| Objective: To analyze retrospectively the clinical data of patients with bronchiectasis in the acute exacerbation of chronic obstructive pulmonary disease in the respiratory department of the Affiliated Hospital of Southwest Medical University,to collect sputum culture in patients with positive results,and to analyze the bacterial distribution and drug resistance of sputum culture.at the same time,the effects of different sex,age,smoking and lung function on the distribution of pathogenic bacteria were analyzed,and the effects of different kinds of pathogenic bacteria,different lung functions and smoking conditions on the levels of serum CRP,PCT,WBC,N% and other inflammatory indexes were analyzed to provide a certain basis for clinical treatment.Methods:The clinical data of patients with bronchiectasis positive sputum culture in the acute exacerbation period of chronic obstructive pulmonary disease(AECOPD)in the respiratory medicine department of the Affiliated Hospital of Southwest Medical University from August 1,2013 to July 31,2017 were analyzed retrospectively.The general situation,the results of sputum culture,pulmonary function results,the CT results of the chest,the C reactive protein(CRP),the Procalcitonin(PCT),Leucocyte count(WBC),neutrophil proportion(N%)and other inflammatory markers were collected.Collect the sputum culture positive patients 80 cases,collected a total of 85 strains of pathogens,were analyzed for clinical data collected by statistical software SPSS23.0,using WHONET5.6 software for COPD acute exacerbation bronchiectasis patients the distribution of pathogenic bacteria and drug resistance analysis.Statistical SPSS23.0 software was used to statistic the collected clinical data,and WHONET5.6 software was used to analyze the distribution and drug resistance of pathogenic bacteria in patients with acute exacerbation of COPD complicated with bronchiectasis,the effects of different age,sex,smoking and lung function on pathogenic bacteria were analyzed with software SPSS23.0,and the effects of different pathogens,different lung functions and smoking conditions on serum CRP,PCT,WBC,N% and other inflammatory indexes were analyzed.The different statistical data were analyzed by t test,2 test and variance analysis.P<0.05 thought the difference was statistically significant.Results:(1).80 cases of positive sputum culture of patients,collected a total of 85 strains of pathogenic bacteria were gram negative bacteria,(G-),gram positive bacteria and fungi(G+),including 60 strains of gram negative bacteria,accounting for 70.58%,including Pseudomonas aeruginosa(28.23%),Pseudomonas fluorescens(7.06%),Klebsiella pneumoniae(7.06%),Bauman Acinetobacter(4.71%),Escherichia coli(4.71%).7 Strains of Gram-positive bacteria,accounting for 8.24%,mainly included Streptococcus pneumoniae(4.71%)and Staphylococcus aureus(3.53%).18 Strains of fungi,accounting for 21.18%,were mainly Candida albicans(16.47%)and Candida tropics(3.53%).(2).Drug resistance of gram negative bacteria commonly resistant to Pseudomonas aeruginosa and Acinetobacter Bauman is the most typical,extensively drug-resistant Pseudomonas aeruginosa,but the low rate of resistance,resistance to ciprofloxacin was 29.17%,the resistance rate of levofloxacin was 20.83%,resistant to piperacillin piperacillin on the rate was 16.67%.Xilin tazobactam resistance rate was 8.33%,the resistant rate of imipenem was 12.5%,were sensitive to beta lactams,beta lactamase inhibitor,aminoglycosides,quinolones,enzyme alkenes hydrocarbon,the sensitive rate of Amikacin,meropenem and piperacillin tazobactam and even up to 90% above.Acinetobacter Bauman is generally resistant to antibiotics and has high drug resistance.The resistance rate to ceftriaxone,ceftazidime,cefotaxime,cefepime,imipenem and compound sulfamethoxazole is 50%.Escherichia coli to ampicillin resistance rate was 100%,of cefepime,cefuroxime,gentamicin,levofloxacin,cotrimoxazole resistance rate greater than 50%.Drug resistance of Klebsiella pneumoniae was rare.In gram positive pathogens,vancomycin and linezolid were found to be drug-resistant.The sensitivity rate was 100%.Streptococcus pneumoniae and Staphylococcus aureus had high resistance rates to quinolones and macrolides.Among.(3).The sex,age,smoking and lung function of the patients with bronchiectasis were compared in the acute exacerbation of chronic obstructive pulmonary disease with bronchiectasis,and the difference was not statistically significant between the sex group and the ?2=9.13 and P>0.05.The difference was statistically significant in the age group ?2=15.75 and P<0.05.The difference was not statistically significant in the lung function group ?2=14.85,P>0.05,and the smoking group ?2=15.63,P<0.05,The difference was statistically significant.There was no statistical difference between the WBC,PCT and N% group P>0.05,and the difference was statistically significant in group CRP,t=2.263 and P<0.05,and there was no statistical difference between the WBC,PCT,N%,CRP group P>0.05,and the difference was statistically significant in CRP group t=2.263 and P<0.05.Conclusion:(1).The results of sputum culture in patients with acute exacerbation of chronic obstructive pulmonary disease and bronchiectasis were mainly Gram-negative bacteria,and common gram-negative bacteria were Pseudomonas aeruginosa,Klebsiella pneumoniae,Acinetobacter Bauman,Escherichia coli.Second of them were fungi,and gram positive bacteria were third,and were rare.Gram-negative bacteria were most commonly seen.Pseudomonas aeruginosa and Acinetobacter baumannii were the most common.(2).The resistance of Pseudomonas aeruginosa was common.But most of the antibiotics were sensitive to Bauman.The resistance rate of Acinetobacter baumannii was generally high and the resistance rate was high.65 years of age or older elderly patients with fungal detection rate is higher than that of non elderly patients(age<65 years).However,the distribution of pathogenic bacteria and drug resistance in different regions,so in the clinical experience of selection of antibiotic,should be based on the distribution of pathogens and drug resistance of various regions to choose,and early sputum bacteria culture and drug susceptibility test,according to drug susceptibility test results of drug selection.(3).Smoking and age have an influence on the distribution of pathogenic bacteria.The older patients are more common with fungal infection,and the higher the age,the higher the detection rate of fungi,the incidence of fungal detection in the smoking group is higher than that in the non smoking group,and the sex and lung function are not related to the distribution of the pathogenic bacteria.The level of serum CRP was different in different kinds of pathogenic bacteria.The level of serum CRP in patients with Gram-positive bacteria was higher than that of Gram-negative bacteria.There was no significant difference between the levels of WBC,PCT and N% among the different kinds of pathogenic bacteria.There was no significant difference in serum inflammatory index between smoking group and non-smoking group.There was no significant difference in serum inflammatory markers among patients with different lung function. |
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