Etiology Analysis and Antimicrobial Selection in Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Kundan Kumar Chaudhary1*, Abhishek Adhikari2, Krishna Kumar Sah3, Subash Kumar Chaudhary2,
He Li1, Gong1 and Jing Ping ma1
Published: June 21, 2022
DOI: 10.55162/MCMS.03.044
Abstract
Objective: This study was conducted to prospectively analyze the clinical features of hospitalized patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD), sputum culture and drug susceptibility results, and the use and efficacy of antimicrobial to guide the pathogens of AECOPD hospitalized patients. Learning judgment and choice of antimicrobial drugs.
Materials and Methods: A total of 327 patients with acute exacerbation of chronic obstructive pulmonary disease admitted to the Department of Respiratory Medicine, Jingzhou Central Hospital from January 1, 2018 to December 31, 2018 were enrolled. Among them, 46 patients were positive for sputum microbial culture, and 48 positive sputum culture results were obtained. The demographic characteristics (age, gender, BMI index), smoking history, acute exacerbation/year, mMRC score were statistically analyzed. CAT score, lung function index, presence or absence of respiratory failure, sputum culture type and drug sensitivity, antibacterial drug selection. All data were tabulated and divided into 2 groups according to the presence or absence of respiratory failure. The clinical data and etiology differences of the 2 groups were counted. According to the sputum culture, G-negative bacilli or fungi were divided into two groups, and the clinical data of the two groups were counted. The measurement data were mean±standard error, and the percentage was used. The statistical analysis was performed by Fisher’s exact test. The measurement data were analyzed by independent sample t test. The count data were analyzed by chi-square test. The P value was less than 0.05, which was statistically significant.
Results: A total of 327 cases were involved in the study, of which 48 were positive for sputum culture (46 patients). In the positive patients, 41 males (89.10%) and 5 females (10.4%) showed that males had higher prevalence than females. The most common age group is mostly 70-79 years old, with an average age of 73.08 years. During the follow-up, 8 people died in first year (58-83 years old, average 70.1 years old), and the mortality rate was 17.39%. Among the 46 patients, the available data were analyzed, BMI: 22.68 ± 0.67 (N = 28), AE / year: 1.82 ± 0.12 (N = 46), age (years): 73.52 ± 1.22 (N = 46), mMRC: 2.82±0.20 (N=28), CAT: 23.55±1.43 (N=27), FEV1:1.05±0.08 (N=28), FEV1%: 45.21%±3.29% (N=28), FVC: 2.25±0.11 (N=28), FVC%: 75.07% ± 3.4% (N=28). The most common microorganism in sputum culture was Candida albicans (50%), a total of 24 cases. There were 14 cases (30%) of bacterial infections and 34 cases (70%) of fungal infections. The most commonly used antibiotics for AECOPD patients are fluoroquinolones, followed by ceftazidime, followed by carbomycins, and antifungal drugs are most commonly fluconazole, followed by voriconazole. There was a statistically significant difference in the composition ratio between bacteriaand fungi between the first sputum culture and the non-first sputum culture (P=0.018), suggesting that the late stage of hospitalization was fungal infection. FEV1 and FVC between the respiratory failure group (14 cases) and the non-respiratory failure group (34 cases). AE/year was statistically significant (P<0.05), 2 groups. Candida albicans is the main pathogen in the patients. According to the pathogen, G-negative bacilli and fungi were divided into two groups. There was no significant difference in age, BMI, mMRC, CAT, AE times/year, FEV1 and FVC between the two groups.
Conclusion: G-negative bacilli and fungal infections were the most common in male, elderly, and recurrent AECOPD hospitalized patients, with the highest incidence of Candida albicans infection. Fungi was main source of infection in the late stay after 5 to 7 days of hospitalization. Candida albicans is most common positive pathogen in hospitalized patients regardless of whether it is associated with respiratory failure. This suggests that our combination of antibacterial and antifungal drugs in clinical treatment, especially in the late hospital stay can benefit these patients.
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