Analysis of the characteristics of the composition of respiratory pathogens and its influencing factors in patients hospitalized with chronic obstructive pulmonary disease

doi:10.19983/j.issn.2096-8493.20220001

Abstract

Abstract:

Objective: To investigate the characteristics of the composition of respiratory pathogens in patients hospitalized with chronic obstructive pulmonary disease (COPD) and to analyze the influencing factors. Methods: The clinical characteristics and laboratory test results of 1251 patients admitted to the Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital, Central South University, from January 2016 to December 2019 who were hospitalized with COPD and underwent sputum culture examination were collected to summarize the characteristics of the composition of pathogenic bacteria and to compare the differences in clinical characteristics between the sputum-positive and sputum-negative groups of patients,to analyze the risk factors of sputum positive. Results: There were 1353 specimens sent for examination, and the positive detection rate was 35.33% (478/1353). The detected pathogens were mainly Gram-negative bacteria (52.51%, 251/478) and fungi (43.72%, 209/478), among which the five Gram-negative bacteria with the highest detection rate were Acinetobacter baumannii (21.51%, 54/251), Klebsiella pneumoniae (21.12%, 53/251), Pseudomonas aeruginosa (19.12%, 48/251), Acinetobacter maltophilia (14.34%, 36/251), and Haemophilus influenzae (5.58%, 14/251); the fungi were 128 strains of Candida (61.24%) and 81 strains of Aspergillus (38.76%). Univariate analysis showed that detection of pathogenic bacteria in COPD patients was associated with age, history of acute exacerbation in previous 1-year, pre-admission hormone use, BMI (body mass index), CAT (COPD assessment test), mMRC (modified British medical research council) and FEV₁%pre (expected value of expiratory volume in 1 second with force). Multifactorial analysis showed that abnormal BMI was an independent risk factor for the detection of pathogenic bacteria (OR=3.158, 95%CI=1.503-6.634). Conclusion: Patients hospitalized with COPD were prone to getting combined Gram-negative bacterial infections. For patients with abnormal BMI, pathogenic investigations should be taken proactively.

Key words: Pulmonary disease,chronic obstructive, Gram-positive bacteria, Gram-negative bacteria, Fungi, Risk factors

CLC Number:

R563.3

XIAN Shao-jing, CHEN Yan, MA Yi-ming, LUO Li-juan, LONG Ying-jiao. Analysis of the characteristics of the composition of respiratory pathogens and its influencing factors in patients hospitalized with chronic obstructive pulmonary disease[J]. Journal of Tuberculosis and Lung Disease , 2022, 3(3): 209-215. doi: 10.19983/j.issn.2096-8493.20220001

Figures/Tables 5

项目	痰菌阳性组(371例)	痰菌阴性组(880例)	统计检验值	P值
男性[例,构成比(%)]	333(89.76)	780(88.64)	χ²=0.331	0.622
>65岁[例,构成比(%)]	282(76.01)	560(71.79)	χ²=18.161	<0.001
病程[年,M(Q₁,Q₃)]	10(8,20)	10(6,20)	Z=-0.810	<0.001
吸烟指数 [支/年,M(Q₁,Q₃)]	800(400,1000)	800(320,1060)	Z=-0.235	0.819
BMI( $x ¯$ ±s)	21.05±3.71	20.45±1.90	t=5.267	<0.001
CAT评分( $x ¯$ ±s)	21.33±7.55	18.24±7.69	t=10.302	<0.001
ALB(g/L, $x ¯$ ±s)	32.37±4.60	33.73±4.33	t=7.731	<0.001
FEV₁%pre[%,M(Q₁,Q₃)]	29.00(22.00,40.20)	34.20(24.85,47.05)	Z=6.950	<0.001
住院时间 [d,M(Q₁,Q₃)]	12(9,15)	10(8,12)	Z=-6.971	<0.001

因素	β值	s $x ¯$ 值	Wald χ²值	P值	OR(95%CI)值
年龄>65岁	-0.192	0.352	0.298	0.585	0.825(0.414~1.646)
FEV₁%pre<50%	0.057	0.521	0.012	0.912	1.059(0.381~2.942)
BMI异常	1.150	0.379	9.218	0.002	3.158(1.503~6.634)
CAT评分≥10分	0.435	0.622	0.489	0.484	1.545(0.457~5.227)
mMRC分级≥2级	0.253	0.519	0.238	0.625	1.289(0.466~3.566)
既往1年有急性加重	0.125	0.325	0.150	0.744	1.009(0.620~2.112)
入院前曾使用糖皮质激素	0.478	0.799	0.501	0.389	0.975(0.359~1.952)
常量	-4.560	5.006	0.830	0.362	0.010

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项目		痰菌阳性例数		痰菌阴性例数		阳性检出率(%)	统计检验值		P值
BMI分组							χ²=126.040		<0.001
低体质量 (≤18.4)		64		77		45.39
正常 (18.5~23.9)		154		672		18.64
超体质量(24.0~17.9)		44		32		57.89
肥胖(≥28)		14		1		93.33
CAT得分(分级)							χ²=26.980		<0.001
0~10(1级)		22		105		17.32
11~20(2级)		74		283		20.73
21~30(3级)		99		184		34.98
31~40(4级)		30		50		37.50
mMRC分级							χ²=25.800		<0.001
0级		9		28		24.32
1级		37		126		22.70
2级		64		192		25.00
3级		74		203		26.71
4级		103		143		41.87
综合评估分组							χ²=9.460	0.024
A组	10		30		25.00
B组	45		142		24.10
C组	15		58		20.50
D组	266		548		32.70
GOLD分级							χ²=12.340	0.006
1级	3		15		16.70
2级	31		119		20.70
3级	83		248		25.10
4级	124		245		33.60
EOS分型							χ²=1.340	<0.001
非EOS型(血嗜酸性粒细胞百分比<2%)	279		456		37.96
EOS型(血嗜酸性粒细胞百分比≥2%)	90		389		18.79

因素	痰菌阳性例数		痰菌阴性例数		OR值		P值
性別					1.123		0.563
女性	38		100
男性	333		780
年龄组(岁)					1.811		<0.001
≤65	89		320
>65	282		560
入院前使用糖皮质激素					0.543		0.047
否	6		12
是	236		414
既往1年急性加重					1.691		0.002
无	52		174
有	294		582
近3个月使用抗生素					1.278		0.104
否	92		174
是	275		407
吸烟状态					1.273		0.181
否	48		141
是	312		720
BMI分组						2.183		<0.001
正常		154		672
异常		122		110
CAT评分						1.377		0.004
<10		22		105
≥10		203		472
mMRC分级						1.410		0.028
<2		46		154
≥2		241		536
FEV₁%pred						1.248		0.015
≥50%		31		119
<50%		195		411

因素	赋值	因素	赋值
年龄	≤65岁=0;>65岁=1	mMRC分级	<2级(0、1级)=1;≥2级(2、3、4级)=2
FEV₁%pre	<50%=1;≥50%=2	mMRC分级	<2级(0、1级)=1;≥2级(2、3、4级)=2
FEV₁%pre	<50%=1;≥50%=2	既往1年急性加重史	否=0;有=1
BMI	正常组(2组)=0;异常组(1、3、4组)=1	既往1年急性加重史	否=0;有=1
BMI	正常组(2组)=0;异常组(1、3、4组)=1	入院前使用糖皮质激素	否=0;有=1
CAT评分	<10分=1;≥10分=2	入院前使用糖皮质激素	否=0;有=1