Is It Possible to Reduce the Use of Antibiotics in Severe Exacerbations of Chronic Obstructive Pulmonary Disease?

摘要

Increasing resistance of respiratory pathogens to the usual treatments is caused by the abuse of antibiotics. It is crucial to identify the patients that do not require antibiotics to reduce their use in the community and particularly in hospitals and intensive care units (ICU). Severe exacerbations of chronic obstructive pulmonary disease (COPD) are a frequent cause of admission to ICU with extensive use of antibiotics. Nevertheless, the mortality of patients admitted to hospital with COPD exacerbation is between 5 and 15%, and the mortality of those admitted to the ICU for exacerbations may be as high as 24%. It is clear that in-hospital antibiotic treatment for exacerbations of COPD is not optimal because of overuse of antibiotics; one of the reasons for this is the difficulty in establishing an etiologic diagnosis in most cases. In ambulatory patients, the change in the color of the sputum is key in identifying bacterial exacerbations and self-reported purulence by the patient has been validated ina bronchoscopic study as an indicator of bacterial etiology in those admitted for an exacerbation. However, this is not useful in ventilated patients in the ICU. In a cohort of patients mechanically ventilated for an exacerbation, Soler et al. did not find any clinical sign or symptom that could help to differentiate between infectious or noninfectious exacerbations.