Etiology Investigation And Bacterial Resistance Analysis Of Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

Background and purpose:Chronic obstructive pulmonary disease(COPD)is one of the more common diseases of chronic respiratory disease.It affects the study,life and work of patients in different degrees.Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is an independent risk factor for mortality.The most common cause of acute exacerbation of COPD is infection,including bacteria,viruses,fungal,atypical pathogens.Bacterial infection is the main cause of AECOPD.Studies have shown that in different regions and at different times,infectious diseases bacteria,drug resistance,and so there may be some differences.In order to better understand the distribution and drug resistance of bacteria and fungi in patients with AECOPD,and guide the rational use of antibiotics in clinical practice,we investigated and analyzed the etiological data of patients admitted to the 967 hospital of the joint logistic support force for AECOPD in recent 4 years.Method:A retrospective analysis on AECOPD patients admitted to the 967 hospital of the joint logistic support force of the people's liberation army from January 2015 to December 2018.Including general information,sputum bacteria culture and drug sensitivity results,sputum fungi culture results.Result:1?A total of 848 AECOPD patients were collected.766 patients completed the etiological examination of sputum specimens.207 cases were positive in etiology,with a positive rate of 27.0%.A total of 328 strains were isolated in this study.There were 208 strains of bacteria(63.4%)and 120 strains of fungi(36.6%).Among the bacteria,there were 199(95.7%)gram-negative bacteria(G~-)and 9(4.3%)gram-positive bacteria(G~+).The main strains of G~-bacteria were Pseudomonas Aeruginosa(PA)55(27.6%),Acinetobacter Baumannii(AB)54(27.1%)and Klebsiella Pneumoniae(KP)52(26.1%).G~+bacteria were mainly 7 strains of Staphylococcus aureus and 2 strains of Staphylococcus haemolyticus.Fungi included 115 strains of candida(95.8%)and 5 strains of aspergillus(4.2%).Among them,87 strains(72.5%)were mainly candida albicans.2?The distribution of bacteria and fungi in Intensive Care Unit(ICU),Old Cadre Ward and Respiratory Ward of AECOPD patients was investigated and analyzed,the positive rate of sputum bacterial culture in ICU(82.8%)was significantly higher than that in the ward of senior cadres(47.9%),the positive rate of old cadre ward was significantly higher than that of respiratory ward(14.5%).Pseudomonas aeruginosa,Acinetobacter baumannii,Klebsiella pneumoniae were more likely to be detected in ICU and Old Cadre Ward patients.The positive rates of sputum fungus culture in ICU and old cadre ward were 55.2%and 33.3%respectively,which were higher than that in respiratory ward(11.9%).ICU patients were more likely to detect candida albicans.Mixed infections are more likely to occur in ICU and Old Cadres Ward.3?Drug susceptibility to major bacteria:The resistance rate of PA to polymyxin B in G~-bacteria was low(10.9%),and the resistance rate to piperacillin/tazobactam,cefoperazone/sulbactam,levofloxacin,imipenem was high(30%?36%).KP had lower drug resistance to amikacin(17.3%)?minocycline(13.5%)?imipenem(7.7%)and meropenem(7.7%),high resistance rate to enzyme inhibitor compound preparation(>26.0%)?AB resistance was more serious than other G~-bacteria,the drug resistance rate to sulbactam and its compound preparation and carbapenems was more than 40%,and the drug resistance rate to polymyxin(11.1%)and minocycline(5.6%)was low.The detection rate of methicillin-resistant strains in Staphylococcus aureus of G~+bacteria was 85.0%,and that of methicillin-resistant strains in staphylococcus haemolytic bacteria was 100%,but it is sensitive to vancomycin,teicolanine and linezolid,and the sensitivity rate is 100%.Conclusion:In the sputum culture results of AECOPD patients in our hospital,G~-bacteria was the dominant,followed by fungi,and G~+bacteria detection rate was the lowest.The positive rate of sputum bacteria and fungus culture of AECOPD patients in ICU and the Old Cadres Wards was significantly higher than that of Respiratory Wards,and PA,AB and KP were more easily detected.The drug sensitivity test of the main isolated bacteria showed that the resistance of AB was serious,but it is sensitive to minocycline,polymyxin;KP has low drug resistance to amikacin and minocycline and is sensitive to carbapenems;PA has a low drug resistance rate to polymyxin B and a high drug resistance rate against?-lactamides and?-lactamase inhibitor compound preparation.Gram-positive bacteria(Staphylococcus aureus,Staphylococcus haemolyticus)are mostly methicillin-resistant bacteria,which are sensitive to vancomycin,teicolanine and linezolid.