Pneumonic vs. non-pneumonic exacerbations in bronchiectasis

Rationale: Exacerbations are relevant in bronchiectasis (BE) but little is known regarding microbiology and outcomes of pneumonic (CAP) vs. non-pneumonic (EXAC) exacerbations Objective: To compare clinical and microbiological characteristics of CAP vs. EXAC in adult patients with BE Methods: Multicentre prospective observational study of consecutive cases from 4 Spanish hospitals Results: We recruited 144 patients: 91 EXAC (63%) and 53 CAP (37%); 89% required hospitalization (CAP 94%, EXAC 86%). Demographics, vaccines, bronchiectasis aetiology and severity, and lung function were similar in both groups. CAP group showed more males and COPD but less chronic bronchial infection, previous exacerbations and macrolides than EXAC group. Clinical presentation was similar excepting higher values of creatinine, C-reactive protein, glucose and leukocytes in CAP. S.pneumoniae and P.aeruginosa were the first cause of CAP and EXAC, respectively. Most patients with P.aeruginosa already had a chronic infection by the same microorganism prior to CAP (71%) or EXAC (81%). Nevertheless, numerous patients with previous chronic P.aeruginosa had a new infection in our study (19% of EXAC, 58% of CAP). CAP showed more atrial fibrillation but similar outcomes (hospital stay, mortality, etc.) than EXAC. Chronic bronchial infection and previous exacerbations≥2/year were protective factors for CAP at multivariate analysis Conclusions: CAP and EXAC in patients with BE have similar clinical presentation.An initial antibiotic treatment should cover S.pneumoniae in CAP and P.aeruginosa in EXAC, particularly in case of previous chronic infection, however a complete microbiological research is recommended. Pneumococcal vaccination should be considered in BE.