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Increased incidence of invasive bacterial disease in chronic obstructive pulmonary disease compared to the general population-a population based cohort study

Inghammar, Malin LU ; Engström, Gunnar LU ; Ljungberg, Bengt LU ; Löfdahl, Claes-Göran LU ; Roth, Adam LU and Egesten, Arne LU (2014) In BMC Infectious Diseases 14.
Abstract
Background: Innate defence mechanisms of the airways are impaired in chronic obstructive pulmonary disease (COPD), predisposing patients to lower respiratory tract infections, but less is known about the association with other infections. In this population-based cohort study, we investigated the associations between COPD and invasive bacterial disease by comparing incidence rates of bacteraemia in COPD patients and randomly selected reference individuals from the general population. Methods: In this population based cohort study all patients with COPD, >= 40 years of age, who were discharged from hospitals in southern Sweden between 1990 and 2003 were identified in the Swedish Inpatient Register (n = 15,403). Age and gender matched... (More)
Background: Innate defence mechanisms of the airways are impaired in chronic obstructive pulmonary disease (COPD), predisposing patients to lower respiratory tract infections, but less is known about the association with other infections. In this population-based cohort study, we investigated the associations between COPD and invasive bacterial disease by comparing incidence rates of bacteraemia in COPD patients and randomly selected reference individuals from the general population. Methods: In this population based cohort study all patients with COPD, >= 40 years of age, who were discharged from hospitals in southern Sweden between 1990 and 2003 were identified in the Swedish Inpatient Register (n = 15,403). Age and gender matched reference individuals were randomly selected from the general population. Records were cross-referenced to the microbiological databases covering the region, 1990-2010. The hazard ratios (HR) of bloodstream infections and hospitalisations for infections were estimated by Cox proportional hazards regression. Results: We found that individuals with COPD had a 2.5-fold increased incidence of bacteraemia compared to the reference individuals from the general population adjusted for other co-morbidity and socio-economic status (hazard ratio: 2.5, 95% confidence interval: 2.2-2.7). The increased incidence of bacteraemia was paralleled by an increased incidence of hospitalisation for non-respiratory infections, i.e., skin infections, pyelonephritis, or septic arthritis. Despite higher absolute rates of bloodstream infections among COPD patients than among the general population, the distribution of different pathogens was similar. Conclusions: In summary this population-based study shows COPD is associated with an increased incidence of invasive bacterial infections compared to the general population, indicating a general frailty of acquiring severe infections in addition to the specific susceptibility to infections of respiratory origin. The underlying contributory factors (e. g. smoking, corticosteroid use, co-morbid diseases or a frailty inherent to COPD itself) need to be disentangled in further studies. (Less)
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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Bacteraemia, Epidemiology, Chronic obstructive pulmonary disease, Infection, Sepsis
in
BMC Infectious Diseases
volume
14
article number
163
publisher
BioMed Central (BMC)
external identifiers
  • wos:000335468800001
  • scopus:84897475423
  • pmid:24661335
ISSN
1471-2334
DOI
10.1186/1471-2334-14-163
language
English
LU publication?
yes
additional info
The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Respiratory Medicine and Allergology (013230111), Cardio-vascular Epidemiology (013241610), Division of Infection Medicine (SUS) (013008000), Clinical Microbiology, Malmö (013011000)
id
c3532b8f-637b-4a9c-869d-e2f69bef0a6b (old id 4487399)
date added to LUP
2016-04-01 14:10:51
date last changed
2021-09-22 01:15:15
@article{c3532b8f-637b-4a9c-869d-e2f69bef0a6b,
  abstract     = {Background: Innate defence mechanisms of the airways are impaired in chronic obstructive pulmonary disease (COPD), predisposing patients to lower respiratory tract infections, but less is known about the association with other infections. In this population-based cohort study, we investigated the associations between COPD and invasive bacterial disease by comparing incidence rates of bacteraemia in COPD patients and randomly selected reference individuals from the general population. Methods: In this population based cohort study all patients with COPD, >= 40 years of age, who were discharged from hospitals in southern Sweden between 1990 and 2003 were identified in the Swedish Inpatient Register (n = 15,403). Age and gender matched reference individuals were randomly selected from the general population. Records were cross-referenced to the microbiological databases covering the region, 1990-2010. The hazard ratios (HR) of bloodstream infections and hospitalisations for infections were estimated by Cox proportional hazards regression. Results: We found that individuals with COPD had a 2.5-fold increased incidence of bacteraemia compared to the reference individuals from the general population adjusted for other co-morbidity and socio-economic status (hazard ratio: 2.5, 95% confidence interval: 2.2-2.7). The increased incidence of bacteraemia was paralleled by an increased incidence of hospitalisation for non-respiratory infections, i.e., skin infections, pyelonephritis, or septic arthritis. Despite higher absolute rates of bloodstream infections among COPD patients than among the general population, the distribution of different pathogens was similar. Conclusions: In summary this population-based study shows COPD is associated with an increased incidence of invasive bacterial infections compared to the general population, indicating a general frailty of acquiring severe infections in addition to the specific susceptibility to infections of respiratory origin. The underlying contributory factors (e. g. smoking, corticosteroid use, co-morbid diseases or a frailty inherent to COPD itself) need to be disentangled in further studies.},
  author       = {Inghammar, Malin and Engström, Gunnar and Ljungberg, Bengt and Löfdahl, Claes-Göran and Roth, Adam and Egesten, Arne},
  issn         = {1471-2334},
  language     = {eng},
  publisher    = {BioMed Central (BMC)},
  series       = {BMC Infectious Diseases},
  title        = {Increased incidence of invasive bacterial disease in chronic obstructive pulmonary disease compared to the general population-a population based cohort study},
  url          = {https://lup.lub.lu.se/search/files/3829335/5147950},
  doi          = {10.1186/1471-2334-14-163},
  volume       = {14},
  year         = {2014},
}