Question 15

Are the pathogens responsible for ABECOPD the same in different geographic regions?

Recently, very intriguing data has been reported from the Asia-Pacific region investigating the bacterial etiology of ABECOPD in 13 sites in 8 Asian countries (China, Hong Kong, Thailand, Taiwan, the Philippines, Malaysia, Korea and Indonesia). One part of this study reported results from 7 Asian countries: Indonesia, the Philippines, Korea, Thailand, Malaysia, Taiwan and Hong Kong (16). This was a prospective, observational study assessing the prevalence of pathogens and their susceptibility to a range of antibiotics. Patients classified with ABECOPD who presented over the period August 2006 to April 2008 were enrolled. ABECOPD was defined as an acute exacerbation of COPD (AECOPD) based on increased cough, and worsening of two of the following signs, dyspnea, sputum volume or purulence. If patients had received antibiotics within the previous 72 hours, they were excluded from the study. A central laboratory performed the testing and all MICs were determined according to the Clinical and Laboratory Standards Institute (CLSI). Antibiotics evaluated included penicillin, amoxicillin/clavulanate, clarithromycin, azithromycin, cefuroxime, cefotaxime, ceftriaxone, ceftazidime, cefepime, imipenem, piperacillin-tazobactam, amikacin, cotrimoxazole, ciprofloxacin, moxifloxacin, and levofloxacin. The results from this study are very interesting with some of the Asian countries having a bacteriology profile similar to the classic triad of S. pneumoniae, M. catarrhalis and H. influenzae. However, surprisingly, other countries reported a predominance of P. aeruginosa, K. pneumoniae and Acinetobacter baumannii, a very different and unexpected bacteriology pattern.