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Previous outpatient antibiotic use in patients admitted to hospital for COPD exacerbations: room for improvement

  • Clinical and Epidemiological Study
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Abstract

Purpose

Several studies have analyzed factors associated to hospitalization in chronic obstructive pulmonary disease (COPD) patients. However, data are lacking on the quality of treatment received by patients prior to hospital admission. The present study analyzed how often patients requiring hospitalization for a COPD exacerbation had received previous treatment for the exacerbation, particularly antibiotics.

Methods

This was a multicenter, cross-sectional, observational study conducted in 30 Spanish hospitals among COPD patients aged >40 years who were hospitalized for an acute exacerbation. Patients were grouped according to whether or not they had received treatment prior to admission and, subsequently, according to whether or not they had received antibiotics. Patient eligibility for antibiotic therapy was assessed using both national and European guidelines.

Results

The study population consisted of 298 patients, of which 277 (93 %) were men, with a mean [standard deviation (SD)] age of 69.1 (9.5) years. One hundred and thirty-three patients (45 %) had received treatment prior to admission; among these, 76/133 (57 %) had received antibiotic therapy. However, 81–91 % of these patients fulfilled criteria for this therapy. Antibiotic use was significantly associated with yellow or green–yellow sputum prior to the exacerbation, a higher number of exacerbations in the previous year, more visits to emergency departments, and bronchiectasis. On the other hand, 10–20 % of patients who did receive antibiotics were not eligible for this therapy according to guidelines.

Conclusions

This study demonstrates a low rate of previous outpatient treatment and antibiotic use among patients with a COPD exacerbation requiring hospital admission.

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Acknowledgments

The authors wish to thank Beatriz Viejo for the editorial support. The following investigators participated in the study: María del Carmen Aguar, Hospital de Vilanova, Valencia (Valencia); Néstor Almeida, Clínica San Roque, Las Palmas de Gran Canaria (Las Palmas); Félix Baranda, Hospital Universitario Cruces, Bilbao (Vizcaya); Marina Blanco, Hospital Universitario A Coruña (A Coruña); Myriam Calle, Hospital Clínico San Carlos, Madrid (Madrid); Francisco Casas, Hospital Clínico San Cecilio, Granada (Granada); José Celdrán, Hospital Nuestra Señora del Prado, Toledo (Toledo); Pedro Cordero, Hospital Nisa 9 de Octubre, Valencia (Valencia); Hugo Dante, Hospital Santa Bárbara, Puertollano (Ciudad Real); David de la Rosa, Clínica Platón, Barcelona (Barcelona); Gustavo de Luiz, Hospital Xanit, Benalmádena (Málaga); Cristobal Esteban, Hospital Galdakao-Usansolo, Galdakao (Vizcaya); Jesús Fernández, Hospital General Universitario de Guadalajara, Guadalajara (Guadalajara); María Ángeles Fernández, Hospital General Río Carrión, Palencia (Palencia); José Vicente Greses, Hospital Nisa 9 de Octubre, Valencia (Valencia); Lourdes Lázaro, Hospital Universitario de Burgos (Burgos); Damián Malía, Hospital General Universitario Los Arcos del Mar Menor, San Javier (Murcia); Pedro Jorge Marcos, Complexo Hospitalario de Ourense (Ourense); Esperanza Martín, Fundació Althaia, Manresa (Barcelona); Luis Molinos, Instituto Nacional de Silicosis, Oviedo (Asturias); Juan Luis Muñoz, Hospital Reina Sofía, Córdoba (Córdoba); Francisco Ortega, Hospital Universitario Virgen del Rocío, Sevilla (Sevilla); Juan Miguel Sánchez, Hospital General Universitario Morales Meseguer, Murcia (Murcia); José Gregorio Soto, Hospital de Jerez, Jerez de la Frontera (Cádiz); Joan Valdeperas, Hospital Universitari de Bellvitge, Barcelona (Barcelona). This work was supported by Bayer Hispania S.L.

Conflict of interest

Marc Miravitlles and Juan José Soler-Cataluña have received speaker fees from Bayer Hispania S.L. Félix Baranda, Pedro Cordero, and José-Vicente Greses declare that they have no conflict of interest. Cristian de la Roza is a full-time employee of Bayer Hispania S.L.

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Authors and Affiliations

  1. Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Ciber de Enfermedades Respiratorias (CIBERES), Hospital Clinic, Barcelona, Spain

    M. Miravitlles

  2. Pneumology Unit, Internal Medicine Service, Hospital de Requena, Valencia, Spain

    J. J. Soler-Cataluña

  3. Department of Pneumology, Hospital Universitario Cruces, Bilbao, Vizcaya, Spain

    F. Baranda

  4. Department of Pneumology, Hospital Nisa 9 de Octubre, Valencia, Spain

    P. Cordero & J.-V. Greses

  5. Medical Department, Bayer Hispania, Sant Joan Despí, Barcelona, Spain

    C. de la Roza

  6. Servei de Pneumologia, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain

    M. Miravitlles

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  1. M. Miravitlles
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  2. J. J. Soler-Cataluña
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  3. F. Baranda
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  4. P. Cordero
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  5. J.-V. Greses
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  6. C. de la Roza
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Correspondence to M. Miravitlles.

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Miravitlles, M., Soler-Cataluña, J.J., Baranda, F. et al. Previous outpatient antibiotic use in patients admitted to hospital for COPD exacerbations: room for improvement. Infection 41, 361–370 (2013). https://doi.org/10.1007/s15010-012-0316-8

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