Analysis On Bacterial Infection And Drug Resistance In Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

Objective This thesis studies on bacteria distribution,drug resistance and the relationship between the bacteria distribution and acute exacerbation of pulmonary function in patients with AECOPD in hospital.It could provide evidence for rational use of antibiotics and contribute to early and effective control of infection.Methods Information of 146 patients with AECOPD at the Department of Respiratory,the First Affiliated Hospital of Changzhi Medical College from January 2007 to December 2008 was collected.The following items were investigated:gender,age,smoking history,natural course of disease,sputum culture,drug sensitivity test and pulmonary function.All cases are classified into three groups by the percent of the first second forced expiratory volume(FEVl) vs.the estimated value.Characteristics of Bacteria distribution,its relationship with severity of disease and drug resistance were studied by retrospective analysis.Results①84 of 146 AECOPD cases were found the growth of bacteria or fungi in sputum culture; the other 62 cases were not.The positive rate is 57.53%(84/146).A total of 92 pathogens were isolated,the majority of which are gram-negative bacilli,or 60.86%(56/92).The top 5 bacterial infections are Acinetobacter baumannii 13(14.13%),Escherichia coli 10 strains(10.87%), Klebsiella pneumoniae 7(7.61%),Enterobacter cloacae 7(7.61%),Pseudomonas aeruginosa 5 (5.43%).There are 6 Gram-positive cocci(6.52%),5 of which are Staphylococcus epidermidis (5.44%);30 fungi(32.61%),29 of which are Candida albicans.②It is common that the detection rate of Pseudomonas,Enterobacter and Acinetobacter increases along with AECOPD patients are exacerbated.③The testing for bacterial susceptibility shows that gram-negative bacilli are resistant to cephalosporins,quinolones,aminoglycosides and carbopenems at all.The first five kinds of gram-negative bacilli are least resistant to imipenem,less resistant to amikacin and piperacillin / tazobactam,resistant to cefepime with the rate of 20%～40%.but quite resistant to ceftazidime with the rate of 30%～60%.Baumanii are most resistant to furadantin with the rate of 92%. Escherichia coli are most resistant to ciprofloxacin at 100%.Enterobacter cloacae and pseudomonas aeruginosa are most resistant to cefazolin at 100%.Klebsiella pneumoniae are generally less resistant to antibacterial drugs than other bacilli.Gram positive coccus are least resistant to minocycline and teicoplanin,but very resistant to ampicillin / sulbactam,TMP-SMZ and penicillins.Conclusions Gram-negative bacteria is the majority on the composition of bacteria of AECOPD patients,including acinetobacter baumannii,escherichia coli,klebsiella pneumoniae,enterobacter cloacae,pseudomonas aeruginosa,etc.It is found the relationship between bacteriology of sputum culture results and damage of lung function.Usually the AECOPD patients' lung function is exacerbated along with the high detection rate of Pseudomonas,Enterobacter and Acinetobacter. The testing results on drug susceptibility show severe drug resistance.Gram-negative bacilli is high resistant to cephalosporins and penicillin,and normal sensible to imipenem and amikacin. Bacterial resistance is a serious problem now and the emergence of multiple drug-resistant bacteria becomes a challenge we must face in clinical use of antibiotics.