De-escalation of antibiotic therapy in acute exacerbation of COPD (AECOPD)

Primary author: Anne Keef
Faculty sponsor: Dr. Megan Undeberg

Primary college/unit: College of Pharmacy and Pharmaceutical Sciences
Campus: Spokane


COPD patients are at increased risk of pulmonary infections secondary to their underlying pathology of the disease: compromised lung function coupled with increased inflammation and mucus production within the lungs provides for a breeding ground for infection. COPD patients are at increased risk of infection by M. catarrhalis, H. influenzae, and S. pneumoniae. Typically, these pathogens induce upper respiratory tract infections. In the COPD patient, however, the compromised lung function and decline in innate respiratory elevator clearing functions results in an increased risk for bacteria to invade the lower respiratory tract and induce inflammation and infection. Additionally, infection with Pseudomonas is not uncommon in COPD patients with more severe symptoms at baseline and especially those with recurrent infections. Regardless of the pathogenic cause, the resultant increase in inflammation in the lungs places the COPD patient at increased risk for further decompensation and increased morbidity. As a result, when a patient presents with cardinal symptoms of an infection inducing an acute exacerbation of COPD (AECOPD), it is not uncommon for a patient to be started on empiric, broad spectrum antibiotic therapy with Pseudomonas coverage, pending sputum culture results. However, once sputum cultures have resulted, antimicrobial therapy is not always refined to correlate with the pathogen present. Our project proposes looking at AECOPD admissions for the first quarter of 2019, initial antibiotic choice, sputum culture results, and subsequent change or no change to antibiotic therapy. Results from this information will guide antimicrobial stewardship and provider education.