admission (p<0.01). Conclusion Static hyperinflation is increased during severe AECOPD requiring hospitalization compared with stable state. We could measure metronome-paced dynamic hyperinflation during severe AECOPD but found no increase.
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Affiliation(s)
- Wouter H van Geffen
- Department of Respiratory Medicine, Medical Centre Leeuwarden, Leeuwarden, the Netherlands.,Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Huib Am Kerstjens
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Pizzini A, Filipiak W, Wille J, Ager C, Wiesenhofer H, Kubinec R, Blaško J, Tschurtschenthaler C, Mayhew CA, Weiss G, Bellmann-Weiler R. Analysis of volatile organic compounds in the breath of patients with stable or acute exacerbation of chronic obstructive pulmonary disease. J Breath Res 2018; 12:036002. [DOI: 10.1088/1752-7163/aaa4c5] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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