Estudo microbiológico dos pacientes com bronquiectasias não fibrocísticas e sua associação com mediadores inflamatórios

Abstract

Introduction: Non-fibrocystic bronchiectasis (NFCB) is a growing global health problem with high morbidity and mortality related to the control of the chronic bronchial infectious and inflammatory process that governs its pathophysiology. Objective: Evaluation of a microbiological study of patients with non-cystic fibrosis bronchiectasis and its association with inflammatory mediators. Methods: Cross-sectional study was carried out from March 2018 to October 2019 in a tertiary referral hospital in Fortaleza-Brazil, in patients with NFCB to analyze the correlation of sputum microbiological agents and serum inflammatory mediators: Creactive protein (CRP), fibrinogen, ESR). The patients were submitted to spirometry, sixminute walking test (6MWT), measurement of fibrinogen, FACED questionnaire, information about azithromycin, radiological involvement was collected, and sputum were sampled. Results: the study included 112 patients with a mean age of 51,6 ± 17 years and the predominance was female (68%). The predominance of disease severity according to FACED was mild to moderate (83%). The mean 6MWT (six-minute walking test) of 468.8±87.9m, FEV1% (forced expiratory volume in the first second) and FVC% (forced vital capacity) values of 60.4±21.8 and 69.9±18.5 respectively. The serum fibrinogen level was 396.1±76.3. Pseudomonas aeruginosa (PA) isolation accounted for 47 patients, 31 isolated other PPMs (Potentially pathogenic microorganisms) and 34 non-PPM. The predominance of sputum colour was mucopurulent/purulent in 77 patients (68%). Comparing PA isolation vs PPMs vs non- PPM, we observed that bronchiectasis was graded more severe, serum fibrinogen was higher and FCV% was lower, sputum was purulent and long-term use of azithromycin was more frequent among PA isolation. For multivariate logistic regression analysis, the independent factors associated with isolation of PA were Fibrinogen >400 (mg/dl) and “Murray” purulent sputum. Conclusion: According to the microbiological status, three different sub-groups of patients were found. Inflammatory markers fibrinogen and sputum colour were able to predict the isolation of PA, emphasizing the importance of routine sputum monitoring.