CHEST Guidelines-Rebuttal-From-Dr-Keir-and-Prof-Chalmers

Rebuttal-From-Dr-Keir-and-Prof-Chalmers_chest

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The document discusses the complexities surrounding the clinical relevance of chronic bacterial infections (CBI) in patients with Chronic Obstructive Pulmonary Disease (COPD). It highlights the need for more research and a consensus on terminology to effectively translate findings into clinical practice. It is suggested that "CBI" could appropriately describe repeated isolation of pathogenic microorganisms, whereas "dysbiosis" still needs a clear definition for clinical use.<br /><br />Martinez-Garcia and Agusti advocate for the clinical relevance of bacterial isolation in COPD, citing its association with disease prognosis. They recommend inhaled antibiotic trials in COPD patients with repeated Pseudomonas aeruginosa isolation when other treatments have failed, even in the absence of bronchiectasis. However, their opponents, Dr. Keir and Prof. Chalmers, raise concerns about using CBI as a treatable trait due to the limitations of sputum culture, which lacks sensitivity and may not accurately reflect bacterial infection.<br /><br />Keir and Chalmers stress the importance of antimicrobial stewardship, warning against increased antibiotic use which could exacerbate antimicrobial resistance. They criticize the approach of defining CBI through sputum culture as it may lead to over-diagnosis, given the dynamic nature of bacterial communities in COPD. They advocate for personalized medicine approaches informed by clinical and molecular tests more reliable than sputum culture, emphasizing the need for evidence demonstrating the clinical benefits of antibiotics or potential future therapies like immunomodulators. There is agreement on the need for additional research to identify the at-risk COPD population for microbial dysbiosis and to determine effective treatments.

Keywords

Chronic Bacterial Infections

Chronic Obstructive Pulmonary Disease

Clinical Relevance

Pseudomonas aeruginosa

Antimicrobial Resistance

Sputum Culture

Antibiotic Trials

Microbial Dysbiosis

Personalized Medicine

Immunomodulators