Optimizing The Routes Of Specimen Collecting In The Lower Respiratory Tract Infection

CHAPTER I Investigation of the qualification rate of expectorated sputum and the pathogenic detection rate with lower respiratory tract infection in 2011-2015Objective To investigate the current status of the qualification rate and the pathogenic detection rate of expectorated sputum in patients with lower respiratory tract infection (LRTI) so as to provide evidence for optimizing sputum culture and guidance for using antibiotics reasonally.Methods The patients’sputum samples were collected to investigate the qualification rate and the pathogenic detection rate of expectorated sputum in the patients with lower respiratory tract infection from 2011 to 2015, and the pathogenic distribution and drug resistance rate were also monitored.Results A total of 3,338 sputum samples were collected and only 1,369 were qualified in the five years; the pooled qualification rate of expectorated sputum was 41.0% with a range of 32.5-46.2%, and the pathogenic detection rate of the qualified sputum samples was 30.1% with a range of 24.6-38.1%. The pathogens were mainly gram-negative (G-) bacilli strains (86.0%) included Escherichia coli, P.aeruginosa, Klebsiella pneumoniae, Acinetobacter spp., and Staphylococcus aureus. The pathogenic distribution was similar in every year, but the drug resistance rates to the common used antibiotics were different in the annual monitoring.Conclusions The qualification rate and pathogenic detection rate of expectorated sputum are very low, it’s necessary to find ways to improve the qualification rate and the pathogenic detection rate of expectorated sputum in patients with lower respiratory tract infection. The doctor should use reasonally the antibiotics by the monitoring results.CHARPTERⅡ Compare Cetylpyridinium Chloride Buccal tablets with Compound Chlorhexidine Gargle in improving the qualification rate and pathogenic detection rate of expectorated sputum:A prospective randomized controlled trialObjective To compare Cetylpyridinium Chloride Buccal tablets with Compound Chlorhexidine Gargle in improving the qualification rate and pathogenic detection rate of expectorated sputum with so as to find ways in optimizing sputum sample.Methods A prospective randomized controlled clinical trial was investigated the role of the qualification rate and pathogenic detection rate of expectorated sputum with Cetylpyridinium Chloride Buccal tablets (CPC) and Compound Chlorhexidine Gargle (CCG) in improving the qualification rate of expectorated sputum. The enrolled inpatients with lower respiratory tract infections were divided into three groups randomly. The contrast group (A group):the patients expectorated sputum before antibiotic as usually, the CPC group (B group):the patients expectorated sputum after taking CPC, and the CCG group (C group):the patients expectorated sputum after taking CCG, then the qualification rate and pathogenic detection rate of expectorated sputum among the 3 groups were compared, and the pathogens distribution and drug resistance rate were analyzed.Results A total of 384 patients with 366 sputum samples were included the study, which were divided into A group (116 cases), B group (128 cases) and C group (122 cases). There were significant statistic different qualification rates of expectorated sputum among the 3 groups, which were 44.8,76.6 and 63.9%, respectively (P=0.000); the qualification rate of B group or C group was higher than the A group (P≤0.003) but with a same effect between B group and C group (P= 0.029>0.017). The pathogenic detection rates were similar among the 3 groups, which were 34.6,42.9 and 38.4%, respectively (P=0.601), however, the number of pathogenic detection in B group and C group were higher than the A group. The pathogens were mainly gram-negative (G’) bacilli strains included P.aeruginosa, Escherichia coli, Klebsiella pneumoniae, Acinetobacter spp., and stenotrophomonas maltophilia, and the resistance rates of different pathogens were different.Conclusions The using of Cetylpyridinium Chloride Buccal tablets and Compound Chlorhexidine Gargle can improve the qualification rate of expectorated sputum and increase the number of pathogenic detection.CHARPTER Ⅲ Compare bronchoalveolar lavage via nasal or tracheal cannula in pathogenic diagnosis and drug resistance rate monitor of pulmonary infectionObjective To investigate the value of bronchoalveolar lavage (BAL) via nasal or tracheal cannula in pathogenic diagnosis and drug resistance rate monitor of pulmonary infection (PI).Methods We conducted a retrospective analysis of pathogenic detection and drug resistance rate by bronchoalveolar lavage via nasal or tracheal cannula in patients with PI from 2013 to 2015. Bacterial identification and antibiotic susceptibility tests were carried out using MicroScanAutoScan-40 system and testing for ESBLs and MRS A; the data were analyzed by SPSS 19.0 and WHONET 5. Softwares.Results 1,332 patients with pulmonary infection were performed bronchoalveolar lavage by fiberoptic bronchoscopy in 3 years,207 cases via nasal (A group) and 1,125 cases via tracheal cannula (B group), and 84.5% of specimens were in the Intensive Care Unit (ICU) and neurosurgery ward. The qualification rates were similar in the 2 groups, which were 99.0% and 99.6%, respectively (P=0.666); the pathogenic detecting rate of bronchoalveolar lavage fluid (BALF) were also similar between the 2 groups, with an 85.5% and 86.9%, respectively (P=0.579). The pathogenic distributions were similar except Acinetobacter spp., however, drug resistant rates to most antibiotics were different between the 2 groups.Conclusions Both of transnasal or transtracheal cannula bronchoalveolar lavages are a high value approach in the pathogenic diagnosis and drug resistance monitor of pulmonary infection.CHAPTER Ⅳ Compare the Value of three sample collecting methods in the etiologic diagnosis for lower respiratory tract infectionObjective To compare the qualification rate and the pathogenic detection rate of samples with conventional expectorated sputum, modified expectorated sputum and bronchoalveolar lavage (BAL) so as to investigate their using values in clinic.Methods The inpatients with lower respiratory tract infection were divided into three groups according to the route of sample collecting. The conventional expectorated sputum group (A group):the patient expectorated sputum before using antibiotic as usually, the modified expectorated sputum group (B group): the patient expectorated sputum after taking Cetylpyridinium Chloride Buccal tablets (CPC) and the Compound Chlorhexidine Gargle, and the BAL group (C group):the sample was collected by BAL; then, the qualification rate and pathogenic detection rate of the 3 groups were compared.Results A total of 4,920 samples were included the study, with 3,338 samples in A group,250 samples in B group and 1,332 samples in C group. The qualification rates of the 3 groups were 41.0,70.4 and 99.5%, respectively; the qualification rate of B group or C group was higher than the A group (P<0.001), at the same time, the qualification rate of C group was higher than the B group (P<0.001). The pathogenic detection rates in the 3 groups were 30.1,40.1 and 87.2%, respectively, the pathogenic detection in C group was higher than A group or B group (P<0.001), and the pathogenic detection of B group was higher than A group (P=0.004)Conclusions The qualification rate and pathogenic detection rate of conventional expectorated sputum are very low, but modified expectorated sputum with Cetylpyridinium Chloride Buccal tablets and Compound Chlorhexidine Gargle can improve the qualification rate and the pathogenic detection rate of expectorated sputum. Compare to the methods with conventional expectorated sputum and modified expectorated sputum, bronchoalveolar lavage can significantly improve the qualification rate and the pathogenic detection rate of lower respiratory tract infection.