Kiran Vishnu Narayan, Thomas George Puthusseril, Deepthi Lalu Mathew
Bronchiectasis is an abnormal dilatation of the bronchi resulting in permanent damage to the pulmonary architecture and function. This disease expresses itself as chronic cough and expectoration, haemoptysis and with recurrent exacerbations of symptoms. The aim of the study is to study the prevalence of chronic bacterial colonisation in the lower respiratory tract of patients with non-cystic fibrosis bronchiectasis in the Pulmonary Medicine Department of Government Medical College, Kottayam, Kerala, India.
MATERIALS AND METHODS
A longitudinal observational study was conducted during a period of 1 year from April 2015 to March 2016 in patients with highresolution CT thorax evidence of bronchiectasis. The sputum was collected for bacterial cultures during exacerbations. Those with coexisting pulmonary diseases and diabetes mellitus were excluded from the study. The patients were treated with empirical antibiotics and bronchial toileting, chest physiotherapy and postural drainage. All patients were kept under follow up and a repeat sputum culture was sent 6 weeks after the episode of exacerbation to determine initial colonisation of the respiratory tract. In stable patients, induced spot sputum samples were sent for culture and when exacerbations occurred during the follow up period, new sputum samples were given.
Among 46 patients enrolled into the study, 10 gave a positive culture isolate during exacerbations, while 78% culture samples yielded normal pharyngeal flora. The organisms during exacerbations were namely Pseudomonas aeruginosa, Klebsiella pneumonia, Haemophilus influenzae, E. coli and one was Burkholderia mallei in a person with Kartagener’s syndrome. 10.8% showed evidence of colonisation and 4 among them showed chronic colonisation with Pseudomonas aeruginosa on repeated cultures taken a month apart when not on any antibiotics.
The prevalence of colonisation of the lower respiratory tract is 10.8% in the study population, which is less compared to other similar studies. Pseudomonas aeruginosa was the predominant coloniser. Proper sputum sampling as well as pre-culture sputum quality assessment is absolutely necessary for increasing the yield of cultures.