BACTEROLOGICALPROFILE AND ANTIBIOTIC SENSITIVITY PATTERN IN SPUTUM CULTURE OF ELDERLY PATIENTS WITH ACUTE EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Abstract

BACKGRAOUND: Chronic obstructive pulmonary disease is a chronic non-communicable disease and its prevalence dramatically increases with age and leads to decreased quality of life in elderly.Knowledge of local bacteria implicated the sensitivity patterns of AECOPD in patients at this geographical area that would facilitate an early introduction of a proper antibiotic, which would reduce the mortality, morbidity and improve the prognosis and Quality of Life among the elderly patients. MATERIAL AND METHODS: This study is a prospective study carried out in 66 cases of Acute Exacerbation of Chronic Obstructive Pulmonary Disease aged more than 60 years. A detailed history was taken, clinical examination was carried out, relevant blood investigations, chest x ray, Pulmonary function test, sputum examination consisting of Gram staining, Ziehl-Neelsen staining and Culture/Sensitivity pattern were studied. The results and observations of the study are as follows. RESULTS: The age group of patients varied from 60 to 91 years with a mean age of 70.63 years. Most of the patients presented with typical complaints of exacerbations, that is increased breathlessness and cough which was productive in nature. P Pulmonale was the most common finding noted in ECG in 62% of the patients. Pulmonary function test was conducted in 58 patients in the study. Among them 75.7% patients showed obstructive and 12.3% showed pseudo restrictive pattern. On gram staining of the sputum, Gram positive cocci were isolated from 39.4% of the patients, Gram negative bacilli in 22.7% of the patients, and mixed in 11% of the patients. Bacteriological isolation by sputum culture showed Streptococcus pneumoniae as the most common xi organism isolated in 16(24.2%) patients. Among all the tested antibiotics for various gram negative and gram-positive organisms, maximum number of patients were sensitive to Cefoperazone that is in 53% of patients. Streptococcus pneumoniae, which was the most common isolate, was sensitive to Cefoperazone, Linezolid, Piperacillin and Clindamycin in decreasing frequency. All case mortality in this study was seen in 1(1.5%) patient. CONCLUSION: Exacerbations of COPD in elderly result in substantial worsening of the general condition of their quality of life. Bacterial infection is the most common triggering factor for exacerbations of COPD in elderly. Knowledge of the local bacteria with their sensitivity pattern resulting in exacerbations in the local geographical area would help in prompt management of them. Adequate awareness regarding the immunization among the elderly COPD patients, their caregivers and the treating doctor would prevent many exacerbations and hence improved quality of life. Elderly patient with COPD requires special attention because of high susceptibility of older people to disease, medication is more and the number of drugs to be taken daily increases progressively with age.