Markers of bacterial infection and features of antibiotic therapy in chronic obstructive pulmonary disease

Objective. To determine the role of bacterial infection in the development of recurrent exacerbations of chronic obstructive pulmonary disease (COPD) and to assess the adequacy of antibiotic therapy for COPD exacerbations during initial and repeat hospitalizations.

Material and methods. Analysis of 423 medical records of patients hospitalized in a therapeutic department due to COPD exacerbation over a period of 4 years. 276 cases were hospitalized once within a year (control group), while 147 were hospitalized repeatedly (main group).

Results. 36.9% of patients in the control group complained of cough with purulent sputum, compared to 25.2% in the main group (p < 0.05). 31.5% of patients in the control group and 17% in the main group reported fever (p < 0.05). A high level of C-reactive protein (CRP) was found in 62.8% of the control group and 49.1% of the main group (p < 0.05), while an increased level of leukocytes in sputum was observed in 47.1% of the control group and 28.6% of the main group. In 90% of cases, patients in both groups received antibiotic therapy, with some patients receiving the same antibiotic during their second and third consecutive hospitalizations. Patients in the main group had extremely severe obstructive disorders twice as often. The degree of respiratory failure increased twofold by the third hospitalization. The main group also had a higher prevalence of arterial hypertension and stage II chronic heart failure.

Conclusion. The severity of obstruction, comorbidity, and overall patient condition may have a more significant impact on the recurrence of exacerbations requiring repeated hospitalizations than bacterial infection. Therefore, a strict differentiated review of indications for initial antibiotic therapy and consideration of the peculiarities of bacterial etiology of exacerbations at the hospital stage is necessary.

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