A Multicenter Study to Identify the Respiratory Pathogens Associated with Exacerbation of Chronic Obstructive Pulmonary Disease in Korea

Abstract

Background: Although respiratory tract infection is one of the most important factors triggering acute exacerbation ofchronic obstructive pulmonary disease (AE-COPD), limited data are available to suggest an epidemiologic pattern ofmicrobiology in South Korea. Methods: A multicenter observational study was conducted between January 2015 and December 2018 across28 hospitals in South Korea. Adult patients with moderate-to-severe acute exacerbations of COPD were eligible toparticipate in the present study. The participants underwent all conventional tests to identify etiology of microbialpathogenesis. 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 wasperformed. Results: We included 1,186 patients with AE-COPD. Patients with pure COPD constituted 87.9% and those with ACOaccounted for 12.1%. Nearly half of the patients used an inhaled corticosteroid-containing regimen and one-fifth usedsystemic corticosteroids. Respiratory pathogens were found in 55.3% of all such patients. Bacteria and viruses were meldetectedin 33% and 33.2%, respectively. Bacterial and viral coinfections were found in 10.9%. The most frequentlydetected 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 SouthKorea. These findings may improve evidence-based management of patients with AE-COPD and represent the basis forfurther studies investigating infectious pathogens in patients with COPD.