https://doi.org/10.4081/monaldi.2021.1771
Respiratory pathogens in patients with acute exacerbation of non-cystic fibrosis bronchiectasis from a developing country
Submitted: January 18, 2021
Accepted: April 14, 2021
Published: April 22, 2021
Accepted: April 14, 2021
Abstract Views: 1262
PDF: 739
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Bronchiectasis unrelated to cystic fibrosis (non-CF bronchiectasis) has become a major respiratory disease in developing nations. The dilated mucus filled airways promote bacterial overgrowth followed by chronic infection, bronchial inflammation, lung injury and re-infection. Accurate pathogen identification and antimicrobial susceptibility allowing appropriate treatment, in turn, may break this vicious cycle. This study aimed to gain kowledge about the spectrum and antimicrobial spectrum of pathogen yielded from respiratory specimens in adult patients with acute exacerbation of non-cystic fibrosis (CF) bronchiectasis. This cross-sectional study was performed at the pulmonology clinics of the Aga Khan University, Karachi, Pakistan from 2016-2019. Respiratory specimens were collected from adult patients with acute exacerbation of non-CF bronchiectasis presenting in pulmonology clinics. Microbial cultures were performed using standard methodology. Susceptibility testing was performed and interpreted using Clinical Laboratory Standard Institute criteria. A total of 345 positive cultures from 160 patients presenting with acute exacerbation were evaluated. The most frequent organisms were Pseudomonas aeruginosa (n=209) followed by Hemophilus influenzae (n=40) and Staphylococcus aureus (n=24). High rates of antimicrobial resistance were found in all these pathogens. Proportion of Pseudomonas aeruginosa strains resistant to ciprofloxacin, imipenem, ceftazidime and piperacillin-tazobactam were 27.1%, 16.8%, 14.8% and 13.1% respectively. 65% of Hemophilus influenzae strains were resistant to cotrimoxazole and ciprofloxacin and 66.7% of Staphylococcus aureus strains were resistant to methicillin. High antimicrobial resistance in non-CF bronchiectasis patients against commonly used antimicrobials is a concern and highlight need for urgent community level interventions to improve clinical outcome in these patients.
Dimakou K, Triantafillidou C, Toumbis M, et al. Non CF-bronchiectasis: Aetiologic approach, clinical, radiological, microbiological and functional profile in 277 patients. Respir Med 2016;116:1-7.
DOI: https://doi.org/10.1016/j.rmed.2016.05.001
Chang A, Bilton D. Exacerbations in cystic fibrosis: Non-cystic fibrosis bronchiectasis. Thorax 2008;63:269-76.
DOI: https://doi.org/10.1136/thx.2006.060913
Foweraker J, Wat D. Microbiology of non-CF bronchiectasis. Eur Respir Mon 2011;52:68-96.
DOI: https://doi.org/10.1183/1025448x.10003610
McShane PJ, Naureckas ET, Tino G, Strek ME. Non–cystic fibrosis bronchiectasis. Am J Respir Crit Care Med 2013;188:647-56.
DOI: https://doi.org/10.1164/rccm.201303-0411CI
Pasteur MC, Helliwell SM, Houghton SJ, et al. An investigation into causative factors in patients with bronchiectasis. Am J Respir Crit Care Med 2000;162:1277-84.
DOI: https://doi.org/10.1164/ajrccm.162.4.9906120
Angrill J, Agusti C, De Celis R, et al. Bacterial colonisation in patients with bronchiectasis: microbiological pattern and risk factors. Thorax 2002;57:15-9.
DOI: https://doi.org/10.1136/thorax.57.1.15
King PT, Holdsworth SR, Freezer NJ, et al. Microbiologic follow-up study in adult bronchiectasis. Respir Med 2007;101:1633-8.
DOI: https://doi.org/10.1016/j.rmed.2007.03.009
Macfarlane J, McAlinden P, De Soyza A. Longitudinal study of sputum microbiology in adult non-CF bronchiectasis. Thorax 2010;65:A177-8.
DOI: https://doi.org/10.1136/thx.2010.151068.41
Palwatwichai A, Chaoprasong C, Vattanathum A, et al.Clinical, laboratory findings and microbiologic characterization of bronchiectasis in Thai patients. Respirology 2002;7:63-6.
DOI: https://doi.org/10.1046/j.1440-1843.2002.00367.x
Olveira C, Padilla A, Martínez-García M-Á, et al. Etiology of bronchiectasis in a cohort of 2047 patients. An analysis of the Spanish historical bronchiectasis registry. Arch Bronconeumol 2017;53:366-74.
DOI: https://doi.org/10.1016/j.arbres.2016.12.003
Chandrasekaran R, Mac Aogáin M, Chalmers JD, et al. Geographic variation in the aetiology, epidemiology and microbiology of bronchiectasis. BMC Pulm Med 2018;18:83.
DOI: https://doi.org/10.1186/s12890-018-0638-0
Dhar R, Singh S, Talwar D, Mohan M, et al. Bronchiectasis in India: results from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India Registry. Lancet Global Health 2019;7:e1269-e79.
Sharif N, Baig MS, Sharif S, Irfan M. Etiology, clinical, radiological, and microbiological profile of patients with non-cystic fibrosis bronchiectasis at a tertiary care hospital of Pakistan. Cureus 2020;12:e7208.
DOI: https://doi.org/10.7759/cureus.7208
Murray MP, Turnbull K, MacQuarrie S, Hill AT. Assessing response to treatment of exacerbations of bronchiectasis in adults. Eur Respira J 2009;33:312-8.
DOI: https://doi.org/10.1183/09031936.00122508
Tunney MM, Einarsson GG, Wei L, et al. Lung microbiota and bacterial abundance in patients with bronchiectasis when clinically stable and during exacerbation. Am J Respir Crit Care Med 2013;187:1118-26.
DOI: https://doi.org/10.1164/rccm.201210-1937OC
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.
DOI: https://doi.org/10.1016/j.rmed.2009.11.021
Gao Y, Guan W, Zhu Y, et al. [Respiratory pathogen spectrum in pulmonary exacerbation of bronchiectasis in adults and its association with disease severity].[Article in Chinese]. Zhonghua Jie He He Hu Xi Za Zhi 2019;42:254-61.
Guan W-J, Gao Y-H, Xu G, et al. Inflammatory responses, spirometry, and quality of life in subjects with bronchiectasis exacerbations. Respir Care 2015;601180-9.
Wong C, Jayaram L, Karalus N, et al. Azithromycin for prevention of exacerbations in non-cystic fibrosis bronchiectasis (EMBRACE): a randomised, double-blind, placebo-controlled trial. Lancet.2012;380:660-7.
DOI: https://doi.org/10.1016/S0140-6736(12)60953-2
Çiftci F, Mülazimoglu DD, Erol S, et al. Effect of sputum bacteriology on the prognosis of patients with acute exacerbations of bronchiectasis in the intensive care unit. Eurasian J Pulmonol 2018;20:85.
Polverino E, Rosales-Mayor E, Benegas M, et al. Pneumonic and non-pneumonic exacerbations in bronchiectasis: clinical and microbiological differences. J Infect 2018;77:99-106.
DOI: https://doi.org/10.1016/j.jinf.2018.04.006
Menéndez R, Méndez R, Polverino E, et al. Risk factors for multidrug-resistant pathogens in bronchiectasis exacerbations. BMC Infect Dis 2017;17:659.
DOI: https://doi.org/10.1186/s12879-017-2754-5
Lonni S, Chalmers JD, Goeminne PC, et al. Etiology of non–cystic fibrosis bronchiectasis in adults and its correlation to disease severity. Ann Am Thorac Soc 2015;12:1764-70.
DOI: https://doi.org/10.1513/AnnalsATS.201507-472OC
Wilson C, Jones P, O'leary C, et al. Effect of sputum bacteriology on the quality of life of patients with bronchiectasis. Eur Respir J 1997;10:1754-60.
DOI: https://doi.org/10.1183/09031936.97.10081754
Davies G, Wells A, Doffman S, et al. The effect of Pseudomonas aeruginosa on pulmonary function in patients with bronchiectasis. Eur Respir J 2006;28:974-9.
DOI: https://doi.org/10.1183/09031936.06.00074605
Miszkiel KA, Wells AU, Rubens MB, et al. Effects of airway infection by Pseudomonas aeruginosa: a computed tomographic study. Thorax 1997;52:260-4.
DOI: https://doi.org/10.1136/thx.52.3.260
Loebinger M, Wells A, Hansell D, et al. Mortality in bronchiectasis: a long-term study assessing the factors influencing survival. Eur Respir J 2009;34:843-9.
DOI: https://doi.org/10.1183/09031936.00003709
Naing D, Anderios F, Lin Z. Geographic and ethnic distribution of P. knowlesi infection in Sabah, Malaysia. Int J Collab Res Inter Med Public Health 2011;3:391-400.
Aslam M, Mirza T, Muhammad A, Sarwat J. Self-medication with antibiotics among secondary and tertiary level students in Karachi, Pakistan: A cross sectional study. Inventi Rapid: Pharmacy Practice 2013;2013:1-5.
Atif M, Asghar S, Mushtaq I, et al. What drives inappropriate use of antibiotics? A mixed methods study from Bahawalpur, Pakistan. Infect Drug Resist 2019;12:687.
DOI: https://doi.org/10.2147/IDR.S189114
Ali I, Khan AU. Self-medication of antibiotics: A perspective on alarming situation in Peshawar, Khyber Pakhtunkhwa, Pakistan. Arch Pharmacy Pract 2015;6:68.
DOI: https://doi.org/10.4103/2045-080X.160993
Zafar A, Hasan R, Nizamuddin S, et al. Antibiotic susceptibility in Streptococcus pneumoniae, Haemophilus influenzae and Streptococcus pyogenes in Pakistan: a review of results from the Survey of Antibiotic Resistance (SOAR) 2002–15. J Antimicrob Chemother 2016;71:i103-9.
DOI: https://doi.org/10.1093/jac/dkw076
Zafar A, Hussain Z, Lomama E, et al. Antibiotic susceptibility of pathogens isolated from patients with community-acquired respiratory tract infections in Pakistan--the active study. J Ayub Med Coll 2008;20:7.
Ali I, Butt M. Antibiotic susceptibility pattern of bacterial isolates from patients of respiratory tract infection at 43 centers in Punjab, Pakistan. Clin Exp Pharmacol 2017;7:229.
Shah SN, Ullah B, Basit A, et al. Prevalence and susceptibility patterns of bacteria causing respiratory tract infections in North Waziristan, Pakistan. Pak J Pharm Sci 2016;29:S701-6.
How to Cite
Shahid, Shayan, Kausar Jabeen, Nousheen Iqbal, Joveria Farooqi, and Muhammad Irfan. 2021. “Respiratory Pathogens in Patients With Acute Exacerbation of Non-Cystic Fibrosis Bronchiectasis from a Developing Country”. Monaldi Archives for Chest Disease 91 (2). https://doi.org/10.4081/monaldi.2021.1771.
Copyright (c) 2021 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Vasiliki Epameinondas Georgakopoulou, Nikolaos Garmpis, Dimitrios Mermigkis, Christos Damaskos, Serafeim Chlapoutakis, Konstantinos Mantzouranis, Aikaterini Gkoufa, Chrysovalantis Papageorgiou, Anna Garmpi, Sotiria Makrodimitri, Evangelos Diamantis, Pagona Sklapani, Nikolaos Trakas, Xanthi Tsiafaki, Pulmonary adverse events due to immune checkpoint inhibitors: A literature review , Monaldi Archives for Chest Disease: Vol. 92 No. 2 (2022)
- Aiswarya M Nair, Sowmya Gopalan, Vaasanthi Rajendran, Priyadarshini Varadaraj , Lakshmi Marappa , Viswanathan Pandurangan , Sudha Madhavan, Rajkumar Mani , Emmanuel Bhaskar , Role of secondary sepsis in COVID-19 mortality: Observations on patients with preexisting diabetes mellitus and newly diagnosed hyperglycemia , Monaldi Archives for Chest Disease: Vol. 92 No. 4 (2022)
- Miguel Osejo-Betancourt, Sebastian Molina-Paez , Mariana Rubio-Romero , Pulmonary tuberculosis and COVID-19 coinfection: A new medical challenge , Monaldi Archives for Chest Disease: Vol. 92 No. 3 (2022)
- Veronica Rossi, Martina Santambrogio, Cesare Del Monaco, Mariangela Retucci, Serena Tammaro, Clara Ceruti, Laura Saderi, Stefano Aliberti, Emilia Privitera, Giacomo Grasselli, Giovanni Sotgiu, Francesco Blasi, Safety and feasibility of physiotherapy in ICU-admitted severe COVID-19 patients: an observational study , Monaldi Archives for Chest Disease: Vol. 92 No. 4 (2022)
- Bhaskar Kakarla, Bronchocele, a common but underrecognized condition: a systematic review , Monaldi Archives for Chest Disease: Vol. 93 No. 1 (2023)
- Bineet Ahluwalia, Neeraj Kumar Gupta, Amitabh Singh, Pranav Ish, Nishanth Dev, Santvana Kohli, Rohit Kumar, Fellisha Marwein, Nitesh Gupta, Effect of COVID-19 vaccination status on outcome of adult patients admitted at a tertiary care centre in India , Monaldi Archives for Chest Disease: Vol. 93 No. 1 (2023)
- Emanuele Stirpe, Floriana Bardaro, Alpha1-antitrypsin deficiency and asthma , Monaldi Archives for Chest Disease: Vol. 92 No. 4 (2022)
- Vidushi Rathi, Pranav Ish, Comments on “Clinical, radiological and histopathological profile of patients with endobronchial lesions on fibreoptic bronchoscopy” by Sarma et al. , Monaldi Archives for Chest Disease: Vol. 93 No. 4 (2023)
You may also start an advanced similarity search for this article.
