Bari M R, Hiron M M, Zaman S M, Rahman M M, Ganguly K C
National Asthma Center, National Institute of Diseases of the Chest & Hospital (NIDCH), Mohakhali, Dhaka, Bangladesh.
Mymensingh Med J. 2010 Oct;19(4):576-85.
This study was designed to find out the microbes responsible for acute exacerbation of chronic obstructive pulmonary disease (COPD). This study was carried out in the National Institute of Diseases of the Chest & Hospital (NIDCH), Dhaka during the period of January 2003 to December 2003. The study was a prospective case control study. There were 88 male and 2 female patients. The majority of the study subjects fell within the range of 50-70 years. All were smokers. 30 stable COPD patients were taken as control for comparison of sputum culture results of acute exacerbated COPD patients. A standard proforma with questionnaire was designed and filled to select patient with COPD. The patients were selected according to the predetermined criteria viz FEV1<70% predicted and FEV1/FVC % <70% of predicted. Morning specimen of sputum was collected after appropriate preparation and physical character of the sputum were noted. Sputum was immediately sent to microbiology lab for culture. Out of 30 stable COPD patients 6(20%) showed positive sputum culture for bacteria, Pseudomonas 3, Klebsiella 1, Streptococcus pneumoniae 1 and Haemophilus influenza 1. Majority of them were Gram-negative organism. Out of 60 patients with acute exacerbation of COPD 39 patients (65%) showed positive culture for bacteria. Pseudomonas 15, Klebsiella 8, Acinetobacter 4, Enterobacter 2, Moraxella catarrhalis 2 and mixed organisms like, Pseudomonas + Klebsiella 2 and Pseudononas + Acinobacter 1. Majority were Gram-negative bacilli viz. Pseudomonas and Klebsiella spp. species. From this study it was concluded that the prevalence of lower airway bacterial colonization in outpatients with stable COPD is high and is mainly due to Gram-negative bacilli like Pseudomonas spp. The greater rate of isolation of pathogenic bacteria in exacerbated COPD than in stable COPD in this study, supports the pathogenic role of bacteria in a proportion of acute exacerbations of chronic obstructive pulmonary disease. The organism commonly play pathogenic role in acute exacerbations of COPD are Pseudomonas and Klebsiella. Acinobacter Moraxella catarrhalis and Enterobacter also contributed in exacerbation of COPD.
本研究旨在找出导致慢性阻塞性肺疾病（COPD）急性加重的微生物。该研究于2003年1月至2003年12月在达卡国家胸科与医院（NIDCH）开展。本研究为前瞻性病例对照研究。共有88名男性和2名女性患者。研究对象大多年龄在50至70岁之间。所有患者均为吸烟者。选取30名稳定期COPD患者作为对照，以比较急性加重期COPD患者的痰培养结果。设计并填写了一份带有问卷的标准表格，以筛选COPD患者。患者根据预定标准入选，即FEV1<预测值的70%且FEV1/FVC%<预测值的70%。经过适当准备后收集清晨痰液标本，并记录痰液的物理特征。痰液立即送往微生物实验室进行培养。在30名稳定期COPD患者中，6名（20%）痰培养细菌阳性，其中铜绿假单胞菌3例、克雷伯菌1例、肺炎链球菌1例、流感嗜血杆菌1例。大多数为革兰氏阴性菌。在60例COPD急性加重患者中，39例（65%）细菌培养阳性。其中铜绿假单胞菌15例、克雷伯菌8例、不动杆菌4例、肠杆菌2例、卡他莫拉菌2例，还有混合菌，如铜绿假单胞菌+克雷伯菌2例、铜绿假单胞菌+不动杆菌1例。大多数为革兰氏阴性杆菌，即铜绿假单胞菌和克雷伯菌属。从本研究得出结论，稳定期COPD门诊患者下呼吸道细菌定植的患病率较高，主要是由于铜绿假单胞菌属等革兰氏阴性杆菌。本研究中，COPD急性加重期病原菌的分离率高于稳定期，这支持了细菌在一部分慢性阻塞性肺疾病急性加重中起致病作用的观点。在COPD急性加重中通常起致病作用的微生物是铜绿假单胞菌和克雷伯菌。不动杆菌、卡他莫拉菌和肠杆菌也促成了COPD的加重。
