Study On The Distribution Of Respiratory Pathogenic Bacteria And TCM Syndromes In Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

Objective: This study is to explore the distribution of AECOPD pathogens,drug resistance characteristics and TCM syndrome distribution characteristics of AECOPD patients in the general respiratory ward of our hospital,so as to provide reference for clinical empirical antibiotic treatment and TCM syndrome differentiation and treatment in the future.Methods: The case data of AECOPD patients who were hospitalized in the respiratory department of Affiliated Hospital of Chengdu University of traditional Chinese medicine from January 1,2018 to December 31,2019 and met the inclusion criteria and exclusion criteria were collected by retrospective investigation.The Excel database was established,and the logarithmic data of spss25.0 software package was used for analysis and processing.Results: 1.Among 328 patients with AECOPD,107 were sputum culture positive and 221 were sputum culture negative.2.The hospitalization time of sputum culture positive group was significantly longer than that of sputum culture negative group(P < 0.05).3.There was no significant difference in inflammatory indexes(total number of peripheral blood leukocytes,neutral ratio,CRP,ESR)between the positive group and the negative group(P > 0.05).4.The positive rate of sputum culture in patients with bronchiectasis was significantly higher than that in patients without bronchiectasis(P < 0.05).5.The percentage of neutrophils in peripheral blood of AECOPD patients with smoking history was higher than that of AECOPD patients without smoking history(P < 0.05).6.The total number of leukocytes,the percentage of neutrophils and the rate of erythrocyte sedimentation in AECOPD patients with diabetes mellitus were higher than those in AECOPD patients without diabetes mellitus(P < 0.05).7.A total of 122 pathogenic strains were detected in the study,including 115 Gram-negative bacteria(92.7%),42 Pseudomonas aeruginosa(34.4%),16 Acinetobacter baumannii(13.1%),14 Klebsiella pneumoniae and 14 Haemophilus influenzae(11.5%),9 Gram-positive bacteria(7.3%),7 Streptococcus pneumoniae(5.7%),and 2 Staphylococcus aureus(1.6%).8.The drug resistance rate of G-bacteria to ampicillin,cefotetan and cefazolin is as high as 100%.The drug resistance rate of G-bacteria to common antibiotics such as quinolones(levofloxacin),aminoglycosides(amikacin,gentamycin),third generation cephalosporins(ceftazidine),β-lactamase inhibitor complex(cefoperazone sulbactam)is relatively low,less than 50%;the drug resistance rate of G + bacteria to large No Streptococcus pneumoniae and Staphylococcus aureus were found to be resistant to moxifloxacin,vancomycin and linezolid.9.In this study,the syndrome types of AECOPD patients were phlegm turbid and Yong lung syndrome(32.3%),phlegm heat stagnation lung syndrome(29.0%),phlegm stasis lung syndrome(25.3%),external cold and internal drink syndrome(13.4%).Conclusion: 1.The average hospitalization time of patients with positive sputum culture was longer than that of patients with negative sputum culture.At present,systemic inflammatory indexes(total leukocyte count,neutral ratio,CRP,ESR)can not be used as absolute reliable indexes to distinguish AECOPD with bacterial infection or not.3.The detection rate of pathogenic bacteria in sputum culture of AECOPD patients with bronchiectasis was higher than that of patients without bronchiectasis.4.Diabetes may increase the inflammatory response of patients with AECOPD.5.The main pathogens of AECOPD infection in the general respiratory ward of our hospital are Gram-negative bacteria.The top four Gram-negative bacteria are Pseudomonas aeruginosa,Acinetobacter baumannii,Klebsiella pneumoniae and Haemophilus influenzae.The Gram-positive bacteria are relatively small,mainly Streptococcus pneumoniae and Staphylococcus aureus.6.Sensitive antibiotics such as cefoperazone sulbactam,third generation cephalosporins and quinolones can be selected in the respiratory department of our hospital to Gram-negative bacteria.Sensitive antibiotics such as moxifloxacin,vancomycin and linezolid can be selected in the respiratory department of our hospital to Gram-positive bacteria.7.The main syndromes of AECOPD patients in this area are phlegm turbid and phlegm heat stagnation lung syndrome,which should be combined with the local climate and eating habits.