Antibiotic use for hospitalized chronic obstructive pulmonary disease exacerbations: A propensity adjusted analysis

Background Antibiotics are frequently used in the treatment of chronic obstructive pulmonary disease (COPD) exacerbations. However, international guidelines suggest their use should be restricted to specific sub-groups based on the Anthonisen Criteria. The aim of this study was to assess the impact of antibiotic therapy on outcome in COPD. Methods We conducted a multi-centre prospective observational study assessing patients hospitalized with COPD exacerbation. Multivariable logistic regression was used to compare outcomes in patients treated with and without antibiotic therapy, including adjustment using a propensity score and adjustment for recognised predictors of 30-day mortality. The outcomes of interest were 30-day mortality and length of hospital stay. Results 1031 patients were included in the study. Median age was 74 years (interquartile range 63-75) and 48.7% were female. Mean FEV1 was 46% (standard deviation 19%). 30-day mortality was 5.4%. 818 patients (79.3%) received antibiotic therapy on admission (23.5% combination therapy, 76.5 % monotherapy). Antibiotic prescribing according to Anthonisen criteria was: Type 1 - 84% patients received antibiotics, Type 2 - 78.6% and Type 3 - 70.3%. After adjustment for propensity to receive antibiotic therapy and recognized predictors of mortality, there was no association between antibiotic use and 30 day mortality (OR 0.96 (0.37-2.48), p=0.9) or length of hospital stay (p=0.8). Conclusion Antibiotic treatment is frequently used in hospitalised acute exacerbations of COPD. This study did not find any evidence of benefit in terms of mortality or length of hospital stay.