Distribution And Antimicrobial Resistance Of Pathogens From Lower Respiratory Tract Infection In Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

Background and Objective : In recent years,due to frequent seizures of acute exacerbation of chronic obstructive pulmonary disease(AECOPD),recurrent hospitalization using antibiotics,glucocorticoid abuse and home oxygen therapy,airway atomization,wet improper operation,fiberoptic bronchoscopy,suction through nose or oropharynx,mechanical ventilation,such as tracheal intubation 、deep venous cetheterization and other invasive diseases,combined with other chronic underlying diseases or structural lung disease and other reasons,AECOPD patients with lower respiratory tract bacterial spectrum of bacteria has undergone great changes,and the phenomenon of bacterial resistance is becoming increasingly serious.To investigate the pathogen distribution and drug resistance from lower respiratory tract infection in patients with acute exacerbation of chronic obstructive pulmonary disease,Not only to provide the basis for the clinical use of antimicrobial agents,but also preliminary estimates of the development trend of drug-resistant strains,then the doctors could use antibiotics rationally,to reduce the productiion of resistant strains.Clinical information and methods: Sputum culture were conducted for 628 AECOPD patients who were admitted to a respiratory disease department from January to December in 2016,to do antimicrobial susceptibility testing for sputum culture positive patients,and antimicrobial susceptibility test results were analyzed by WHONET 5.6 software,to describe and analyze the date.Results : 628 AECOPD patients,248 cases were positive for sputum culture,with a positive rate of 39.4%.There were 157 males(63.3%)and 91 females(37.7%).The age ranged from 42 to 98 years,with a median age of 73 years;187 cases(75.4%)are from urban areas,the rest from rural areas(24.6%).Gram-negative(G-)bacilli 153 strains(61.69%),The main pathogens were Pseudomonas aeruginosa(41.18%),Klebsiella pneumoniae 57 strains(37.25%),Acinetobacter baumannii 9 strains(5.88%),Enterobacter aerogenes 5 strains(3.27%),Escherichia coli 5 strains(3.27%),Enterobacter cloacae 4 strains(2.61%),Proteus mirabilis 3 strains(1.96%);Between the strains of Pseudomonas aeruginosa and Acinetobacter baumannii,4 strains and 7 strains of multidrug-resistant strains were detected,accounting for 6.35%,77.78%,respectively,5 strains and 2 strains of ESBLs were detected in Klebsiella pneumoniae and Escherichia coli,Accounting for 8.77%,40% respectively.Gram-positive(G-)cocci 2 strains(0.81%),both were Staphylococcus aureus.93 strains(37.5%)were fungi,64 strains of Candida albicans(68.81%)and 10 strains of Candida glabrata(10.75%)and 8 strains of near smooth Candida glabrata(8.6%)were located in the top three.Gram-negative(G-)bacilli are most sensitive to erlipenem,meropenem,imipenem cilastatin,compound sulfamethoxazole,ciprofloxacin,levofloxacin,gentamicin,tetracycline,tobramycin;2 strains of Staphylococcus aureus were MSSA,MRSA,and both are sensitive to vancomycin 、 linezolid 、 sulfamethoxazole 、ciprofloxacin 、 levofloxacin 、 streptomycin 、 rifampicin 、 moxifloxacin 、quinupristin/dalfopristin and tetracycline.Fungal strains are most sensitive to amphotericin B,but candida albicans resistance to fluconazole was 20%,and Voriconazole was 10%.Conclusion: 1.AECOPD patients infected with pathogens were mainly bacterial infection.and The most common is Gram-negative bacilli.2.Sensitive antimicrobials for Gram-negative bacilli should be selected for the treatment.According to this study,the initial treatment can choose quinolones、 sensitive three-generation of cephalosporin 、 broad-spectrum penicillin+enzyme inhibitor compound preparation,and aminoglycosides can be used as a combination of choice,and carbapenems can be used as the last line of defense of antibiotics.3.infection with antimicrobial resistant Staphylococcus aureus and fungi should also be paid enough attention.if infect MRSA,vancomycin or linezolid is still as the first choice.4.Pseudomonas aeruginosa and Acinetobacter baumannii appear multidrug resistance,especially Acinetobacter baumannii,the use of antibiotics should be standardized and shorten the time of broad-spectrum antibiotics in clinical and we should pay attention to the treatment of complications,rational use of glucocorticoids,reducing the multidrug-resistant infections of Pseudomonas aeruginosa and Acinetobacter baumannii as far as possible.5.Although the proportion of multidrug-resistant strains is low,the hospital should continue to strengthen the detection of pathogens,master the distribution of pathogens and drug resistance,provide the basis for the clinical application of antibiotics.