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《Chinese Journal of Practical Internal Medicine》 2019-05
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Distribution of pathogenic bacteria and drug resistance analysis in patients with acute exacerbation of chronic obstructive pulmonary disease

TANG Huo-yan;LIU Hu;ZHAO Yun;XU Jian-ying;Department of Respiratory Medicine, Shanxi Dayi Hospital Affiliated to Shanxi Medical University;  
Objective To investigate the distribution of pathogenic bacteria and drug resistance analysis in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD), so as to guide clinical medication. Methods A retrospective study was conducted in Shanxi Dayi Hospital. Totally 1173 cases of AECOPD patients, hospitalized with infection from September 2013 to August 2018, were included. Then relevant laboratory data was collected, including sputum culture, drug sensitivity test, and some commonly used laboratory results. The data was analyzed. Results A total of 231 strains were isolated in 1173 AECOPD patients,the mian pathogenic bacteria were Gram-negative bacteria(115, 49.7%), fungi(66, 28.6%), Gram-positive bacteria(48, 20.8%),other bacteria(2, 0.9%). Drug-resistant strains of producing ESBLs mainly included Acinetobacter(88.9%), Escherichia coli(87.5%),Pseudomonas aeruginosa(70.6%) and Klebsiella pneumoniae(19.4%). The drug-resistance of Acinetobacter to carbapenems and quinolones was more than 70%. The drug-resistance of Escherichia coli to quinolones was 87.5%. The drug-resistance of Streptococcus pneumoniae to penicillin and first and second generation cephalosporins was 66.7%. The drug-resistance of Staphylococcus to penicillin and first and second generation cephalosporins, quinolones and methicillin was 92.3%, 76.9% and 46.2%, respectively. In all Gram-positive bacteria, drug-resistant strains for Vancomycin and linezolid can't be found. The positive rate of bacteria in the group of PaO_2≤60 mmHg(37.3%) was higher than that in the group of PaO_2 60 mmHg(8.8%). The detection rate of bacteria in the WBC≥10×10~9/L group(18.7%), NLR≥7.3 group(19.7%)and PCT0.5 ng/mL group(50.7%),which in turn was higher than that in the WBC10×10~9/L group(12.7%), NLR7.3 group(12.0%) and PCT≤0.5 ng/mL group(23.9%). The detection rate of bacteria in the Neu%≤75% group, Neu%(76%~90%) group and Neu%90% group was 10.6%, 16.9% and 30.1%, respectively. The results of trend chi-square test showed that the detection rate of bacteria increased with the decrease of PaO_2 and the increase of WBC, Neu%, NLR and PCT. Conclusion The distribution and drug resistance of pathogenic bacteria in sputum culture of AECOPD are serious, and the distribution of pathogens in AECOPD patients with different levels of PaO_2, WBC, Neu%, NLR and PCT was different. Therefore, we should pay more attention to sputum culture and some commonly used laboratory results in AECOPD patients, so as to provide the basis for the clinical medication.
【Fund】: 山西省青年科技研究基金资助面上青年基金项目(201701D221261)
【CateGory Index】: R563.9;R446.5
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