Bacterial colonisation in patients with bronchiectasis: microbiological pattern and risk factors
- J Angrill1,
- C Agustí1,
- R de Celis1,
- A Rañó1,
- J Gonzalez2,
- T Solé1,
- A Xaubet1,
- R Rodriguez-Roisin1,
- A Torres1
- 1Unitat de Vigilància Intensiva Respiratoria (UVIR), Servei de Pneumologia, Institut Clínic de Pneumologia I Cirurgia Toràcica, Universitat de Barcelona, Villarroel 170, E-08036 Barcelona, Spain
- 2Institut Clínic de Infeccions e Immunologia, Hospital Clinic, Institut d'Investigacions Biomédiques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona
- Correspondence to:
Dr A Torres, Unitat de Vigilància Intensiva Respiratoria (UVIR), Servei de Pneumologia, Institut Clínic de Pneumologia I Cirurgia Toràcica, Hospital Clínic I Provincial, Villarroel 170, 08036 Barcelona, Spain;
- Accepted 16 August 2001
- Revised 20 July 2001
Background: A study was undertaken to investigate the incidence, diagnostic yield of non-invasive and bronchoscopic techniques, and risk factors of airway colonisation in patients with bronchiectasis in a stable clinical situation.
Methods: A 2 year prospective study of 77 patients with bronchiectasis in a stable clinical condition was performed in an 800 bed tertiary university hospital. The interventions used were pharyngeal swabs, sputum cultures and quantitative protected specimen brush (PSB) bacterial cultures (cut off point ≥102 cfu/ml) and bronchoalveolar lavage (BAL) (cut off point ≥103 cfu/ml).
Results: The incidence of bronchial colonisation with potential pathogenic microorganisms (PPMs) was 64%. The most frequent PPMs isolated were Haemophilus influenzae (55%) and Pseudomonas spp (26%). Resistance to antibiotics was found in 30% of the isolated pathogens. When the sample was appropriate, the operative characteristics of the sputum cultures were similar to those obtained with the PSB taken as a gold standard. Risk factors associated with bronchial colonisation by PPMs in the multivariate analysis were: (1) diagnosis of bronchiectasis before the age of 14 years (odds ratio (OR)=3.92, 95% CI 1.29 to 11.95), (2) forced expiratory volume in 1 second (FEV1) <80% predicted (OR=3.91, 95% CI 1.30 to 11.78), and (3) presence of varicose or cystic bronchiectasis (OR=4.80, 95% CI 1.11 to 21.46).
Conclusions: Clinically stable patients with bronchiectasis have a high prevalence of bronchial colonisation by PPMs. Sputum culture is a good alternative to bronchoscopic procedures for evaluation of this colonisation. Early diagnosis of bronchiectasis, presence of varicose-cystic bronchiectasis, and FEV1 <80% predicted appear to be risk factors for bronchial colonisation with PPMs.
J Angrill and A Rañó are supported by a clinical research grant from Hospital Clinic de Barcelona, SEPAR, SOCAP and Comissionat per a Universitat I Recerca de la Generalitat de Catalunya (Grant 1999SGR00228 ).