RELATIONSHIPS BETWEEN BACTERIA, EXACERBATIONS, AND HOSPITALIZATIONS IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Bacteria within the lower respiratory tract plays a critical role in the clinical course and pathogenesis of chronic obstructive pulmonary disease (COPD). Evidence suggests that acute exacerbations are attributable to bacteria, and these exacerbations have a significant impact on a patient’s health status and health services utilization. New bacterial strains play a central role in the pathogenesis of exacerbations, and acquisition of a new strain of potentially pathogenic bacteria (e.g., Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae, and Pseudomonas aeruginosa) is strongly associated with the occurrence of an exacerbation. The first part of this dissertation investigates the clinical impact of P. aeruginosa isolation in an outpatient COPD cohort. P. aeruginosa is an important pathogen in choric airway diseases including cystic fibrosis and bronchiectasis, significantly contributing to both morbidity and mortality. The relationship between P. aeruginosa and COPD mortality has been primarily investigated in hospitalized patients and is associated with higher mortality. Whether this extends to an outpatient sample is unknown, however a greater understanding of this relationship would help guide specific therapies and help inform eradication strategies. Therefore, this aim investigated the association of P. aeruginosa isolation with long-term mortality and patient outcomes (exacerbations and hospitalizations) in a sample of U.S. veterans with COPD (n=181). After adjustment for age and pulmonary status, there was a positive association between the P. aeruginosa culture-positivity and mortality. Moreover, the rate of exacerbations and hospitalizations were higher for P. aeruginosa positive patients. Interestingly, we found an upward trend in exacerbation and hospitalization rates prior to isolation of P. aeruginosa in sputum culture, indicating that patients may be acquiring this organism prior to its isolation. As colonization by P. aeruginosa has adverse consequences, early eradication as practiced with cystic fibrosis may be applicable to COPD and should be considered.

Grantor dc:publisher

State University of New York at Buffalo

Year dc:date.issued

2018

Author dc:creator

• Jacobs, David

Contributors dc:contributor

• Ochs-Balcom, Heather
• Epidemiology and Environmental Health

• epidemiology

Statement dc:rights

• Users of works found in University at Buffalo Institutional Repository (UBIR) are responsible for identifying and contacting the copyright owner for permission to reuse. University at Buffalo Libraries do not manage rights for copyright-protected works and cannot assist with permissions.
• Copyright retained by author.

Language dc:language

eng

Handle dc:identifier

http://hdl.handle.net/10477/77988

OAI record oai:identifier

https://ubir.buffalo.edu/oai/request?verb=GetRecord&metadataPrefix=qdc&identifier=oai%3Aubir.buffalo.edu%3A10477%2F77988