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Abstract：
BACKGROUND: Respiratory infections have long been recognized as a primary cause of acute exacerbation of chronic obstructive pulmonary disease (AE-COPD). Additionally, the emergence of antimicrobial resistance has led to an urgent and critical situation in developing countries, including Vietnam. This study aimed to investigate the distribution and antimicrobial resistance of bacteria in patients with AE-COPD using both conventional culture and multiplex real-time PCR. Additionally, associations between clinical characteristics and indicators of pneumonia in these patients were examined.
METHODS: This cross-sectional prospective study included 92 AE-COPD patients with pneumonia and 46 without pneumonia. Sputum specimens were cultured and examined for bacterial identification, and antimicrobial susceptibility was determined for each isolate. Multiplex real-time PCR was also performed to detect ten bacteria and seven viruses.
RESULTS: The detection rates of pathogens in AE-COPD patients with pneumonia were 92.39%, compared to 86.96% in those without pneumonia. A total of 26 pathogenic species were identified, showing no significant difference in distribution between the two groups. The predominant bacteria included Klebsiella pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae, followed by Acinetobacter baumannii and Streptococcus mitis. There was a slight difference in antibiotic resistance between bacteria isolated from two groups. The frequency of H. influenzae was notably greater in AE-COPD patients who experienced respiratory failure (21.92%) than in those who did not (9.23%). S. pneumoniae was more common in patients with stage I (44.44%) or IV (36.36%) COPD than in patients with stage II (17.39%) or III (9.72%) disease. ROC curve analysis revealed that C-reactive protein (CRP) levels could distinguish patients with AE-COPD with and without pneumonia (AUC = 0.78).
CONCLUSIONS: Gram-negative bacteria still play a key role in the etiology of AE-COPD patients, regardless of the presence of pneumonia. This study provides updated evidence for the epidemiology of AE-COPD pathogens and the appropriate selection of antimicrobial agents in Vietnam.
METHODS: This cross-sectional prospective study included 92 AE-COPD patients with pneumonia and 46 without pneumonia. Sputum specimens were cultured and examined for bacterial identification, and antimicrobial susceptibility was determined for each isolate. Multiplex real-time PCR was also performed to detect ten bacteria and seven viruses.
RESULTS: The detection rates of pathogens in AE-COPD patients with pneumonia were 92.39%, compared to 86.96% in those without pneumonia. A total of 26 pathogenic species were identified, showing no significant difference in distribution between the two groups. The predominant bacteria included Klebsiella pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae, followed by Acinetobacter baumannii and Streptococcus mitis. There was a slight difference in antibiotic resistance between bacteria isolated from two groups. The frequency of H. influenzae was notably greater in AE-COPD patients who experienced respiratory failure (21.92%) than in those who did not (9.23%). S. pneumoniae was more common in patients with stage I (44.44%) or IV (36.36%) COPD than in patients with stage II (17.39%) or III (9.72%) disease. ROC curve analysis revealed that C-reactive protein (CRP) levels could distinguish patients with AE-COPD with and without pneumonia (AUC = 0.78).
CONCLUSIONS: Gram-negative bacteria still play a key role in the etiology of AE-COPD patients, regardless of the presence of pneumonia. This study provides updated evidence for the epidemiology of AE-COPD pathogens and the appropriate selection of antimicrobial agents in Vietnam.
摘要：
背景：呼吸道感染长期以来被认为是慢性阻塞性肺疾病（AE-COPD）急性加重的主要原因。此外,抗菌素耐药性的出现导致发展中国家的紧急和危急局势，包括越南。本研究采用常规培养法和多重实时荧光定量PCR检测AE-COPD患者的细菌分布及耐药性。此外,研究了这些患者的临床特征与肺炎指标之间的关联.
方法：这项横断面前瞻性研究包括92例有肺炎的AE-COPD患者和46例无肺炎的患者。培养痰标本并检查细菌鉴定，并确定每个分离株的抗菌药物敏感性。还进行了多重实时PCR以检测十种细菌和七种病毒。
结果：AE-COPD合并肺炎患者病原菌检出率为92.39%,与无肺炎患者的86.96%相比。共鉴定出26种病原,两组之间的分布没有显着差异。优势细菌包括肺炎克雷伯菌，流感嗜血杆菌,卡他莫拉菌,和肺炎链球菌，其次是鲍曼不动杆菌和链球菌。从两组分离的细菌之间的抗生素耐药性存在轻微差异。发生呼吸衰竭的AE-COPD患者（21.92％）的流感嗜血杆菌频率明显高于未发生呼吸衰竭的患者（9.23％）。肺炎链球菌在I期(44.44%)或IV期(36.36%)COPD患者中比在II期(17.39%)或III期(9.72%)COPD患者中更常见。ROC曲线分析显示，C反应蛋白（CRP）水平可以区分AE-COPD伴肺炎和不伴肺炎患者（AUC=0.78）。
结论：革兰氏阴性菌在AE-COPD患者的病因中仍然起关键作用，不管肺炎的存在。这项研究为越南AE-COPD病原体的流行病学和适当选择抗菌药物提供了最新证据。
方法：这项横断面前瞻性研究包括92例有肺炎的AE-COPD患者和46例无肺炎的患者。培养痰标本并检查细菌鉴定，并确定每个分离株的抗菌药物敏感性。还进行了多重实时PCR以检测十种细菌和七种病毒。
结果：AE-COPD合并肺炎患者病原菌检出率为92.39%,与无肺炎患者的86.96%相比。共鉴定出26种病原,两组之间的分布没有显着差异。优势细菌包括肺炎克雷伯菌，流感嗜血杆菌,卡他莫拉菌,和肺炎链球菌，其次是鲍曼不动杆菌和链球菌。从两组分离的细菌之间的抗生素耐药性存在轻微差异。发生呼吸衰竭的AE-COPD患者（21.92％）的流感嗜血杆菌频率明显高于未发生呼吸衰竭的患者（9.23％）。肺炎链球菌在I期(44.44%)或IV期(36.36%)COPD患者中比在II期(17.39%)或III期(9.72%)COPD患者中更常见。ROC曲线分析显示，C反应蛋白（CRP）水平可以区分AE-COPD伴肺炎和不伴肺炎患者（AUC=0.78）。
结论：革兰氏阴性菌在AE-COPD患者的病因中仍然起关键作用，不管肺炎的存在。这项研究为越南AE-COPD病原体的流行病学和适当选择抗菌药物提供了最新证据。
