Analysis Of Etiology Characteristics And Drug Resistance In Chronic Obstructive Pulmonary Disease With Acute Aggravating Period

ObjectiveTo analyze the characteristics of pathogenic bacteria in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and study the relationship between pulmonary function in each phase of AECOPD patients.At the same time,it is analysised the risk factor of infectious pathogens,and the common pathogenic bacteria resistance and changes,so as to provide guidance for clinical choice of antimicrobial agents.MethodsIt is collected 435 patients with AECOPD clinical data from January 2014 to October 2017 for nearly three years in Tang-du hospital which record the patient's basic situation.Methods in into different groups which intrusive group(fiberoptic bronchoscopy)and non-intrusive group(natural deep sputum)according to return secretion record and analysis each pathogen detection.At the same time,according to the difference of lung function is divided into moderate,severe,very severe,the differences of pathogenic bacteria of each phase of the lung function are analyzed.Results1.In this study,435 cases are collected,with an average age of(65.14±9.76),course of COPD(8.72±5.24)years,the average hospitalization days(7.43±2.79).Among them,275 patients(culture positive rate 63.22%)with isolated pathogenic bacteria,34 cases of mixed infection.In 1305 sputum samples,there are 678 sputum specimens the qualified,accounting for 51.95%.All 309 strains pathogenic bacteria are checked out,Positive rate of sputum culture is 45.58%.Gram-positive bacteria 60 strains(19.42%),staphylococcus aureus 24 strains,hemolytic streptococcus 17 strains,streptococcus pneumoniae 10 strains.Gram-negative bacteria 193 strains(62.45%),pseudomonas aeruginosa 56 strains,hemolytic acinetobacter bauman 36 strains,pneumonia klebsiella 27 strains.fungus 56 strains(18.13%),of which 27 strains aspergillus,25 strains of candida albicans,4 strains candida tropical.It is 124 patients with isolated pathogenic bacteria of 149 patients with invasion method to return secretion.There 136 strains of pathogenic bacteria are isolated and cultured,accounting for 83.22%.286 patients with non-intrusive method isolated pathogenic bacteria is 151 cases.There 173 strains of pathogenic bacteria are isolated and cultured,accounting for 52.80%.2.Pathogenic bacteria culture positive group 275 cases,including 217 males and 58 females,negative group of 160 cases,including110 males and 50 females.Pathogenic bacteria susceptible factors regression analysis showed that diabetes mellitus,history of the long-term use of hormone and invasive operation,respiratory failure,the recent use three or more antibiotics,long-term lie in bed is the risk factor of pathogen infection AECOPD patients(P<0.05).3.In the moderate,severe,very severe group of the patients is 121,176 and 138 respectively.Pathogen strains 40,121 and 148 respectively,the pathogen infection positive rate is 33.06%,67.05% and 84.78% respectively.The probability of gram-negative bacteria,fungal infectious in patients with very severe group is higher than moderate group(P<0.05).And common gram-positive bacteria and the lung function classification difference has no statistical significance(P>0.05).4.Susceptibility results show that common gram-negative and gram-positive bacteria to clinical commonly used antimicrobial agents have different degree resistance,especially bowman /hemolytic acinetobacter,the percentages of up to more than 60%,only sensitive to for ring element and the more slime molds element B.Gram-positive bacterium shows sensitive to vancomycin and linezolid.Conclusion1.This study is given priority with gram-negative bacteria infection among AECOPD patients.The heavier lung function damage degree,the more susceptible to gram-negative bacteria and fungal.2.The independent risk factors for patients with AECOPD pathogen infection including diabetes,long-term use of hormone,having a history of invasive operation,respiratory failure,the recent use more than 3 kinds of antibiotics,long-term bed and so on.3.Susceptibility results show that the gram-negative bacteria multiple drug resistance in severe cases,especially bowman/hemolytic acinetobacter.Gram-positive bacterium shows sensitive to vancomycin and linezolid.