Clinical Analysis Of Patients With Positive Culture Of Burkholderia Cepacia Infection And The Value Of Sputum Smear In The Diagnosis Of Pulmonary Infection

ObjectiveTo analyze the clinical characteristics and drug resistance of 59 inpatients with positive sputum culture of Burkholderia cepacia from February 2022 to February 2023 in the First Affiliated Hospital of SoochowUniversity,to explore the risk factors of Burkholderia cepacia infection and factors affecting prognosis,and to provide scientific basis for clinical diagnosis and treatment.To explore the value of sputum smear detection of leukocyte phagocytosis phenomenon or bacterial concomitant phenomenon in the diagnosis of pulmonary infection,to provide a basis for early identification of the infecting pathogen,so as to guide the rational use of antibiotics.MethodPart Ⅰ1.59 hospitalized patients with positive sputum culture for Burkholderia cepacia between February 2022 and February 2023 were selected for the study using a retrospective analysis to collect their clinical data,analyze the general clinical data,laboratory tests,underlying diseases,catheter retention,and antibiotic use,and analyze the risk factors and drug resistance of BC infection.2.To explore the influence of demographic characteristics,antibiotic use,combination of different underlying diseases,duration of mechanical ventilation,invasive operation,and APACHE Ⅱ score on the risk of patient death according to different prognosis.Part Ⅱ141 sputum specimens were collected from inpatients diagnosed with pulmonary infections from July 2022 to February 2023,and sputum smear examination and bacterial culture were performed on all 102 eligible specimens.Specimens were divided into WBC phagocytosis group(n=76)and no WBC phagocytosis group(n=26)based on the presence of WBC phagocytosis or bacterial concomitant observed on sputum smear microscopy.The rate of agreement between sputum smear microscopy results and bacterial culture results and the rate of bacterial infection in both groups were analyzed.ResultPart Ⅰ1.59 strains of BC were isolated from sputum specimens sent from various clinical departments from February 2022 to February 2023,mainly in intensive care units(21 strains,35.59%)and infectious disease units(12 strains,20.34%)and neurosurgery(6 strains,10.17%);31 of the 59 patients(52.54%)were male and 28 were female(47.46%);33(55.93%)had mixed bacterial infections;58 of 59(98.30%)had indwelling catheters of at least one type;almost all patients had used different types of antimicrobial drugs before sputum culture results were returned,and the average number of days in hospital for patients with culture BC was 43.54±23.95 days;42 of 59 patients improved(71.19%)and 17 cases died(28.81%),accounting for nearly onethird of deaths.Among the 59 patients,the composition ratio of underlying diseases was analyzed,and hypertension,diabetes mellitus and cirrhosis were the top three underlying diseases,with 35 cases of hypertension,21 cases of diabetes mellitus and 3 cases of cirrhosis.3.Patients in the death group had higher neutrophil count,NLR,blood creatinine value,calcitoninogen,days of polymyxin use,frequency of combined sepsis ratio,frequency of combined heart failure,frequency of combined renal insufficiency,frequency of shock,and frequency of polymyxin use than those in the improvement group,and only platelet count was lower than that in the improvement group.Renal insufficiency and shock were independent risk factors affecting the prognosis of patients with Burkholderia cepacia infection.4.Cefoperazone sulbactam had the highest resistance rate(79.66%),ceftazidime had the highest sensitivity rate(93.22%)to this bacterium,and the sensitivity rates were cotrimoxazole(50.85%),levofloxacin(44.07%),minocycline(33.90%),and meropenem(22.03%)in descending order,and BC had decreasing sensitivity rates to them in descending order.Part ⅡAmong the 102 qualified sputum specimens,sputum smears showed leukocyte phagocytosis or bacterial companionship in 51 specimens(78.4%),and the concordance with bacterial culture results was 85.3%,which was significantly higher than that of specimens without leukocyte phagocytosis or bacterial companionship in sputum smears(48.1%,P<0.05),and the identification rate of pathogenic bacteria(90.2%)was also significantly higher than that of specimens without WBC specimens with phagocytosis or bacterial companionship(37.8%,P<0.05).Sputum smear microscopy had high concordance with the patient’s clinical condition and sputum culture results.and was valuable in the identification of colonizing and pathogenic bacteria.Conclusion1.Renal insufficiency and the presence of shock significantly increased the mortality rate of BC-positive patients,while the combination of sepsis,heart failure,polymyxin use and days of use,neutrophil count,neutrophil/lymphocyte count ratio(NLR),blood creatinine value,platelet count,and calcitoninogen had no significant effect on the mortality rate of BC-positive patients.2.BC is not highly sensitive to many antibiotics,clinical treatment of BC infection should be’ based on the results of drug sensitivity test of isolated strains,our hospital can empirically choose ceftazidime in the treatment of patients infected with Burkholderia onioms.3.The sputum smear Gram stain microscopy results have a good correlation with the sputum culture results.We can make preliminary prediction of respiratory pathogen infection based on the sputum smear examination results at an early stage,and guide the application of antibacterial drugs according to the pathogenic bacteria species and the local drug resistance situation.