The Analysis On Status And Corresponding Factors Of Infection By Mycoplasma Pneumoniae In Inpatients With AECOPD

Object To investigate the status of infection by mycoplasma pneumoniae in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and potential clinical factor in order to provide clinical guidance on management of treatment.Method An agreed questionnaire on infection by atypical pathogen and summary of its treatment among AECOPD inpatients was designed based on a seminar among Chronic Obstructive Pulmonary Disease Committee,Tianjin Medical Association.The questionnaire was used to collect clinical information on AECOPD inpatients who were hospitalized into 19 hospitals of Level II and Level III during April 2015 and April 2016.ELISA test was used to determine the level of mycoplasma pneumoniae Ig M(MP-Ig M).MP infection was defined as a double-check fourfold increase in MP-Ig M titer at the time of discharge compared with that at the time of admission,or negative result for MP-Ig M at the time of admission and positive result at the time of discharge.The MP infection rate among AECOPD inpatients was calculated considering such factor as gender,age,duration of admission,vital sign at the time of admission,respiratory symptoms,non-respiratory symptoms,partial signs,residence,status of smoking,family-based oxygen therapy,medicine administration during stable phase,classification of pulmonary function,frequency of acute exacerbation in previous year,laboratory test results,status of mechanical ventilation,administration of anti-infection and glucocorticoid medicine.Results 1.Serum samples from 683 AECOPD inpatients were collected,among which 98 were determined as MP-infected,585 non-MP-infected.The MP infecteion rate was 14.35%.2.There was no significant difference in MP infection rate among male and female inpatients(P>0.05).3.There was no significant difference in MP infection rate among inpatients of different age groups(P>0.05).4.There was significant increase in the duration of admission in MP-infected inpatients compared with non-MP-infected inpatients(P=0.001).5.There was significant increase in breath frequency in MP-infected inpatients(P=0.001).There was no significant difference in body temperature,pulse frequency,systolic pressure,diastolic blood pressure between MP-infected and non-MP-infected inpatients(P>0.05).6.There was significant increase of frequency of purulent sputhum and significant exacerbation in dyspnea in MP-infected inpatients(P<0.05).There was no significant exacerbation in cough and no significant increase in phlegm volume between MP-infected and non-MP-infected inpatients(P>0.05).7.In terms of non-respiratory symptoms,the weakness in strength and the decrease in endurance was significantly more severe in MP-infected group(P=0.000),who also experienced significantly severe insomnia(P=0.014).There is no significant difference in somnolence,depression,abalienation(P>0.05)8.The degree of polypnea and tachycardia in MPinfected group was significantly higher than those in non-MP-infected group(P<0.05);there is no significant difference in incidence rate of fever between the two groups(P>0.05).9.The MP infection rate in AECOPD patients in different residence was as follows: urban area 13.24%,suburban area 20.98%,country area 5.56%,and the difference was significant(P=0.001);the infection rate was also significantly different between patients living in different buildings: patients living in tall buildings 15.92%,patients living in one-story building 8.22%(P=0.018).10.There was no significant difference in MP-infection rate between AECOPD smoking and nonsmoking inpatients(P>0.05)11.There was significant increase in MP-infection rate between inpatient group with family-based oxygen therapy compared with group without(P<0.01).12.The MP-infection rate in inpatients with regular intake of ICS/LABA was 11.38%,which was significantly lower than that of those without regular intake of ICS/LABA(17.13%,P=0.0033).The infection rate in inpatients with regular intake of expectorant drugs was 18.39%,which was significantly higher than that of those without regular intake of expectorant drugs(9.15%,P=0.001).There was no significant difference in percentage of regular intake of LAMA,LTRA or Theophylline drugs during stable phase between MP-infected group and non-MPinfected group.13.There was significant decrease in MP infection rate in COPD inpatients with frequent acute exacerbation compared with those without frequent acute exacerbation(P=0.000).14.The infection rate in inpatients with different GOLD classification of pulmonary function was as follows: Class I 7.69%,Class II 8.92%,Class III 10.67%,Class IV 11.83%.The difference was not signiciant(P>0.05).15.There was no significant difference in WBC,neutrophil cell ratio,lymph cell ratio,mononuclear leucocyte ratio,eosinophilic granulocyte ratio,hemoglobin ratio,blood platelet ratio between MP-infection and non-MP-infection group(P>0.05).There was no significant difference in PCT and CRP between MPinfection and non-MP-infection group(P>0.05).16.There was no significant difference in MP-infection rate between inpatients with mechanical ventilation and those without mechanical ventilation(P>0.05).17.There was no significant difference in duration of hospitalization or duration of administration of glucocorticoid between groups with different initial treatment(macrolide-treated group,levofloxacin-treated group,moxifloxacin –treated group and groupo with noncovered anti-atypical-pathogen treatment)(P>0.05).However,analysis on therapeutic prognosis showed that in MP-infected inpatients,all cases were discharged with improvement except one death and one discharged without improvement.These two inpatients were in group with non-covered anti-atypical-pathogen treatment.Conclusion 1.Using 683 serum samples from AECOPD inpatients for analysis,the study showed that the MP infection rate among AECOPD inpatients in multiple parts of local area was 14.35%.2.There was significant difference in respiratory symptom,non-respiratory symptom,vital signs,residence and living environment and significant increase in duration of admission among AECOPD inpatients infected with MP.3.Long-term family-based oxygen therapy and regular intake of ICS/LABA decreased the MP infection rate.It demands further study to show the relation of MP infection rate with status of illness and pulmonary function variation.4.The MP infection rate was lower in AECOPD inpatients with frequent acute exacerbation before hospitalization,which might be explained by higher risk of bacteria infection.The specific reason remains to be investigated with larger-sample and multi-center study.