Epidemiology and Infection

Short Reports

Bacterial infection in exacerbated COPD with changes in sputum characteristics

E. MONSÓ a1c1, J. GARCIA-AYMERICH a2, N. SOLER a3, E. FARRERO a4, M. A. FELEZ a5, J. M. ANTÓ a6, A. TORRES a3 and for the EFRAM Investigators 1
a1 Servei de Pneumologia, Hospital Germans Trias i Pujol, Badalona
a2 Unitat de Recerca Respiratòria i Ambiental, Institut Municipal d'Investigació Médica, Barcelona, Spain
a3 Servei de Pneumologia, Hospital Clínic i Provincial, Barcelona, Spain
a4 Servei de Pneumologia, Hospital de Bellvitge, L'Hospitalet del Llobregat, Spain
a5 Servei de Pneumologia, Hospital del Mar, Barcelona, Spain
a6 Unitat de Recerca Respiratòria i Ambiental, Institut Municipal d'Investigació Médica, Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain

Article author query
monso e   [PubMed][Google Scholar] 
garcia-aymerich j   [PubMed][Google Scholar] 
soler n   [PubMed][Google Scholar] 
farrero e   [PubMed][Google Scholar] 
felez m   [PubMed][Google Scholar] 
anto j   [PubMed][Google Scholar] 
torres a   [PubMed][Google Scholar] 


We examined the risk factors for bacterial exacerbation, defined as the presence of pathogenic bacteria in sputum, in 90 chronic obstructive pulmonary disease (COPD) patients with an exacerbation and changes in sputum characteristics. Smoking, alcohol, lung function, body mass index, medical visits and treatments were the independent variables assessed using multivariable logistic regression modelling (OR, 95% CI). A bacterial exacerbation was diagnosed in 39 (43·3%) of 90 patients. Bacterial exacerbations were more prevalent among current smokers (OR 3·77, 95% CI 1·17–12·12), in patients with poor compliance with inhalation therapy (OR 3·25, 95% CI 1·18–8·93) and with severe lung function impairment (FEV1 OR 0·96, 95% CI 0·93-1·00). Prior use of antibiotics was a risk factor for Pseudomonas aeruginosa infection (OR 6·06, 95% CI 1·29–28·44) and influenza vaccination appeared to have a protective effect against this infection (OR 0·15, 95% CI 0·03–0·67). We conclude that severe impairment of lung function, smoking and poor compliance with therapy are risk factors for bacterial infection in COPD, and P. aeruginosa should be suspected in patients who have been treated with antibiotics and in those not vaccinated against influenza.

(Accepted April 1 2003)

c1 Servei de Pneumologia, Hospital Germans Trias i Pujol, Carretera de Canyet s/n, Apartat de correus 72, 08916 Badalona, Catalonia, Spain.


1 EFRAM Investigators: Jordi Alonso, Josep Maria Antó, Esther Barreiro, Glòria Bonet, Joan Escarrabill, Eva Farrero, Miguel Angel Felez, Judith Garcia-Aymerich, José Izquierdo, Ramon Marrades, Eduard Monsó, Josep Morera, María José Redondo, Néstor Soler, Jordi Sunyer and Antoni Torres.