Measurement of bacterial species causing AECOPD and their Sensitivity pattern to antibiotics.

Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality worldwide.

Acute exacerbation is a common problem during the natural course of COPD, which is characterized by an increase in the patient's daily symptoms of dyspnea, cough, and/or sputum beyond normal day-to-day variability and severe enough to require an additional therapy.

The most common cause of acute exacerbations of COPD (AECOPD) is an infection of the tracheobronchial tree and air pollution. As many as one-third of AECOPD causes are never identified. The microbial aetiology of AECOPD includes bacteria and viruses with more than 50% of cases being caused by bacterial infection.

The bacterial etiologies of AECOPD keep changing from time to time and the choice of antimicrobial depends upon on local prevalence of bacterial etiologies and their resistance pattern.

Antibiotics are the main form of treatment for AECOPD which are often initiated empirically based on healthcare provider's previous experiences , which often lead to the inappropriate use of antibiotics , thereby contributing to Antimicrobial Resistance.

Early diagnosis and knowledge of the predominant bacterial etiologies and antimicrobial resistance patterns will also help to correct treatment protocol for the management of AECOPD.

Inclusion Criteria:

• Must be at least 18 years of age and less than 80 years of age for both genders
• Confirmed diagnosis of COPD by spirometry
• Must be an AECOPD patient (with increased grade of dyspnea, increased purulence and amount of sputum) and admitted to the chest department or ICU
• Positive sputum culture

Exclusion Criteria:

• Age less than 18 years old
• Any associated pulmonary co-morbidity

Demographic characteristics of these patients will be recorded, including sex, age, smoking status, underlying comorbidities, occupation and number of exacerbations.

Clinical features will be recorded including increase grade of dyspnea , purulence and amount of sputum , history of previous NIV or MV.

Spirometry as a confirmation tool of COPD. Arterial blood gases on admission. Complete blood count ( CBC ) and ESR Radiological profile of COPD patients. Sputum sample ; Spontaneous sputum sample by asking the patient to cough up sputum into sterile container.

NIV patients : by spontaneous sputum sample. MV patients : by sputum suction through the endotracheal tube .