Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) are a common cause of hospitalization. It could have either an infective or non-infective etiology. Primary line of treatment is administration of empirical antibiotic therapy. CRP (C Reactive Protein) levels may be used as a biomarker to increase confidence about administering antibiotics. Periodic isolation and determination of antibiotic sensitivity pattern of causative bacteria is essential to formulate appropriate treatment strategies and avoid indeterminate use of antibiotics, to avoid rise in resistance. This cross sectional study was undertaken to determine the prevalence and bacterial etiological agents of AECOPD and their antimicrobial susceptibility pattern, and to correlate serum CRP levels with the causative factor. Sputum samples obtained from 50 AECOPD patients was subjected to bacterial culture and antibiotic sensitivity testing. Venous blood samples were also collected on admission and was subjected to a Rapid Latex Agglutination Test to determine CRP levels. Prevalence of sputum culture positivity was 62%. Commonest bacterial isolates were Klebsiella pneumonia (49%) and Pseudomonas aeruginosa (24%) . Extended spectrum beta lactamase was detected in 13.6% of enterobacteriaceae. Culture positivity was significantly higher in patients with purulent sputum as compared to non-purulent sputum. (p value=0.002). Serum CRP levels showed significant correlation with sputum purulence (p value=0.001) and culture positivity (p value= 0.003). Thus sputum bacteriology results and the antibiotic resistance pattern provide guidance for the choice of empirical antibiotic treatment for COPD patients with clinical evidence of airway infection such as increased sputum purulence and elevated serum CRP levels.

Keywords: AECOPD, ESBL, CRP.

1. Sethi S, Murphy TF . Infection in the pathogenesis and course of Chronic Obstructive Pulmonary Disease. Proc Am Thorac Soc 2007; 4:554-464
2. Stolz D, Christian-Crain M, Morgenthaler N, et al. Copeptin ,C-reactive protein , and prolactin as prognostic biomarkers in acute exacerbations of COPD. Chest 2007;131: 1058-1067.
3. Thiruvengadam KV, Sekar TS, Rajagopal KR. Study of chronic bronchitis in Tamil Nadu. Indian J Chest Disease 1974;16:1-10
4. Bailey and Scotts Diagnostic Microbiology (12^th edition) Betty A, Forbes, Daniel F. Sahm, Alice S. Weissfeld Mosby Publishers 11830, Westline Industrial Drive St Louis, Missouri .807-812
5. Chawla K, Mukhopadhay C, Majumdar M, Bairy, Bacteriological profile and their antibiogram from cases of Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A hospital based study journal of clinical and diagnostic research 2008,2,612-616
6. Pallavi Torka, Surender K. Sharma: Microbial patterns in severe exacerbations of COPD; CHEST November 20107.
7. Jindal SK.A field study on the follow up at 10 years of prevalence of COPD and PEFR. IJMres1993;98:20-26
8. Arora N., M.K. Daga et al. 2001 “Microbial pattern of Acute Infective Exacerbation of Chronic Obstructive Airway Disease in Hospital Based Study”. Indian Chest Dis.Allied Sci.: 43:157-162
9. Alamoudi OS et al. Bacterial infections and risk factors in OP with AECOPD: 2 year prospective study; Respiratory 2007 Mar;12(2):283-7
10. Stockley RA, O’brien C, Pye et al. Relationship to sputum colour to nature and outpatient management of AECOPD. Chest 2000;117:1638-45
11. Soler, Néstor, Mariano Esperatti, Santiago Ewig, Arturo Huerta, Carlos Agustí, and Antoni Torres. "Sputum Purulence-guided Antibiotic Use in Hospitalised Patients with Exacerbations of COPD." EurRespir J European Respiratory Journal 40.6 (2012): 1344-353
12. Gerard Rakesh, T.Kasturi, and S. Yuvarajan Int.J. Curr. Microbiol. App.Sci (2013)2(11): 273-282 Bacterial agents causing acute exacerbations in Chronic Obstructive Pulmonary Disease (COPD) patients their antibiograms to ESBL production in a tertiary care hospital, India
13. Niederman Michael S et al antibiotic therapy of Chronic Bronchitis Jour in Resp Infection 2000;vol 15 Mar:15-60
14. Pradhan K.C., SudharshiniKar, B.K. Nanda. 1979 “Bacteriology of Chronic Respiratory Disease of Non-Tubercular Origin.” Indian J. Pathol Microbiol; Vol.22 (April):133-138
15. Madhavi S et al Bacterial etiology of acute exacerbations of Chronic Obstructive Pulmonary Disease J.Microbiol. Biotech. Res.,2012,2(3):440-444
16. Rajesh Gupta et al, “Serial estimation of serum CRP levels in patients of COPD with acute exacerbation.” Global Journal of Medicine and Public Health(2012) No.6
17. Pinto-Plata et al., C-reactive protein in patients with COPD, control smokers and non-smokers. Thorax., 61: 23-28, 2006
18. Abdelsadek H. et al Study of Serum C-Reactive Protein Level in Patients with COPD J. Cairo Univ., Vol. 80, No. 2, December: 163-168, 2012
19. Dev D, Wallance E, Sankaran J, and Cunniffe J. Value of C‐reactive protein measurement in exacerbation of COPD. Respiratory medicine, 1998; 92: 664‐
20. Methaq A. M. Hussein, Hashim M. Al‐Kadhimi Value of C ­Reactive Protein Measurements in Exacerbations ofChronic Obstructive Pulmonary Disease ,Iraq JMS, 2010; 80-88

Dr David Agatha

Associate Professor of Microbiology, Thanjavur Medical College, Thanjavur

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mobile no.-  9444048079

Residential Address:  No15 Dhanam Nagar, Mugalivakkam, Chennai-600125, India