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THERAPY IN PRACTICE

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Pseudomonal Infections in Patients with COPD Epidemiology and Management David Lieberman1,2,3 and Devora Lieberman2,3 1 2 3

Pulmonary Unit, The Soroka University Medical Center, Beer-Sheva, Israel Division of Internal Medicine, The Soroka University Medical Center, Beer-Sheva, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

Contents Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 459 1. Diagnostic Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 460 1.1 Bronchial Colonization in Stable COPD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 460 1.2 Microbiologic Sampling of the Respiratory Tract During Acute Exacerbations of COPD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461 1.3 Bronchiectases and COPD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461 2. Management Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461 2.1 Antibacterial Treatment of Acute Exacerbations of COPD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461 2.2 Choice of Specific Antibacterial Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461 3. Microbiology of Pseudomonas spp. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461 4. Epidemiology of Pseudomonal Infection in COPD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462 4.1 Colonization with P. Aeruginosa in COPD Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462 4.2 Pseudomonal Infection in Outpatients with Acute Exacerbations of COPD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462 4.3 Pseudomonal Infection in COPD Patients with Severe Airflow Obstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 463 4.4 Pseudomonal Infection in Mechanically Ventilated Patients with Acute Exacerb

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