The Study Of The Distribution Characteristics Of Bacteria And The Clinical Significance In COPD Patients With Ventilator-associated Pneumonia

Purpose: The aim of this study was to observate the difference between COPD patients and non-COPD patients with VAP in microbiologic results,blood gas analysis and clinical results. We will find the COPD patients with VAP are different from non-COPD patients in microbiologic distribution,blood gas analysis and the net result,to guide antimicrobial treatment,observe the clinical process and speculate the result.Methods:Representative,observational, case-control study conducted in the Fujian Provincial Hospital during a 4-year period. All COPD patients who required intubation and mechanical ventilation (MV) for > 48 h were eligible. VAP diagnosis was based on CPIS(Clinical pulnonary infection score). In the controls, patients with VAP,but without COPD are chosen,they are from Neurology.Investigating microbiologic results,the sequence of blood gas analysis and clinical results,to compare patients from two groups.Results: A total of 38 patients were eligible in group A, their age was 75.36±15.61 years, male patients were 28 ones. A total of 37 patients were eligible in group B, their age was 71.43±24.64 years, male patients were 27 ones. There were 108 bacteriums be found in group A, 76.63% of the samples(86ones) were Gram-negative bacterias,mainly Acinetobacter baumannii which had 22 ones,secondly Pseudomonas aeruginosa which had 20 ones.Most Acinetobacter baumanniis were multidrug-resistant. Gram-positive bacterias were based on Staphylococcus. VAP was polymicrobial in 22 patients(56.41%). There were 77 bacteriums be found in group B, 98.83% of the samples(53ones) were Gram-negative bacterias,mainly Acinetobacter baumannii which had 17 ones.Most Acinetobacter baumanniis were multidrug -resistant. Gram-positive bacterias were based on Staphylococcus,were 15.58%. VAP was polymicrobial in 20 patients(53.85%). Mortality rate and length of hospital stay were significantly higher in case patients(group A) than in control patients (group B). In VAP patients, group A compared with group B, gram-negative bacterias,fungi and multiple infection were not sensible difference,but gram-positive bacterias and Pseudomonas aeruginosa were significantly difference. Before and after the using mechanical ventilation(MV) All VAP patients had significant changes in the PH, partial pressure of carbon dioxide, partial pressure of oxygen,but bicarbonate did not change.Meanwhile comparing group A with group B ,partial pressure of carbon dioxide and partial pressure of oxygen returned to normal were not significantly different in statistical analysis.Conclusion: Whether is or not change in lung function, multiple infection in VAP patients are familiar, Pseudomonas aeruginosa Ventilator-Associated Pneumonia is associated with increased morbidity rates in COPD patients. The infection of gram-negative bacterias is increased in COPD patients with VAP,in contrast, the infection of gram- positive bacterias often appear in the non-COPD patients. The cause of death is not significant correlate to the time which respiratory failure is improved. COPD is one of the prediction risk factors for VAP.