A Prospective Study of Bacteriological Etiology in Hospitalized Acute Exacerbation of COPD Patients: Relationship with Lung Function and Respiratory Failure
A Prospective Study of Bacteriological Etiology in Hospitalized Acute Exacerbation of COPD Patients: Relationship with Lung Function and Respiratory Failure
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DOI：
10.5152/turkthoracj.2017.17035
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发表时间：
2018-01-01
影响因子：
0.9
通讯作者：
Purohit, Gopal
中科院分区：
文献类型：
--
作者：
Kuwal, Ashok;Joshi, Vinod;Purohit, Gopal
目的：细菌感染是慢性阻塞性肺病急性加重（AE-COPD）的主要原因。肺功能和呼吸衰竭（动脉血气参数）与 AE-COPD 病因之间的关系尚未明确。我们进行这项研究是为了确定 AE-COPD 的细菌谱，并确定相关的危险因素和药物敏感性模式。材料和方法：对 72 名因 AE-COPD 住院的患者进行了前瞻性评估。入院时进行定量痰培养、血气分析和药敏试验，出院后6周按照标准指南进行肺功能检测。结果：分离出细菌病原体34例（47.22%）。分离出的病原体为铜绿假单胞菌（38.23%）、肺炎克雷伯菌（29.41%）、金黄色葡萄球菌（23.53%）、肺炎链球菌（5.88%）和不动杆菌属。 （2.94%）。在年龄较大 (p=0.02)、频繁加重 (p55 岁 (p=0.017) 和全身类固醇使用 (p=0.017) 的患者中观察到细菌病原体的分离。抗生素敏感性测试显示，环丙沙星和哌拉西林/他唑巴坦对 27/34 (79.41%) 的分离株有效，其次是庆大霉素，对 26/34 的分离株有效。 (76%)。结论：除了高龄和全身类固醇使用之外，高碳酸血症呼吸衰竭是分离肺炎克雷伯菌和铜绿假单胞菌的独立危险因素。这些发现可能是决定初始抗生素治疗的重要辅助因素。
OBJECTIVES: Bacterial infections are the major cause of acute exacerbation of COPD (AE-COPD). The relationship between lung functions and respiratory failure (arterial blood gas parameters) with the etiology of AE-COPD has not been clearly understood. We conducted this study to determine the bacterial profile in AE-COPD and to identify the associated risk factors and drug sensitivity pattern.MATERIAL AND METHODS: Seventy-two patients hospitalized for AE-COPD were prospectively evaluated. Quantitative sputum culture, blood gas analysis, and drug sensitivity testing were performed at the time of admission, and pulmonary function testing was performed 6 weeks after discharge as per standard guidelines.RESULTS: Bacterial pathogens were isolated in 34 (47.22%) cases. Pathogens isolated were Pseudomonas aeruginosa (38.23%), Klebsiella pneumoniae (29.41%), Staphylococcus aureus (23.53%), Streptococcus pneumoniae (5.88%), and Acinetobacter spp. (2.94%). Isolation of bacterial pathogen was observed in patients with advancing age (p=0.02), frequent exacerbations (p55 years (p=0.017) and systemic steroid use (p=0.017). Antibiotic sensitivity testing showed that ciprofloxacin and piperacillin/tazobactum were effective in 27/34 (79.41%) of isolates followed by gentamycin in 26/34 (76%).CONCLUSION: Hypercapnic respiratory failure is an independent risk factor for isolation of K. pneumoniae and P. aeruginosa in addition to advanced age and systemic steroid use. These findings may be an important adjunct in deciding the initial antibiotic therapy.