Significant Bacterial Islolates in Patients Presenting with Acute Exacerbation of Idiopathic Pulmonary Fibrosis

Abstract

Introduction: Idiopathic Pulmonary Fibrosis (IPF) is a chronic and progressive, condition that is due to aberrant wound healing response following repetitive alveolar injury. Though traditionally viruses have played a key role in altering the wound healing cascade, the role played by bacteria in the pathogenesis of IPF is unclear. If there is a recurrent bacterial isolate in sputum or bronchial wash, an appropriate antibiotic both prophylactically and therapeutically can help prevent the decline in lung function and morbidity. This is particularly relevant in the treatment since it involves immunosuppressives during exacerbations. Aim: This study analyses the sputum for bacterial isolates in patients with acute exacerbation of IPF and aims to find the significance of such association. Materials and Methods: Sputum samples of 60 patients who came with acute exacerbation of IPF to a Tertiary Medical College and Hospital between February 2015 to March 2016 were analysed. Patients who were unable to produce sputum and who had received antibiotics for the present exacerbation prior to admission were excluded. Expectorated sputum samples were collected in wide mouth sterile containers and were subjected to gram staining and culture using blood agar after assessing the sputum quality. Chi-Square tests were used to find the significant association between the bacterial isolates in the sputum samples. Results: Among the 60 patients, there were isolates in 78.3% (n=47) and rest had no isolates. Streptococcus pneumoniae was isolated in 12 patients and Escherichia Coli in 13 patients and these were found to have significant association statistically in patients presenting with acute exacerbation of IPF. Whereas the rest of the isolates like Klebsiella (n=9), Haemophillus influenza (n=8), Enterococcus (n=2) and Moraxella catarrhalis (n=3) were found to have insignificant association. Conclusion: Preserving the lung functions in patients with IPF is the basis of treatment. Whether infectious causes play a role in attenuating lung function and treating these with prophylactic antibiotics needs to be seen with larger studies in different geographic areas.

Keywords

• blood agar
• lung function
• prophylactic antibiotics
• sputum