Prognostic factors in the management of exacerbation of chronic obstructive pulmonary disease in Kuwait

To evaluate the clinical presentation and the factors of prognostic importance in the management of exacerbation of chronic obstructive pulmonary disease [COPD]. Subjects and One hundred and four patients who were hospitalized because of exacerbation of COPD between 1996 and 2000 were selected for further evaluation. Only patients who fulfilled the American Thoracic Society criteria for diagnosis of COPD were included. The factors examined included age, clinical features, duration of symptoms of exacerbation, severity of underlying disease, comorbid diseases, level of consciousness, previous hospitalization, intubation and assisted ventilation, hypercapnia, degree of acidemia and complications. Seventy-four of 104 [71%] hospitalized patients reviewed met the inclusion criteria for COPD. The mean age was 63.68 ' 12.6 years. There was a male:female ratio of 3:1. Fifty-eight patients [78%] had a baseline FEV1 <50% before hospitalization and 45 [64%] had previous hospitalization. Comorbid disease was found in 50% of the cases, while 78% had acidemia and 70% hypercapnia. Fourteen [19%] died on admission. Risk factors identified included severity of disease [p < 0.05]; presence of comorbid disease [p < 0.01]; acidemia [p < 0.0001]; hypercapnia [p < 0.0001]; previous hospitalization [p < 0.01], and assisted ventilation [p < 0.001]. This study revealed that the presence of comorbid disease, acidemia, previous hospitalization and assisted ventilation significantly contributed to mortality in patients with exacerbation of COPD.

Significance of atypical pathogens among community-acquired pneumonia adult patients admitted to hospital in Kuwait

The aim of this study is to determine the microbial etiology and severity of community-acquired pneumonia [CAP] in Kuwait. The severity of consecutive adult CAP cases admitted to 3 hospitals over a 1-year period was classified according to the Pneumonia Outcome Research Team [PORT] severity index. The microbial etiology was determined using st and ard methods for bacteria and serological tests for atypical and viral pathogens. The study population was 124 of the 135 admissions; 63 female, 61 male; mean age 41.3 +/- 18 years. The severity class distribution was: class 131%, class II 37%, class III 17%, class IV 13%, and class V 2%. Etiological agents were identified from 44 patients [35%], with one pathogen in 31 [25%], two in 9 [7%], and three or more in 4 [3%]. The most common pathogens identified were: Mycoplasma pneumoniae in 14 patients [11%], Legionella pneumophila in 10 [8%], Chlamydia pneumoniae in 8 [6%], influenza B virus in 8 [6%], influenza A virus in 5 [4%], Haemophilus influenzae in 4 [3%], Streptococcus pneumoniae in 3 [2%], Staphylococcusaureus in 3 [2%], gram-negative enterobacteria in 5 [4%], Moraxella catarrhalis in 2 [2%], and viruses in 4 [3%]. The yields from laboratory tests were 48% for paired serology, 20% from adequate sputum sample, and 3% from blood culture. Our study shows that a large percentage of mild CAP cases are admitted to hospitals in Kuwait, Atypical pathogens have a significant role in the etiology of CAP. There is overtreatment of CAP with a combination treatment consisting mainly of third-generation chephalosporins and macrolides