Roche N, Kouassi B, Rabbat A, Mounedji A, Lorut C, Huchon G
Service de Pneumologie et Réanimation, Hôpital de l'Hôtel-Dieu, Université Paris 5, Paris, France.
Respiration. 2007;74(1):19-25. doi: 10.1159/000093158. Epub 2006 May 3.
Whether sputum microbiological examination should be performed systematically in hospitalized patients with chronic obstructive pulmonary disease (COPD) exacerbations remains unclear.
To assess the yield of sputum microbiological examination in COPD patients hospitalized in a medical ward for an acute exacerbation with purulent sputum.
Two hundred consecutive exacerbations in 118 patients were studied. Patients underwent sputum microbiological examination on admission and baseline lung function tests and CT scans were recorded. Factors associated with positive culture were analyzed.
Sputum culture was positive (>or=10(7) CFU/ml) in 59% of samples, Haemophilus influenzae and Streptococcus pneumoniae being the most frequent pathogens. Factors associated with positive culture were bronchiectasis, long-term oxygen therapy and low FEV1. Pseudomonas spp. were found in 8.5% of all patients, who all had a FEV1<50% of predicted and were older. Only 25% of sputum samples satisfied all quality criteria. Sputum culture was positive in a high proportion of these samples (80.5%), but also in one half of samples with >25 leukocytes but >10 epithelial cells per field. Microbiological results induced a change in antibiotic therapy in 43.9% of cases with both quality criteria but also in 25.2% of cases with only one quality criterion. Finally, a predominant aspect after Gram stain was found in all positive samples.
These data suggest that sputum microbiological examination with direct examination and leukocyte count should be performed routinely in patients hospitalized for COPD exacerbations with purulent sputum, especially when FEV1 is less than 50% predicted and in patients with bronchiectasis.
对于慢性阻塞性肺疾病（COPD）急性加重期的住院患者，是否应系统地进行痰微生物学检查仍不明确。
评估因急性加重伴脓性痰而入住内科病房的COPD患者痰微生物学检查的阳性率。
对118例患者连续发生的200次急性加重进行研究。患者入院时接受痰微生物学检查，并记录基线肺功能测试和CT扫描结果。分析与培养阳性相关的因素。
59%的样本痰培养阳性（≥10⁷CFU/ml），流感嗜血杆菌和肺炎链球菌是最常见的病原体。与培养阳性相关的因素有支气管扩张、长期氧疗和低FEV₁。所有患者中有8.5%发现假单胞菌属，这些患者的FEV₁均<预计值的50%且年龄较大。只有25%的痰样本符合所有质量标准。这些样本中很大一部分（80.5%）痰培养阳性，但每视野白细胞>25个且上皮细胞>10个的样本中也有一半培养阳性。微生物学结果使43.9%符合两项质量标准的病例以及25.2%仅符合一项质量标准的病例的抗生素治疗发生了改变。最后，在所有阳性样本中均发现革兰染色后的主要特征。
这些数据表明，对于因COPD急性加重伴脓性痰而住院的患者，应常规进行痰微生物学检查，包括直接检查和白细胞计数，尤其是当FEV₁小于预计值的50%时以及支气管扩张患者。
