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Clinical Microbiology Reviews, April 2001, p. 336-363, Vol. 14, No. 2
0893-8512/01/$04.00+0   DOI: 10.1128/CMR.14.2.336-363.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Bacterial Infection in Chronic Obstructive Pulmonary Disease in 2000: a State-of-the-Art Review

Sanjay Sethi1,2 and Timothy F. Murphy2,3,4,*

Division of Pulmonary and Critical Medicine1 and Division of Infectious Diseases,3 Department of the Medicine, and Department of Microbiology,4 State University of New York at Buffalo, and the VA Western New York Healthcare System,2 Buffalo, New York

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States. The precise role of bacterial infection in the course and pathogenesis of COPD has been a source of controversy for decades. Chronic bacterial colonization of the lower airways contributes to airway inflammation; more research is needed to test the hypothesis that this bacterial colonization accelerates the progressive decline in lung function seen in COPD (the vicious circle hypothesis). The course of COPD is characterized by intermittent exacerbations of the disease. Studies of samples obtained by bronchoscopy with the protected specimen brush, analysis of the human immune response with appropriate immunoassays, and antibiotic trials reveal that approximately half of exacerbations are caused by bacteria. Nontypeable Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae are the most common causes of exacerbations, while Chlamydia pneumoniae causes a small proportion. The role of Haemophilus parainfluenzae and gram-negative bacilli remains to be established. Recent progress in studies of the molecular mechanisms of pathogenesis of infection in the human respiratory tract and in vaccine development guided by such studies promises to lead to novel ways to treat and prevent bacterial infections in COPD.

* Corresponding author. Mailing address: Medical Research 151, VA Western New York Healthcare System, 3495 Bailey Ave., Buffalo, NY 14215. Phone: (716) 862-7874. Fax: (716) 862-6526. E-mail: murphyt{at}acsu.buffalo.edu.

Clinical Microbiology Reviews, April 2001, p. 336-363, Vol. 14, No. 2
0893-8512/01/$04.00+0   DOI: 10.1128/CMR.14.2.336-363.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.


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