Source: Annual Congress 2002 - Acute exacerbations of COPD: aetiology and therapy
Disease area: Airway diseases, Respiratory infections

Abstract

In COPD Haemophilus influenzae (HI) is the most prevalent organism isolated from patients undergoing infective exacerbations. Antibiotic therapy has been shown to improve outcomes in patients with an infective exacerbation of COPD. However, antibiotic resistance is an important determinant in treatment failure. The present study asks whether there is a correlation between COPD patients with poor lung function and resistant HI.
Methods From 1998-2001 all organisms from purulent sputum from patients with a lower respiratory tract infection were stored. Antibiotic MIC sensitivity was done using the BSAC methodology. FEV1 data was collected from respiratory datasets. Total MIC was derived by the summation of all the individual MICs.
Results Data was collected on 415 HI. The resistance to the tested antibiotics were: amoxycillin 40.5%, co-amoxiclav 10%, erythromycin 95.5%, clarithromycin 95.5%, tetracycline 7%, trimethoprim 18.8%, cefotaxime and levofloxacin 0%. We analysed respiratory data from 44 patients.
There is a strong correlation between lower FEV1 and increasing antibiotic resistance in HI (r = -0.62, p < 0.001). Mean resistance in American Thoracic Society (ATS) group I was 34.4 and in ATS group III 19.7 (difference 14.7, 95% CI, 9.01, 20.4 p < 0.001). There is also a significant difference between group I and II, mean resistance 27.1, (p = 0.023).
Discussion As the lung function in patients with COPD declines, there is a higher rate of antibiotic resistance in HI. This implies that for patients with FEV < 35%, the standard recommended first line antibiotics should be avoided. The relative lung function of COPD patients should be a factor when considering antibiotic treatment options.

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A. Leanord, D. Raeside, J. Gravil, C. Williams (Airdrie, Paisley, Hull, United Kingdom). Haemophilus influenzae in COPD patients with poorer lung function carry more antibiotic resistance. Eur Respir J 2002; 20: Suppl. 38, 3372

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