Study of microbial pattern and antibiotic sensitivity pattern in hospitalised acute exacerbation of COPD patients


  • Raveendra K. R. Department of Medicine, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
  • Devapriya Rejeev Department of Medicine, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
  • Nandan kodur Department of Medicine, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India



Antibiotic resistance, COPD, Infective exacerbation, MDR strains


Background: Most of the acute exacerbations of COPD are preventable and curable. More than 50% of them are infectious in nature and strain of the pathogen causing them is quite variable from place to place and often determines the severity of exacerbation. Antibiotic resistance has created a bigger challenge for the treating physicians to have a better treatment outcome. Our objective was to study the bacterial profile and antibiotic sensitivity pattern in all acute exacerbation of hospitalized COPD patients.

Methods: All patients admitted for COPD exacerbation were evaluated for their sputum culture and sensitivity and followed up.

Results: Totally 148 patients were included in the study and organisms were isolated 72 patients. Important organisms isolated were Klebsiella (20), Pseudomonas (16), Streptococci (8), Staphylococcus aureus (8), MTB (4) etc. Many MDR strains were noted. Resistance to newer antibiotics were also noted.64 patients out of 148 required a change in antibiotic (40 in culture positive group, 24 in culture negative group) and there were 12 deaths noted in study. Mortality and morbidity were more in culture negative group and in those who had MDR strains.

Conclusions: Gradual shift to gram negative bacilli was observed in infective exacerbation of COPD. Multiple resistant strains were noted and often responsible for poor recovery. Early diagnosis and proper antibiotic selection is the key for a good treatment outcome.


Seeger W, Adir Y, Barberà JA, Champion H, Coghlan JG, Cottin V, et al. Pulmonary hypertension in chronic lung diseases. J Am Col Cardioy. 2013 Dec 24;62(25 Supplement):D109-16.

Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet. 2012 Dec 15;380(9859):2095-128.

Noncommunicable Diseases in the South-East Asia Region [Internet]. South-East Asia Regional Office. 2019 [cited 22 September 2019]. Available at:

Chhabra SK, Dash DJ, Acute exacerbation of chronic obstructive pulmonary disease causes and impacts: Ind J Chest Dis Allied Sci. 2014 Jun;56(2):93-104.

Rubinsztajn R, Przybyłowski T, Maskey-Warzęchowska M, Karwat K, Chazan R. Exacerbations of chronic obstructive pulmonary disease and quality of life of patients. In Pathophysiology of Respiration; Springer, Cham; 2015:69-74.

Papi A, Bellettato CM, Braccioni F, Romagnoli M, Casolari P, Caramori G, et al. Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations. Am J Res Crit Care Med. 2006 May 15;173(10):1114-21.

Miravitlles M, Espinosa C, Fernández-Laso E, Martos JA, Maldonado JA, Gallego M. Relationship between bacterial flora in sputum and functional impairment in patients with acute exacerbations of COPD. Chest. 1999 Jul 1;116(1):40-6.

Rodriguez-Roisin R. Toward a consensus definition for COPD exacerbations. Chest. 2000 May 1;117(5):398S-401S.

Wu X, Chen D, Gu X, Su X, Song Y, Shi Y. Prevalence and risk of viral infection in patients with acute exacerbation of chronic obstructive pulmonary disease: a meta-analysis. Mol Bio Reports. 2014 Jul 1;41(7):4743-51.

Ram SFS, Rodriguez-Rohin R, Grandos NA, Gracia AJ, Barnes N. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Thorax. 2002;57:847-52.

Rangelov K, Sethi S. Role of Infections. Clin Ches Med. 2014 Mar;35(1):87-100.

Ma X, Cui J, Wang J, Chang Y, Fang Q, Bai C, et al. Multicentre investigation of pathogenic bacteria and antibiotic resistance genes in Chinese patients with acute exacerbation of chronic obstructive pulmonary disease. J Intern Med Res. 2015 Oct;43(5):699-710.

Sharan H, Aerobic Bacteriological Study of Acute Exacerbation of Chronic Obstructive Pulmonary Disease. J Clin Diagn Res JCDR. 2015 Aug;9(8):DC10-2.

Desai H, Richter S, Doern G, Heilmann K, Dohrn C, Johnson A, et al. Antibiotic resistance in sputum isolates of Streptococcus pneumoniae in chronic obstructive pulmonary disease is related to antibiotic exposure. COPD: J COPD. 2010 Sep 1;7(5):337-44.

Goshal AG, Dhar R, Kundu S. Treatment of acute exacerbation of COPD.J Assoc Physicians India. 2012 Feb;60 Suppl:38-43.

Phillips I in Prudent Use of Antibiotics: Are Our Expectations Justified? in Clin Infect Dis. 2001;33 (Supplement 3):S130-S132.

Multi-resistance hospital bacteria linked to India and Pakistan health production report 2009;3:26:3. Available at:

Merino-Sanchez M, Alfageme-Michavila I, Reyes-Nunez N, Lima-Alvarez J. Prognosis in patients with pneumonia and chronic obstructive pulmonary disease. Archivos de Bronconeumología (English Edition). 2005 Nov 1;41(11):607-11.






Original Research Articles