Clinical significance of respiratory bacteria and mycobacteria isolates in adult bronchiectasis in Taiwan

Chia-Ling Chang; Chau-Chyun Sheu; Ping-Huai Wang; Meng-Heng Hsieh; Wu-Huei Hsu; Ming-Tsung Chen; Wei-Fan Ou; Yu-Feng Wei; Tsung-Ming Yang; Chou-Chin Lan; Cheng-Yi Wang; Chih-Bin Lin; Ming-Shian Lin; Yao-Tung Wang; Ching-Hsiung Lin; Shih-Feng Liu; Meng-Hsuan Cheng; Yen-Fu Chen; Wen-Chien Cheng; Chung-Kan Peng; Ming-Cheng Chan; Ching-Yi Chen; Lun-Yu Jao; Ya-Hui Wang; Chi-Jui Chen; Shih-Pin Chen; Yi-Hsuan Tsai; Shih-Lung Cheng; Horng-Chyuan Lin; Jung-Yien Chien; Hao-Chien Wang

doi:10.1183/23120541.00865-2024

Clinical significance of respiratory bacteria and mycobacteria isolates in adult bronchiectasis in Taiwan

ERJ Open Res. 2025 Jul 14;11(4):00865-2024. doi: 10.1183/23120541.00865-2024. eCollection 2025 Jul.

Authors

Chia-Ling Chang^{1

2}, Chau-Chyun Sheu^{3

4}, Ping-Huai Wang⁵, Meng-Heng Hsieh^{6

7}, Wu-Huei Hsu^{8

9

10}, Ming-Tsung Chen¹¹, Wei-Fan Ou¹², Yu-Feng Wei^{13

14}, Tsung-Ming Yang¹⁵, Chou-Chin Lan¹⁶, Cheng-Yi Wang¹⁷, Chih-Bin Lin^{18

19}, Ming-Shian Lin²⁰, Yao-Tung Wang^{21

22}, Ching-Hsiung Lin^{23

24

25}, Shih-Feng Liu^{7

26

27}, Meng-Hsuan Cheng^{3

28}, Yen-Fu Chen^{29

30}, Wen-Chien Cheng⁸, Chung-Kan Peng¹¹, Ming-Cheng Chan³¹, Ching-Yi Chen¹³, Lun-Yu Jao¹⁶, Ya-Hui Wang³², Chi-Jui Chen¹⁸, Shih-Pin Chen^{21

22}, Yi-Hsuan Tsai^{26

33}, Shih-Lung Cheng^{5

34}, Horng-Chyuan Lin^{6

7

35}, Jung-Yien Chien^{36

37}, Hao-Chien Wang^{36

38

37}

Affiliations

¹ Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
² Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
³ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
⁴ Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁵ Division of Thoracic Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
⁶ Department of Thoracic Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
⁷ College of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁸ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
⁹ Critical Medical Center, China Medical University Hospital, Taichung, Taiwan.
¹⁰ School of Medicine, China Medical University, Taichung, Taiwan.
¹¹ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
¹² Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
¹³ Division of Chest Medicine, Department of Internal Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan.
¹⁴ School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
¹⁵ Division of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
¹⁶ Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
¹⁷ Department of Internal Medicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
¹⁸ Division of Pulmonary Medicine, Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
¹⁹ School of Medicine, Tzu Chi University, Hualien, Taiwan.
²⁰ Division of Pulmonary Medicine, Department of Internal Medicine, Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
²¹ Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
²² School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
²³ Department of Internal Medicine, Division of Chest Medicine, Changhua Christian Hospital, Changhua, Taiwan.
²⁴ Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan.
²⁵ PhD Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan.
²⁶ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.
²⁷ Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.
²⁸ Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
²⁹ Department of Internal Medicine, National Taiwan University Hospital, Yunlin Branch, Douliu, Taiwan.
³⁰ Thoracic Medicine Center, Department of Medicine and Surgery, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan.
³¹ School of Post Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
³² Medical Research Center, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
³³ Department of Pulmonary Medicine, Lee's Clinic, Pingtung, Taiwan.
³⁴ Department of Chemical Engineering and Materials Science, Yuan Ze University, Taoyuan City, Taiwan.
³⁵ Department of Respiratory Therapy, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
³⁶ Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
³⁷ J-Y. Chien and H-C. Wang contributed equally to this article as lead authors and supervised the work.
³⁸ Department of Medicine National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan.

Abstract

Background: The clinical impact of bacterial and mycobacterial isolates on bronchiectasis remains uncertain.

Methods: Patients with bronchiectasis at 16 hospitals in Taiwan were recruited with a 1-year follow-up. The patients were classified into six groups: Group 1, Pseudomonas aeruginosa; Group 2, Klebsiella pneumoniae; Group 3, other bacteria; Group 4, non-tuberculous mycobacteria (NTM); Group 5, daily sputum without bacterial or NTM colonisation; and Group 6, dry bronchiectasis.

Results: In total, 1416 patients (mean age 67 years; 43% males) were included. The mean modified Reiff score was 5 (range 1-18). 59% (829 patients) had sputum, whereas the remaining did not. The proportions of bacteria and NTM cultured from sputum within 1 year of observation were 27% (381/1416) and 15% (202/1416), respectively. The most common bacterial isolate was P. aeruginosa (13%), followed by K. pneumoniae (7%). 26% of the patients experienced severe exacerbations at least once within the year. The 1-year all-cause mortality rate was 3%. Patients with sputum exhibited a higher rate of severe exacerbations compared to patients with dry bronchiectasis, regardless of the presence of bacteria or NTM (p<0.001). Patients with bacterial colonisation had a higher mortality rate (p<0.001). Further, the highest mortality rate was observed among those with K. pneumoniae colonisation (hazard ratio (HR) 8.39 (95% CI 2.39-29.49)), followed by individuals colonised with other bacteria (HR 8.04 (95% CI 2.36-27.38)) and P. aeruginosa (HR 7.83 (95% CI 2.45-25.03)). Additionally, old age was an independent risk factor (HR 2.72 (95% CI 1.19-6.18)).

Conclusion: K. pneumoniae was more frequently isolated from patients with bronchiectasis in Taiwan compared to Western countries and was associated with unfavourable clinical outcomes.