Acute Exacerbations of COPD: Aetiology and Antibiotic Resistance

  • G. Nicoletti
  • R. Mattina
  • S. Stefani


The worldwide occurrence of acute exacerbations of chronic obstructive pulmonary disease (COPD), a persistent inflammation and irritation of the bronchial tree, is one of the most important problems which face researchers today. Patients who fall under the umbrella of the clinical definition of chronic bronchitis form a heterogeneous group due to the range of severity of the condition, its common association with airflow obstruction (which may or may not be reversible) and emphysema, and a variable susceptibility to infective exacerbations. Acute exacerbations of chronic bronchitis are common, but their cause may be difficult to identify and might include viral infections, environmental pollutants, allergic responses and bacterial infections. The cause may be multifactorial, so that viral infection or level of air pollution may exacerbate bronchitis, which in turn may predispose to secondary bacterial infections.


Acute Exacerbation Chronic Bronchitis Moraxella Catarrhalis Sputum Specimen Haemophilus inJluenzae 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Baquero F, Alvarez ME, Canton R (1996) Bacteriologic diagnosis of respiratory tract infections. Clin Microbiol Infect 1(Suppl 2):2S10–2S15CrossRefGoogle Scholar
  2. 2.
    Gump DW, Phillips CA, Forsyth BR, et al. (1976) Role of infection in chronic bronchitis. Am Rev Respir Dis 113:465PubMedGoogle Scholar
  3. 3.
    Mayaud C, Mangiapan G (1998) Role of intracellular pathogens in respiratory tract infections. Clin Microbiol Infect 4(Suppl 4):4S14–4S22CrossRefGoogle Scholar
  4. 4.
    Blasi F, Legnani D, Lombardo V, et al. (1993) Chlamydia pneumoniae infection in acute exacerbations of COPD. Eur Respir J 6:19–22PubMedGoogle Scholar
  5. 5.
    Tager D, Speizer TE (1975) The role of infection in chronic bronchitis. N Engl J Med 292:563–571PubMedCrossRefGoogle Scholar
  6. 6.
    Krasemann C, Koch RC (1991) Microrganismi patogeni nella bronchite cronica. In: Ciprofloxacin in pulmonology symposium, Lausanne, June 1990. Edizioni Minerva Medica, pp 3–6Google Scholar
  7. 7.
    Pellegrino MB, Privitera A, Primavera A, Puntorieri M, Nicoletti A, Stefani S, Nicoletti G (1992) Microbiological considerations of the etiological agents of lower respiratory tract infections. J Chemother 4(4):211–215PubMedGoogle Scholar
  8. 8.
    Grossman RF (1999) Management of acute exacerbation of chronic bronchitis. Can Respir J 6(Suppl A):40A–50APubMedGoogle Scholar
  9. 9.
    Smith CB, Golden CA, Kanner RE, Renzetti AD (1976) Haemophilus influenzae and Haemophilus parainfluenzae in chronic obstructive pulmonary diseases. Lancet 1:1253–1255PubMedCrossRefGoogle Scholar
  10. 10.
    Rhind GB, Gould GA, Ahmad F, Croughan MJ, Calder MA (1985) Haemophilus influenzae and H. parainfluenzae respiratory infections: comparison of clinical features. BMJ 291:707–708PubMedCrossRefGoogle Scholar
  11. 11.
    Devalia JL, Grady D, Harmanyeri Y, Tabaqchali S, Davies RJ (1989) Histamine synthesis by respiratory tract micro-organisms: possible role in pathogenicity. J Clin Pathol 42:516–522PubMedCrossRefGoogle Scholar
  12. 12.
    Cole P (1989) Host-microbe relationship in chronic respiratory infections. Respiration 55(Suppl 1):5–8PubMedCrossRefGoogle Scholar
  13. 13.
    Stefani S, Russo G, Schito GC, Varaldo PE, Filadoro F, Satta G, Covelli I, Varanese L (1993) Multicenter study of isolation and resistance to some antibiotics of Branhamella catarrhalis In: Recent Advances in Chemotherapy, Proceedings of 18th ICC, Stockholm 1993. American Society for Microbiology, Washington DC, pp 308–309Google Scholar
  14. 14.
    McGregor K, Chang BJ, Mee BJ, Riley TV (1998) Moraxella catarrhalis: clinical significance, antimicrobial susceptibility and BRO beta-lactamases. Eur J Clin Microbiol Infect Dis 17: 219–234PubMedGoogle Scholar
  15. 15.
    Anon R (1982) Branhamella catarrhalis: pathogen or opportunistic? Lancet 1:1056Google Scholar
  16. 16.
    Catlin BW (1990) Branhamella catarrhalis: an organism gaining respect as a pathogen. Clin Microbiol Rev 3:292–320Google Scholar
  17. 17.
    Stefani S, Pellegrino MB, Russo G, Nicoletti G (1991) Direct and indirect pathogenicity of beta-lactamase producing bacteria in respiratory tract infections in children. Drugs 42(Suppl 4):14–18PubMedCrossRefGoogle Scholar
  18. 18.
    Eller J, Aja Ede MD, Schaberg T, Niederman MS, Mauch H, Lode H (1998) Infective exacerbations of chronic bronchitis. Chest 113:1542–1548Google Scholar
  19. 19.
    Miravitlles M, Espinosa C, Fernandez-Laso E, Martos JA, Maldonado JA, Gallego M (1999) Relationship between bacterial flora in sputum and functional impairment in patients with acute exacerbations of COPD. Study Group of Bacterial Infection in COPD. Chest 116(1):40–46PubMedCrossRefGoogle Scholar
  20. 20.
    Cosentini R, Tarsia P, Blasi F (1999) Chlamydia pneumoniae: clinical characteristics of acute respiratory infections. In: Allegra L, Blasi F (eds) Chlamydia pneumoniae-The lung and the heart. Springer, Berlin Heidelberg New York, pp 70–79Google Scholar
  21. 21.
    Forsgren JA, Samuelson A, Ahlin A, Jonasson J, Rynnel-Dagoo B, Lindberg A (1994) Haemophilus influenzae resides and multiplies intracellularly in human adenoid tissue as demonstrated by in situ hybridization and bacterial viability assay. Infect Immun 62:673–679PubMedGoogle Scholar
  22. 22.
    Bresser P, van Alphen L, Habets FJ, Hart AA, Dankert J, Jansen M, Lutter R (1997) Persisting Haemophilus influenzae strains induce lower levels of interleukin-6 and interleukin-8 in H292 lung epithelial cells than non-persisting strains. Eur Respir J 10:2319–2326PubMedCrossRefGoogle Scholar
  23. 23.
    Brunham RC, Plummer FA, Stephens RS (1993) Bacterial antigenic variation, host immune response, and pathogen-host coevolution. Infect Immun 61:2273–2276PubMedGoogle Scholar
  24. 24.
    Groenenveld K, van Alphen C, Voorter C, Eijk PP, Jansen HM, Zanen HC (1989) Antigenic drift of Haemophilus influenzae in patients with chronic obstructive pulmonary disease. Infect Immun 57:3038–3044Google Scholar
  25. 25.
    Groeneveld K, van Alphen L, Eijk PP, Visschers G, Jansen HM, Zanen HC (1990) Endogenous and exogenous reinfections by Haemophilus influenzae in patients with chronic obstructive pulmonary disease: the effect of antibiotic treatment on persistence. J Infect Dis 161:512–517PubMedCrossRefGoogle Scholar
  26. 26.
    Hood DW, Deadman ME, Jennings M.P, Bisercic M, Fleischmann RD, Venter JC, Moxon ER (1996) DNA repeats identify novel virulence genes in Haemophilus influenzae. Proc Natl Acad Sci USA 93:1121–1125CrossRefGoogle Scholar
  27. 27.
    van Belkum A, Scherer S, Van Leeuwen W, Willemse D, van Alpèhen L, Verbrugh H (1997) Variable number of tandem repeats in clinical strains of Haemophilus influenzae. Infect Immun 65:5017–5027PubMedGoogle Scholar
  28. 28.
    Gump DW, Christmas WA, Forsyth BR, Phillips CA, Stouch WH (1973) Serum and secretory antibodies in patient with chronic bronchitis. Arch Intern Med 132:847–851PubMedCrossRefGoogle Scholar
  29. 29.
    Privitera A, Licciardello L, Giannino V, Agodi A, Rappazzo G, Nicoletti G, Stefani S (1998) Molecular epidemiology and phylogenetic analysis of Haemophilus parainfluenzae from chronic obstructive pulmonary diseases exacerbations. Eur J Epidemiol 14:405–412PubMedCrossRefGoogle Scholar
  30. 30.
    Gruneberg RN, Felmingham D and the Alexander Project Group (1996) Results of the Alexander Project: a continuing, multicenter study of the antimicrobial susceptibility of community-acquired lower respiratory tract bacterial pathogens. Diagn Microbiol Infect Dis 25:169–181PubMedCrossRefGoogle Scholar
  31. 31.
    Garau J (1999) Basic empiric treatment choices for respiratory tract infection on the results of the Alexander Project. J Chemotherapy 11(1):51–55Google Scholar
  32. 32.
    Doern GV, Pfaller MA, Kugler K, Freeman J, Jones RN (1998) Prevalence of antimicrobial resistance among respiratory tract isolates of Streptococcus pneumoniae in North America: 1997 results from the SENTRY antimicrobial surveillance program. Clin Infect Dis 27:764–770PubMedCrossRefGoogle Scholar
  33. 33.
    Gruneberg RN, Felmingham D, Harding I, Shrimpton SB, Nathwani A (1998) The Nearchus project: antibiotic susceptibility of respiratory pathogens and clinical outcome in lower respiratory tract infections at 27 centres in the UK. Int J Antimicrob Agents 10:127–133PubMedCrossRefGoogle Scholar
  34. 34.
    Doern GV, Jones RN, Pfaller MA, Kugler K, and The Sentry Participants Group (1997) Haemophilus influenzae and Moraxella catarrhalis from patients with community-acquired respiratory tract infections: antimicrobial susceptibility patterns from the SENTRY antimicrobial surveillance program (United States and Canada 1997). Antimicrob Agents Chemother 43:385–389Google Scholar
  35. 35.
    Schito GC, Nicoletti G (1998) Osservatorio Epidemiologico Italiano per il rilevamento delle resistenze ai farmaci antimicrobici nei patogeni batterici delle vie respiratorie. Gior Ital Microbiol Med Odont Clin II(2):5–43Google Scholar

Copyright information

© Springer-Verlag Italia 2000

Authors and Affiliations

  • G. Nicoletti
    • 1
  • R. Mattina
    • 2
  • S. Stefani
    • 1
  1. 1.Department of Microbiological and Gynaecological SciencesUniversity of CataniaCataniaItaly
  2. 2.Institute of MicrobiologyUniversity of MilanMilanItaly

Personalised recommendations