TY - JOUR
T1 - Pneumonic and non-pneumonic exacerbations in bronchiectasis
T2 - Clinical and microbiological differences
AU - Polverino, Eva
AU - Rosales-Mayor, Edmundo
AU - Benegas, Mariana
AU - Menendez, Rosario
AU - Alcaraz-Serrano, Victoria
AU - Ansotegui, Emilio
AU - Montull, Beatriz
AU - Girón, Rosa María
AU - Cisneros, Carolina
AU - Vendrell, Montserrat
AU - Muñoz, Gerard
AU - Marcos, María Angeles
AU - Sanchez, Marcelo
AU - Torres, Antoni
N1 - Funding Information:
Funding: This work was supported by SEPAR (106|2012) PII de bronquiectasias (Area TIR), Ciberes (CB06/06/0028), Ciberes is an initiative of ISCIII, 2009SGR911, IDIBAPS. These institutions had no role in the design of the study, the collection of and analysis of the data, or in the preparation of the manuscript.
Publisher Copyright:
© 2018
PY - 2018/8
Y1 - 2018/8
N2 - Objectives: Despite the clinical relevance of exacerbations in bronchiectasis (BE), little is known about the microbiology and outcomes of pneumonic (CAP) vs. non-pneumonic (NOCAP) exacerbations. Methods: This study compares clinical and microbiological characteristics of CAP vs. NOCAP in adults with BE. We performed a multicenter prospective observational study of consecutive cases of NOCAP and CAP from four Spanish hospitals (2011-2015). Results: We recruited 144 patients, 47 of them CAP (33%) cases. CAP patients were older, with a larger representation of males, more comorbidities, higher arterial hypertension and COPD but less chronic bronchial infection and previous history of exacerbations. Clinical presentation was similar, excepting creatinine, C-reactive protein (C-RP), glucose and leukocytes which were higher in CAP. C-RP of 8.38 mg/dL showed a significant predictive discrimination for CAP. Streptococcus pneumoniae and Pseudomonas aeruginosa were the first causes of CAP and NOCAP, respectively. The rate of microbiological concordance with previous chronic bronchial infection was variable. Main clinical outcomes (mortality, length of stay, etc.) were similar in the two groups. Chronic bronchial infection and history of frequent exacerbations (≥ 2/year) were associated with a reduced risk of CAP. Conclusions: CAP and NOCAP in BE had similar clinical presentation with the exception of fever, leukocytosis, and C-RP. Microbiology also differed. A cut-off value of C-RP ≥ 8.38 mg/dL can predict CAP in bronchiectasis.
AB - Objectives: Despite the clinical relevance of exacerbations in bronchiectasis (BE), little is known about the microbiology and outcomes of pneumonic (CAP) vs. non-pneumonic (NOCAP) exacerbations. Methods: This study compares clinical and microbiological characteristics of CAP vs. NOCAP in adults with BE. We performed a multicenter prospective observational study of consecutive cases of NOCAP and CAP from four Spanish hospitals (2011-2015). Results: We recruited 144 patients, 47 of them CAP (33%) cases. CAP patients were older, with a larger representation of males, more comorbidities, higher arterial hypertension and COPD but less chronic bronchial infection and previous history of exacerbations. Clinical presentation was similar, excepting creatinine, C-reactive protein (C-RP), glucose and leukocytes which were higher in CAP. C-RP of 8.38 mg/dL showed a significant predictive discrimination for CAP. Streptococcus pneumoniae and Pseudomonas aeruginosa were the first causes of CAP and NOCAP, respectively. The rate of microbiological concordance with previous chronic bronchial infection was variable. Main clinical outcomes (mortality, length of stay, etc.) were similar in the two groups. Chronic bronchial infection and history of frequent exacerbations (≥ 2/year) were associated with a reduced risk of CAP. Conclusions: CAP and NOCAP in BE had similar clinical presentation with the exception of fever, leukocytosis, and C-RP. Microbiology also differed. A cut-off value of C-RP ≥ 8.38 mg/dL can predict CAP in bronchiectasis.
KW - Bronchiectasis
KW - Etiology
KW - Exacerbation
KW - Microbiology
KW - Pneumonia
UR - http://www.scopus.com/inward/record.url?scp=85047355809&partnerID=8YFLogxK
U2 - 10.1016/j.jinf.2018.04.006
DO - 10.1016/j.jinf.2018.04.006
M3 - Article
C2 - 29746946
AN - SCOPUS:85047355809
SN - 0163-4453
VL - 77
SP - 99
EP - 106
JO - Journal of Infection
JF - Journal of Infection
IS - 2
ER -