Tuberc Respir Dis > Accepted Articles
DOI: https://doi.org/10.4046/trd.2021.0080    [Accepted]
Published online October 20, 2021.
A multicenter study to identify the respiratory pathogens associated with exacerbation of chronic obstructive pulmonary disease in Korea
Hyun Woo Lee1, Yun Su Sim2, Ji Ye Jung3, Hyewon Seo4, Jeong-Woong Park5, Kyung Hoon Min6, Jae Ha Lee7, Byung-Keun Kim8, Myung Goo Lee9, Yeon-Mok Oh10, Seung Won Ra11, Tae-Hyung Kim12, Yong il Hwang13, Chin Kook Rhee14, Hyonsoo Joo15, Eung Gu Lee16, Jin Hwa Lee17, Hye Yun Park18, Woo Jin Kim19, Soo-Jung Um20, Joon Young Choi21, Chang-Hoon Lee22, Tai Joon An23, Yeonhee Park24, Young-Soon Yoon25, Joo Hun Park26, Kwang Ha Yoo27, Deog Kyeom Kim1
1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
2Division of Pulmonary, Allergy and Critical Care Medicine, Kangnam Sacred Heart Hospital, Seoul, Korea
3Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
4Department of Internal Medicine, School of Medicine, Kyungpook National University Hospital, Daegu, Korea
5Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
6Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
7Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
8Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
9Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
10Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
11Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
12Division of Pulmonary and Critical Care Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
13Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
14Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
15Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
16Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
17Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
18Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
19Department of Internal Medicine and Environmental Health Center, Kangwon National University College of Medicine, Chuncheon, Korea
20Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
21Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
22Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
23Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
24Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea
25Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea
26Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea
27Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
Correspondence:  Kwang Ha Yoo, Tel: +82-2-2030-7522, Fax: +82-2-2030-7458, 
Email: khyou@kuh.ac.kr
Deog Kyeom Kim, Tel: +82-2-870-2228, Fax: +82-2-870-7378, 
Email: kimdkmd@snu.ac.kr
Received: 14 May 2021   • Revised: 23 July 2021   • Accepted: 16 October 2021
Abstract
Background
Although respiratory tract infection is one of the most important trigger factors for acute exacerbation of chronic obstructive pulmonary disease (AE-COPD), there are limited data on the epidemiologic patterns of microbiology in South Korea.
Methods
A multicenter observational study was conducted in 28 hospitals in South Korea between January 2015 and December 2018. Adult COPD patients with moderate to severe acute exacerbations were eligible for the present study. They underwent all conventional tests to identify etiologic microbiologic pathogens. The primary outcome was the percentage of different microbiological pathogens that caused AE-COPD. Comparative microbiological analysis was performed between the patients with asthma–COPD overlap (ACO) and pure COPD.
Results
We included 1,186 patients with AE-COPD. Pure COPD patients were 87.9% and ACO patients were 12.1%. Nearly half of the patients used an ICS-containing regimen and one-fifth used systemic corticosteroids. Among them, respiratory pathogens were found in 55.3%. Bacteria and viruses were found in 33% and 33.2%, respectively. Bacterial and viral coinfections were found in 10.9%. The most frequently detected bacteria were Pseudomonas aeruginosa (9.8%), and the most frequently detected virus was influenza A (10.4%). Multiple bacterial infections were more likely found in ACO compared to pure COPD (8.3% vs 3.6%, p-value=0.016).
Conclusion
Distinct microbiological patterns were identified in patients with moderate to severe AE-COPD in South Korea. These findings may improve evidence-based management for AE-COPD and become the basis for further research related with infectious pathogens in COPD patients.
Key Words: Symptom Flare Up, Pulmonary Disease, Chronic Obstructive, Microbiology, Bacteriology, Virology


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