Pela R, Marchesani F, Agostinelli C, Staccioli D, Cecarini L, Bassotti C, Sanguinetti C M
Dept of Pulmonology, City Hospital, Osimo, Ancona, Italy.
Monaldi Arch Chest Dis. 1998 Jun;53(3):262-7.
Patients affected with chronic obstructive pulmonary disease (COPD) undergo frequent exacerbations of their illness characterized by increased cough and expectoration. The precise aetiology of these episodes often remains unknown. In the absence of clinical or radiographic signs of pneumonia, bacterial or viral cultures of sputum usually provide little useful information. Thus, we performed fibreoptic bronchoscopy using a protected specimen brush (PSB) to obtain uncontaminated secretions for culture from 56 patients with COPD, 16 with stable clinical conditions and 40 affected with exacerbations of the disease. The aim of our study was to evaluate bronchial microbial flora by quantitative aerobic and anaerobic culture of each specimen. Twenty five subjects (45%), 4 (16%) in stable state and 21 (84%) with COPD exacerbations, had specimens which gave rise to significant bacterial growth (> 10(3) colony forming units.mL-1). The predominant bacteria were Streptococcus pneumoniae (in 10 cases) and alpha-haemolytic streptococci (in 6 cases); other bacteria found were coagulase-negative staphylococci and Branhamella catarralis in (2 cases each), and Proteus mirabilis, Haemophilus influenzae, Pseudomonas aeruginosa, Aerococcus viridans and Chromobacterium violaceum (each in a single case only). Although significant bacterial growth was more frequently found in patients with chronic obstructive pulmonary disease exacerbations and in those with a higher degree of bronchial inflammation, the differences between the two groups of patients were not statistically significant. Nevertheless, the results obtained in our study confirm the validity of and the need for reliable sampling methods (like the protected specimen brush) to demonstrate significant bacterial colonization of the airways in chronic obstructive pulmonary disease patients.
慢性阻塞性肺疾病（COPD）患者常经历病情频繁加重，其特征为咳嗽和咳痰增多。这些发作的确切病因通常仍不清楚。在没有肺炎的临床或影像学迹象的情况下，痰的细菌或病毒培养通常提供的有用信息很少。因此，我们使用保护性标本刷（PSB）对56例COPD患者进行了纤维支气管镜检查，其中16例临床状况稳定，40例病情加重。我们研究的目的是通过对每个标本进行需氧和厌氧定量培养来评估支气管微生物菌群。25名受试者（45%），稳定状态下有4名（16%），COPD加重期有21名（84%），其标本有显著细菌生长（>10³菌落形成单位/mL）。主要细菌是肺炎链球菌（10例）和α溶血性链球菌（6例）；还发现其他细菌有凝固酶阴性葡萄球菌和卡他布兰汉菌（各2例），以及奇异变形杆菌、流感嗜血杆菌、铜绿假单胞菌、绿色气球菌和紫色色杆菌（各仅1例）。虽然在慢性阻塞性肺疾病加重期患者和支气管炎症程度较高的患者中更常发现显著细菌生长，但两组患者之间的差异无统计学意义。然而，我们研究获得的结果证实了可靠采样方法（如保护性标本刷）在证明慢性阻塞性肺疾病患者气道中显著细菌定植方面的有效性和必要性。
