Frequent severe exacerbations of chronic obstructive pulmonary disease: markers of bacterial infection and features of antibiotic therapy

Aim. To evaluate markers of bacterial infection and features of antibiotic therapy in patients hospitalized with exacerbation of chronic obstructive pulmonary disease (COPD) once and again during the year. Materials and methods. Analysis of 423 medical records of inpatients hospitalized in the therapeutic department of a city hospital with exacerbation of COPD over 4 years. 276 cases were hospitalized once during the year (control group), 147 – hospitalized repeatedly (main group). Results. In the control group 36.9% of patients complained of cough with purulent sputum, while in the main group – 25.2% (p0.05). 31.5% of patients in the control group and 17% of the main group reported fever during hospitalization (p0.05). A high level of CRP during hospitalization was observed in 62.8% of patients in the control group and 49.1% in the main group (p0.05); 47.1% of patients in the control group and 28.6% of patients in the main group had an increased level of leukocytes in sputum. According to the results of bacteriological analysis of sputum, there were no differences in the inoculation of infectious agents in the groups. At the same time, in almost 90% of cases, patients in both groups were prescribed antibiotic therapy, and in some cases, the same antibiotic for 2 and 3 hospitalizations in a row. Patients of the main group had extremely severe obstructive disorders twice as often. The degree of respiratory failure in patients with repeated exacerbations increased by 2 times from the first to the third hospitalization. Arterial hypertension and chronic heart failure of the 2nd stage were more common in the main group. Conclusion. The severity of obstructive disorders, the severity of the comorbidity, and the general condition of patients may have a more significant effect on the recurrence of severe exacerbations requiring repeated hospitalizations than bacterial infection. In this regard, in this group of patients, special attention should be paid to assessing the indications for prescribing antibiotic therapy, as well as optimizing its regimens.