The Role of Pulmonary Bacterial Infections in Severe Exacerbations of COPD Patients
Infection is usually considered as the main cause of acute exacerbation in chronic obstructive pulmonary disease (COPD). However, uncertainty persists concerning the exact role of bacterial and viral infection in this setting because of the confusing and conflicting data on the role of tracheobronchial microflora and the usefulness of antibiotics in treating this disease. Most COPD patients have evidence of lower respiratory tract chronic bacterial colonization during remission periods as well as during acute exacerbations. This is evidenced by using microbiological analysis of secretions which reflect all the respiratory tract (sputum), the lower respiratory tract (transtracheal aspiration) or the distal respiratory tract (protected specimen brush, PSB). Potentially pathogenic organisms can be recovered from the respiratory tract secretions of virtually all patients with COPD at some time during the course of their disease. Absence of a difference between remission periods and acute exacerbations suggests that bacterial infection is probably not the predominant cause of acute exacerbations in COPD. In contrast, data indicate that the association between viral infections and acute exacerbations is clearer than that with bacteria, affecting probably more than 20% of cases.
KeywordsPneumonia Influenza Tetracycline Erythromycin Chloramphenicol
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