Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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A Multicenter Study to Identify the Respiratory Pathogens Associated with Exacerbation of Chronic Obstructive Pulmonary Disease in Korea

  • Lee, Hyun Woo (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine) ;
  • Sim, Yun Su (Division of Pulmonary, Allergy and Critical Care Medicine, Kangnam Sacred Heart Hospital) ;
  • Jung, Ji Ye (Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • Seo, Hyewon (Department of Internal Medicine, School of Medicine, Kyungpook National University Hospital) ;
  • Park, Jeong-Woong (Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Min, Kyung Hoon (Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Lee, Jae Ha (Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Kim, Byung-Keun (Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine) ;
  • Lee, Myung Goo (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Oh, Yeon-Mok (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ra, Seung Won (Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Kim, Tae-Hyung (Division of Pulmonary and Critical Care Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine) ;
  • Hwang, Yong Il (Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Rhee, Chin Kook (Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Joo, Hyonsoo (Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lee, Eung Gu (Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lee, Jin Hwa (Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine) ;
  • Park, Hye Yun (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Woo Jin (Department of Internal Medicine and Environmental Health Center, Kangwon National University College of Medicine) ;
  • Um, Soo-Jung (Department of Internal Medicine, Dong-A University College of Medicine) ;
  • Choi, Joon Young (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lee, Chang-Hoon (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital) ;
  • An, Tai Joon (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Park, Yeonhee (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Yoon, Young-Soon (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dongguk University Ilsan Hospital) ;
  • Park, Joo Hun (Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine) ;
  • Yoo, Kwang Ha (Department of Internal Medicine, Konkuk University School of Medicine) ;
  • Kim, Deog Kyeom (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine)
  • Received : 2021.05.14
  • Accepted : 2021.10.16
  • Published : 2022.01.31
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Abstract

Background: Although respiratory tract infection is one of the most important factors triggering acute exacerbation of chronic obstructive pulmonary disease (AE-COPD), limited data are available to suggest an epidemiologic pattern of microbiology in South Korea. Methods: A multicenter observational study was conducted between January 2015 and December 2018 across 28 hospitals in South Korea. Adult patients with moderate-to-severe acute exacerbations of COPD were eligible to participate in the present study. The participants underwent all conventional tests to identify etiology of microbial pathogenesis. The primary outcome was the percentage of different microbiological pathogens causing AE-COPD. A comparative microbiological analysis of the patients with overlapping asthma-COPD (ACO) and pure COPD was performed. Results: We included 1,186 patients with AE-COPD. Patients with pure COPD constituted 87.9% and those with ACO accounted for 12.1%. Nearly half of the patients used an inhaled corticosteroid-containing regimen and one-fifth used systemic corticosteroids. Respiratory pathogens were found in 55.3% of all such patients. Bacteria and viruses were detected in 33% and 33.2%, respectively. Bacterial and viral coinfections were found in 10.9%. The most frequently detected bacteria were Pseudomonas aeruginosa (9.8%), and the most frequently detected virus was influenza A (10.4%). Multiple bacterial infections were more likely to appear in ACO than in pure COPD (8.3% vs. 3.6%, p=0.016). Conclusion: Distinct microbiological patterns were identified in patients with moderate-to-severe AE-COPD in South Korea. These findings may improve evidence-based management of patients with AE-COPD and represent the basis for further studies investigating infectious pathogens in patients with COPD.

Keywords

Acknowledgement

This work was supported by Grant No. KATRD-S-2019-1 awarded by the Korean Academy of Tuberculosis and Respiratory Diseases.

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