P. aeruginosa Associated With Higher Hospital Readmission Rate in COPD

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Some patients with chronic obstructive pulmonary disease (COPD) experience a sudden worsening of their symptoms that require additional treatment—also known as acute exacerbation of COPD (AECOPD). A recent study, which investigated whether readmissions of patients with severe AECOPD varied according to the bacterium or virus identified, found that P. aeruginosa identification is associated with a higher readmission rate in patients.

The study, published by the International Journal of Chronic Obstructive Pulmonary Disease, involved a retrospective review of medical records of 704 severe AECOPD events at Korea University Guro Hospital from January 2011 to May 2017. The researchers sorted the records into 2 groups, those who were readmitted within 30 days after discharge and those who were not readmitted. The researchers then analyzed the 3 most frequently identified bacteria and viruses in the study.

“In many cases, the exact cause of AECOPD is unknown. It also remains unclear how causes of AECOPD are related to its prognosis. For example, it is unknown whether the prognosis for severe AECOPD differs depending on the bacterium or virus identified as a cause of infection,” explained the authors. “Many studies have been conducted on the relationship between the prognosis of COPD and the bacterial or respiratory viral pathogens. And Pseudomonas aeruginosa has been suggested to be associated with a poor prognosis.”

Sixty-five of the 704 events considered were followed by readmission within 30 days. The 3 most commonly identified bacteria were Pseudomonas aeruginosa, Streptococcus pneumoniae, and Haemophilus influenzae. The 3 most commonly identified viruses were influenza virus, rhinovirus, and parainfluenza virus.

The readmission group demonstrated a higher rate of bacterial identification with no viral identification and a higher rate of identification with the P. aeruginosa. The researchers used propensity score matching and found that the readmission group still showed a higher P. aeruginosa identification rate, yet there was no significant difference in the rate of bacterial identification, with no viral identification. Furthermore, when the multivariate analysis was conducted, the readmission group demonstrated a higher P. aeruginosa identification rate than the no-readmission group.

“P. aeruginosa is a Gram-negative rod bacterium that can cause opportunistic infections. It is the causative agent of infections mainly in immunocompromised or chronic lung disease patients, including patients with cystic fibrosis or COPD,” concluded the authors. “P. aeruginosa infections in severe AECOPD are difficult to treat, and secondary problems often arise. P. aeruginosa infections occur mainly in high-risk patients. In severe AECOPD, P. aeruginosa infections mean poor prognosis and an increased rate of readmission.”

The authors suggested the need for an additional large-scale, multicenter, randomized control study in order to confirm these results.

Reference

Chi J, Oh JY, Lee YS, et al. Pseudomonas aeruginosa infection increases the readmission rate of COPD patients. [published online October 2, 2018]. Int J Chron Obstruct Pulmon Dis. doi: 10.2147/COPD.S173759.