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Etiology and Microbiological Profile of Bronchiectasis in Adults
Description
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A1975 - Etiology and Microbiological Profile of Bronchiectasis in Adults
Author Block: J. Lee1, A. Verma2, S. H. Chotirmall3, S. Ang1, J. Yuan1, Z. Ng2, S. H. Puah2, P. Wong4, L. C. Tan4, J. A. Abisheganaden2, A. Y. H. Lim2; 1Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore, 2Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore, 3Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore, 4Tan Tock Seng Hospital, Singapore, Singapore.
Rationale
The evaluation of the etiology is an important part of the management of bronchiectasis. Whilst the etiology of the European bronchiectasis population had been established, the etiology of the Asian bronchiectasis population is less clear. The association of the etiology of bronchiectasis and microbiogical profile has yet to be established. We aimed to determine the etiology of bronchiectasis in a Singapore cohort and its association with sputum microbiology.
Methods
We prospectively analysed all adult patients attending the bronchiectasis specialist out-patient clinic (SOC) at Tan Tock Seng Hospital, Singapore, between Jan 2016 and May 2017. All of the patients underwent British Thoracic Society recommendations for diagnostic workup. The data on patients’ demography, spirometric lung function, co-morbidities, and bronchiectasis etiology was collated and analysed. The sputum microbiology of the patients with identified etiology of bronchiectasis was compared with patients with idiopathic disease.
Results
We studied 181 patients (88 male) with a median (IQR) age of 69 (60-77). Of these, 61% (n=111) of the study cohort has a determined etiology, including post infective (38.7%), primary immune deficiency (7.7%), COPD related (7.2%), gastro-oesophageal reflux disease (2.8%), asthma related (2.2%), allergic bronchopulmonary aspergillosis (1.1%), primary ciliary dyskinesia (PCD) (0.6%), connective tissue disease related (0.6%), and cystic fibrosis (0.6%). The five commonest organisms isolated from the sputum were non-tuberculous mycobacteria (NTM) (19.9%), followed by Pseudomonas aeruginosa (11%), Klebsiella pneumoniae (5.5%), Haemophilus influenza (2.2%), and Escherichia coli (1.7%).
P. aeruginosa was significantly more common in patients of idiopathic etiology than patients of post infective etiology (17.1% vs. 2.9%, p=0.009). K. pneumoniae was significantly more common in patients with less common etiologies such as gastro-oesophageal reflux disease, than patients with idiopathic disease (21.4% vs. 2.9%, p=0.03). There was a trend of greater Mycobacterium abscessus in patients with post infective as opposed to idiopathic etiology , although this was not statistically significant (15.7% vs. 5.7%, p=0.09).
Conclusions
Our study demonstrates a spectrum of etiologies of bronchiectasis in the Singaporean population. P. aeruginosa was the commonest organism isolated in idiopathic patients while K. pneumoniae was significantly more common in patients with less common etiologies.
Author Block: J. Lee1, A. Verma2, S. H. Chotirmall3, S. Ang1, J. Yuan1, Z. Ng2, S. H. Puah2, P. Wong4, L. C. Tan4, J. A. Abisheganaden2, A. Y. H. Lim2; 1Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore, 2Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore, 3Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore, 4Tan Tock Seng Hospital, Singapore, Singapore.
Rationale
The evaluation of the etiology is an important part of the management of bronchiectasis. Whilst the etiology of the European bronchiectasis population had been established, the etiology of the Asian bronchiectasis population is less clear. The association of the etiology of bronchiectasis and microbiogical profile has yet to be established. We aimed to determine the etiology of bronchiectasis in a Singapore cohort and its association with sputum microbiology.
Methods
We prospectively analysed all adult patients attending the bronchiectasis specialist out-patient clinic (SOC) at Tan Tock Seng Hospital, Singapore, between Jan 2016 and May 2017. All of the patients underwent British Thoracic Society recommendations for diagnostic workup. The data on patients’ demography, spirometric lung function, co-morbidities, and bronchiectasis etiology was collated and analysed. The sputum microbiology of the patients with identified etiology of bronchiectasis was compared with patients with idiopathic disease.
Results
We studied 181 patients (88 male) with a median (IQR) age of 69 (60-77). Of these, 61% (n=111) of the study cohort has a determined etiology, including post infective (38.7%), primary immune deficiency (7.7%), COPD related (7.2%), gastro-oesophageal reflux disease (2.8%), asthma related (2.2%), allergic bronchopulmonary aspergillosis (1.1%), primary ciliary dyskinesia (PCD) (0.6%), connective tissue disease related (0.6%), and cystic fibrosis (0.6%). The five commonest organisms isolated from the sputum were non-tuberculous mycobacteria (NTM) (19.9%), followed by Pseudomonas aeruginosa (11%), Klebsiella pneumoniae (5.5%), Haemophilus influenza (2.2%), and Escherichia coli (1.7%).
P. aeruginosa was significantly more common in patients of idiopathic etiology than patients of post infective etiology (17.1% vs. 2.9%, p=0.009). K. pneumoniae was significantly more common in patients with less common etiologies such as gastro-oesophageal reflux disease, than patients with idiopathic disease (21.4% vs. 2.9%, p=0.03). There was a trend of greater Mycobacterium abscessus in patients with post infective as opposed to idiopathic etiology , although this was not statistically significant (15.7% vs. 5.7%, p=0.09).
Conclusions
Our study demonstrates a spectrum of etiologies of bronchiectasis in the Singaporean population. P. aeruginosa was the commonest organism isolated in idiopathic patients while K. pneumoniae was significantly more common in patients with less common etiologies.
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