Study On The Pathogen Characteristics In Patients With Acute Exacerbations Of Chronic Obstructive Pulmonary Disease And Its Relationship With Lung Function

Objective:To study the characteristics of pathogenic bacteria in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and analyze the relationship between pulmonary function in each phase of AECOPD patients in respiratory medicine of our hospital,so as to evaluate the pathogenetic condition correctly and provide valuable clinical reference for the selection of antibiotic agents.Methods:Statistic the admitted medical records of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)patients in our hospital respiratory from January 2015 through December 2016.The sputum(All specimens by microscopy screening,the sputum specimens of each low power lens epithelial cells from the perspective of<10,neutrophils>25 or both ratio <2.5 as a qualified sputum specimens)was used to carry out pathogen bacteria,separation and drug susceptibility test.Meanwhile the statistical result of the lung function which is divided into three groups according to the global strategy for GOLD(Revised2017),namely stage II(moderate)?stage III(severe)?stage IV(extremely severe),the differences of pathogenic bacteria of each phase of the lung function are analyzed.Results:1.In this study,580 cases were collected,among them,Positive rate of sputum culture was 41.21%,289 strains pathogenic bacteria were Checked out,gram negative bacterium play a major role,a total of 178 strains;Followed by fungus,90 strains(31.14%);Gran positive bacterium rare,21stains(7.27%).Top four Gram negative bacterium in sputum culture as follows:klebsiella bacillus(57 strains),pseudomonas aeruginosa(37 strains),acinetobacter baumannii(32strains),klebsiella oxytoca(14 strains).Fungus is given priority to with candida albicans(67strains);Gram-positive bacteria include Streptococcus pneumonia(11strains)?Staphylococcus aureus(8 strains)?Streptococcus viridans(2 strains).2.In the stage II(moderate)?stage III(severe)?stage IV(extremely severe)groups of the patients,pathogenic bacteria infection rate is 14.40%,25.31% and27.57% respectively.The probability of gram-negative bacteria,gram-positive bacteria infectious in patients with stage IV is higher than stage II and stage III groups(P<0.05),the probability of fungal infection inpatients with stage III and stage IV is higher than stage II(P<0.05).And the patients of groups stage IV are more likely to be infected with klebsi-ella bacillus,pseudomonas aeruginosa and acinetobacter baumannii.3.Susceptibility results suggest that the main gram-negative bacteria are sensitive to aminoglycosides(amikacin)?carbapenems??-Lactamaseinhibitors(piperacillin)?The fourth generation cephalosporin drugs and so on,but resistant rate is high in the second?third generation cephalosporin?ampicillin minocycline.Gram-positive bacterium shows sensitive to vancomycin,teicoplanin and linezolid,whereas a high drug resistance to erythromycin?clindamycin?tetracycline.Fungi is keep sensitive to voriconazole?fluconazole and so on antifungal drugs.Conclusions:1.The sputum bacteria is priority with gram-negative bacteriumamong our respiratory AECOPD patients,followed by fungus,gram-positive bacterium is least?2.The heavier lung function damage degree,the more susceptiblely topathogens infections;Extremely severe patients with AECOPD are more likely to be infected with klebsiella bacillus,pseudomonas aeruginosa and acinetobacter baumannii.