Pseudomonas aeruginosa and risk of death and exacerbations in patients with chronic obstructive pulmonary disease: an observational cohort study of 22.053 patients.
Clin Microbiol Infect. 2019 Jun 22;:
Authors: Eklöf J, Sørensen R, Ingebrigtsen TS, Sivapalan P, Achir I, Boel JB, Bangsborg J, Ostergaard C, Dessau RB, Jensen US, Browatzki A, Lapperre TS, Janner J, Weinreich UM, Armbruster K, Wilcke T, Seersholm N, Jensen JUS
OBJECTIVES: The role of Pseudomonas aeruginosa on long-term prognosis in COPD is unknown. The purpose of this study was to determine whether P. aeruginosa is associated with increased risk of exacerbations or death in patients with chronic obstructive pulmonary disease (COPD).
METHODS: This is a multiregional epidemiological study based on complete data on COPD outpatients between 1 January 2010 and 31 October 2017 and corresponding microbiology and national register data. Time-dependent Cox proportional hazards models and propensity matching was used to estimate hospitalisation-demanding exacerbations and death after two years, separately and in combination.
RESULTS: A total of 22.053 COPD outpatients were followed for a median of 1.082 days (interquartile-range: 427-1.862). P. aeruginosa was present in 905 (4.1%) patients. During 730 days of follow-up, P. aeruginosa strongly and independently predicted an increased risk of hospitalisation for exacerbation or all-cause death (HR 2.8, 95% CI 2.2-3.6; p<0.0001) and all-cause death (HR 2.7, 95% CI 2.3-3.4; p<0.0001) in analyses adjusted for known and suspected confounders. The signal remained unchanged in unadjusted analyses as well as propensity-matched subgroup analyses. Among patients "ever-colonized" with P. aeruginosa, the incidence of hospital-demanding exacerbations doubled after the time of the first colonization.
CONCLUSIONS: COPD patients with P. aeruginosa cultured from the airways had a markedly increased risk of exacerbations and death. It is still not clear whether this risk can be reduced by offering patients targeted antipseudomonal antibiotics. A randomised trial is currently recruiting patients to clarify this (ClinicalTrials.gov: NCT03262142).
PMID: 31238116 [PubMed - as supplied by publisher]