Estimating the contribution of respiratory pathogens to acute exacerbations of COPD using routine data. Issue 3 (March 2023)

• Record Type: Journal Article
• Authors: Sivakumaran, Shanya; Alsallakh, Mohammad A.; Lyons, Ronan A.; Quint, Jennifer K.; Davies, Gwyneth A.
• Is Part Of: Journal of infection. Volume 86:Issue 3(2023)
• Page Start: 233
• Page End: 238
• Publication Date: 2023-03
• Subjects: Respiratory tract infections -- Pulmonary disease -- Chronic obstructive -- Electronic health records; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2023.01.012
• Languages: English
• ISSNs: 0163-4453

Abstract

Highlights: Linkage of microbiology data to national admissions data over a two year period. Respiratory viruses are detected in a substantial proportion of COPD exacerbations. Increased respiratory viral testing could aid antimicrobial stewardship efforts. ICD codes have low sensitivity in identifying respiratory pathogens in routine data. Large-scale data linkage delineates the burden of specific pathogens with greater accuracy. Abstract: Objectives: To characterise microbiology testing and results associated with emergency admissions for acute exacerbation of COPD (AECOPD), and determine the accuracy of ICD-10 codes in retrospectively identifying laboratory-confirmed respiratory pathogens in this setting. Methods: Using person-level data from the Secure Anonymised Information Linkage Databank in Wales, we extracted emergency admissions for COPD from 1/12/2016 to 30/11/2018 and undertook linkage of admissions data to microbiology data to identify laboratory-confirmed infection. We further used these data to assess the accuracy of pathogen-specific ICD-10 codes. Results: We analysed data from 15, 950 people who had 25, 715 emergency admissions for COPD over the two-year period. 99.5% of admissions could be linked to a laboratory test within 7 days of admission date. Sputum was collected in 5, 013 (19.5%) of admissions, and respiratory virus testing in 1, 219 (4.7%). Where respiratory virus testing was undertaken, 46.7% returned any positive result. Influenza was the virus most frequently detected, in 21.5% of admissions where testing was conducted. ICD-10 codes exhibited low sensitivity in detecting laboratory-confirmed respiratory pathogens. Conclusions: In people admitted to hospital with AECOPD, increased testing for respiratory viruses could enable more effective antibiotic stewardship and isolation of cases. Linkage with microbiology data achieves more accurate and reliable case definitions.