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New strains of bacteria and exacerbations of chronic obstructive pulmonary disease.
N Engl J Med 2002; 347(7):465-71NEJM

Abstract

BACKGROUND

The role of bacterial pathogens in acute exacerbations of chronic obstructive pulmonary disease is controversial. In older studies, the rates of isolation of bacterial pathogens from sputum were the same during acute exacerbations and during stable disease. However, these studies did not differentiate among strains within a bacterial species and therefore could not detect changes in strains over time. We hypothesized that the acquisition of a new strain of a pathogenic bacterial species is associated with exacerbation of chronic obstructive pulmonary disease.

METHODS

We conducted a prospective study in which clinical information and sputum samples for culture were collected monthly and during exacerbations from 81 outpatients with chronic obstructive pulmonary disease. Molecular typing of sputum isolates of nonencapsulated Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae, and Pseudomonas aeruginosa was performed.

RESULTS

Over a period of 56 months, the 81 patients made a total of 1975 clinic visits, 374 of which were made during exacerbations (mean, 2.1 per patient per year). On the basis of molecular typing, an exacerbation was diagnosed at 33.0 percent of the clinic visits that involved isolation of a new strain of a bacterial pathogen, as compared with 15.4 percent of visits at which no new strain was isolated (P<0.001; relative risk of an exacerbation, 2.15; 95 percent confidence interval, 1.83 to 2.53). Isolation of a new strain of H. influenzae, M. catarrhalis, or S. pneumoniae was associated with a significantly increased risk of an exacerbation.

CONCLUSIONS

The association between an exacerbation and the isolation of a new strain of a bacterial pathogen supports the causative role of bacteria in exacerbations of chronic obstructive pulmonary disease.

Authors+Show Affiliations

Division of Pulmonary and Critical Care Medicine, Department of Medicine, State University of New York, Buffalo, NY, USA. ssethi@buffalo.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

12181400

Citation

Sethi, Sanjay, et al. "New Strains of Bacteria and Exacerbations of Chronic Obstructive Pulmonary Disease." The New England Journal of Medicine, vol. 347, no. 7, 2002, pp. 465-71.
Sethi S, Evans N, Grant BJ, et al. New strains of bacteria and exacerbations of chronic obstructive pulmonary disease. N Engl J Med. 2002;347(7):465-71.
Sethi, S., Evans, N., Grant, B. J., & Murphy, T. F. (2002). New strains of bacteria and exacerbations of chronic obstructive pulmonary disease. The New England Journal of Medicine, 347(7), pp. 465-71.
Sethi S, et al. New Strains of Bacteria and Exacerbations of Chronic Obstructive Pulmonary Disease. N Engl J Med. 2002 Aug 15;347(7):465-71. PubMed PMID: 12181400.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - New strains of bacteria and exacerbations of chronic obstructive pulmonary disease. AU - Sethi,Sanjay, AU - Evans,Nancy, AU - Grant,Brydon J B, AU - Murphy,Timothy F, PY - 2002/8/16/pubmed PY - 2002/9/6/medline PY - 2002/8/16/entrez SP - 465 EP - 71 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 347 IS - 7 N2 - BACKGROUND: The role of bacterial pathogens in acute exacerbations of chronic obstructive pulmonary disease is controversial. In older studies, the rates of isolation of bacterial pathogens from sputum were the same during acute exacerbations and during stable disease. However, these studies did not differentiate among strains within a bacterial species and therefore could not detect changes in strains over time. We hypothesized that the acquisition of a new strain of a pathogenic bacterial species is associated with exacerbation of chronic obstructive pulmonary disease. METHODS: We conducted a prospective study in which clinical information and sputum samples for culture were collected monthly and during exacerbations from 81 outpatients with chronic obstructive pulmonary disease. Molecular typing of sputum isolates of nonencapsulated Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae, and Pseudomonas aeruginosa was performed. RESULTS: Over a period of 56 months, the 81 patients made a total of 1975 clinic visits, 374 of which were made during exacerbations (mean, 2.1 per patient per year). On the basis of molecular typing, an exacerbation was diagnosed at 33.0 percent of the clinic visits that involved isolation of a new strain of a bacterial pathogen, as compared with 15.4 percent of visits at which no new strain was isolated (P<0.001; relative risk of an exacerbation, 2.15; 95 percent confidence interval, 1.83 to 2.53). Isolation of a new strain of H. influenzae, M. catarrhalis, or S. pneumoniae was associated with a significantly increased risk of an exacerbation. CONCLUSIONS: The association between an exacerbation and the isolation of a new strain of a bacterial pathogen supports the causative role of bacteria in exacerbations of chronic obstructive pulmonary disease. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/12181400/New_strains_of_bacteria_and_exacerbations_of_chronic_obstructive_pulmonary_disease_ L2 - http://www.nejm.org/doi/full/10.1056/NEJMoa012561?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -