| Objective:To explore the distribution and drug resistance of pathogens in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),to analyze the relationship between pathogen infection and pulmonary function and oxygen therapy,as well as the risk factors of infection.At the same time,the current situation of the use of antibiotics in our department and its coincidence rate with the consensus of Chinese experts on anti-infective treatment of AECOPD in 2019 were analyzed,in order to guide and standardize the anti-infective treatment of AECOPD.Methods:The clinical data of 519 inpatients diagnosed as acute exacerbation of chronic obstructive pulmonary disease in the Department of Respiratory and critical Medicine of the second Hospital of Hebei Medical University from December 31,2017 to December 31,2020 were collected.The detection of pathogenic bacteria in patients’lower respiratory tract samples and the results of drug sensitivity test were recorded.According to the GOLD classification of airflow limitation,the pulmonary function was divided into 4 grades,and the difference of pathogen isolation rate among all levels of patients was analyzed.According to the different methods of oxygen therapy,the patients were divided into nasal catheter oxygen inhalation group,non-invasive mechanical ventilation group and invasive mechanical ventilation group,and the difference of pathogen isolation rate among each group was analyzed.The effective rate of empirical anti-infective treatment regimen and the adjustment of antimicrobial regimen according to the results of drug sensitivity test were analyzed.To analyze the current situation of anti-infective treatment in our department and its coincidence rate with the consensus of Chinese experts in anti-infective treatment of AECOPD.Results:1.A total of 519 patients with AECOPD were selected in this retrospective study,including 398 males and 121 females,with a male-to-female ratio of 3.29:1.The average age was 70.74±9.70 years old,and the average hospital stay was 14.70±9.35 days.Samples of lower respiratory tract were taken from 412 patients for pathogen detection,155patients were positive(37.62%),and a total of 183 strains of pathogens were detected.There were 8 strains of gram-positive bacteria(4.37%),162 strains of gram-negative bacteria(88.52%)and 13 strains of fungi(7.11%).The main pathogens were 51 strains of Acinetobacter baumannii(27.87%),45 strains of Klebsiella pneumoniae(24.59%),37 strains of Pseudomonas aeruginosa(20.22%)and 12 strains of Aspergillus(6.56%).2.In 193 patients with positive etiology and perfect pulmonary function examination,the positive rates of pathogens in each group were 17.39%,32.63%,43.18%and 62.5%,respectively,and the worse the lung function,the more likely to infect pathogens(P<0.05).The positive rates of pathogens in different oxygen therapy groups were 31.15%,50.94%and 73.68%,the level of oxygen delivery pathway was correlated with the infection of pathogenic bacteria(P<0.001).The independent risk factors of pathogen infection in AECOPD patients were diabetes,pneumonia,respiratory failure and hospitalization due to AECOPD in the past year.3.The drug sensitivity results showed that the drug resistance rates of G~-bacteria to commonly usedβ-lactam and quinolones were more than 25%,and the most serious drug resistance was Acinetobacter baumannii,which was more than 50%to quinolones andβ-lactam.Sensitive only to colistin and tegacycline.All G~+bacteria were sensitive to linezolid and vancomycin.4.In this study,we found that in the empirical anti-infective treatment of AECOPD patients in our department,231cases(44.51%)were treated with single drug and 288 cases(55.49%)were combined with drugs.The most common regimens wereβ-lactam/β-lactamase inhibitors combined with quinolones(36.62%)andβ-lactam/β-lactamase inhibitors(30.64%).The anti-infective treatment regimen was adjusted according to the drug sensitivity test in 86 cases.The effective rate of each antimicrobial treatment fluctuated between 66.67%and 100%.The principle of the use of antimicrobials is basically in line with China’s"AECOPD Anti-infection Chinese expert consensus"in 2019.Conclusions:1.In this study,patients with AECOPD were mainly infected by G~-bacteria,mainly Acinetobacter baumannii,Klebsiella pneumoniae and Pseudomonas aeruginosa.All of them were resistant to antibiotics commonly used in our department(β-lactam,quinolones)in varying degrees.Acinetobacter baumannii was the most resistant and was only sensitive to colistin and tegacycline.The main G~+bacteria were Staphylococcus aureus and Streptococcus pneumoniae,and no resistant strains of MRSA,oxazolidinone and glycopeptide were found.2.The most common choice of empirical anti-infective therapy for AECOPD patients in our department isβ-lactam/β-lactamase inhibitors combined with or not combined with quinolones(67.36%).The total effective rate of antimicrobial treatment was 87.48%.However,the use of antibiotics is stronger and the treatment course is longer than the Chinese Expert Consensus on Anti-Infection of AECOPD in China in 2019.3.The more severely impaired lung function,the more likely it is to be infected with pathogenic bacteria.The level of oxygen delivery pathway correlates with pathogen infection.Diabetes,pneumonia,respiratory failure and hospitalization due to AECOPD in the past year were all independent risk factors of pathogen infection. |
PDF Full Text Request