Objective To explore the distribution of bacteria among community acquired lower respiratory tract infection (LRTI) inpatients with underlying chronic respiratory tract diseases.Methods The clinical data，sputum culture and drug susceptibility results of 212 community acquired LRTI patients who were hospitalized during the period 2001-2005 were retrospectively analyzed.All patients had various underlying chronic respiratory tract diseases.Results A total of 229 strains of pathogens were detected，with the majority being gram negative bacteria.In pathogens of acute exacerbation of chronic obstructive pulmonary disease，gram negative bacteria occupied 73.9%.And Pseudomonas aeruginosa and Klebsiella pneumoniae were the most common pathogens，with each occupying 18.2% and 13.6% respectively.Gram positive bacteria occupied 23.8%，mainly Staphylococcus aureus (10.2%) and Streptococcus pneumoniae (9.1%).In patients with bronchiectasis exacerbated by bacterial infection，86.2% were caused by gram negative bacteria，the top three being，in descending order，Pseudomonas aeruginosa (27.5%)，Haemophilus parainfluenzae (13.7%)，and Haemophilus influenzae (11.8%).Bronchiectasis was the major risk factor of getting Pseudomonas aeruginosa infection (OR=5.590，95%CI 2.792~11.192).The risk factors of getting Acinetobacter baumanii infection were antacid usage within 1 month (OR=9.652，95%CI 2.792~11.192) and hypoalbuminemia (OR=2.679，95%CI 1.108~6.476).For enterobacters infections，including Klebsiella pneumoniae，Enterobacter cloacae and Escherichia coli，the risk factors were antibiotic usage within 1 month (OR=4.236，95%CI 1.982~9.057)，having renal diseases (OR=4.305，95%CI 1.090~17.008) and diabetes mellitus (OR=2.836，95%CI 1.339~6.009).Conclusions Gram negative bacteria were the main pathogens of community acquired LRTI in hospitalized patients with underlying chronic respiratory tract diseases.The pathogens were influenced by underlying diseases，severity of diseases and drug usage history of patients.
Citation：
ZHOU Qingtao,YAO Wanzhen,CHEN Yahong,SHEN Ning,WU Rui,LIU Zhenying. Bacterial analysis of community acquired lower respiratory tract infection in hospitalized patients with underlying chronic respiratory tract diseases. Chinese Journal of Respiratory and Critical Care Medicine, 2007, 6(2): 82-87. doi:
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中华医学会呼吸病学分会.社区获得性肺炎诊断和治疗指南（草案）.中华结核和呼吸杂志，1999，22：201-203.
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刘又宁，赵铁梅.下呼吸道感染病原体组成、耐药现状及对策.国外医学呼吸系统分册，2003，23：281-283.
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苏欣，施毅，宋勇.社区获得性肺炎病原体流行病学、耐药性及诊断研究进展.中国呼吸与危重监护杂志，2005，4：321-326.
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Angrill J，Agustí C，de Celis R，et al.Bacterial colonization in patients with bronchiectasis：microbiological pattern and risk factors.Thorax，2002，57：15-19.
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Groenewegen KH，Wouters EF.Bacterial infections in patients requiring admission for an acute exacerbation of COPD；a 1-year prospective study.Respir Med，2003，97：770-777.
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Papi A，Bellettato CM，Braccioni F，et al.Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations.Am J Respir Crit Care Med，2006，173：1114-1121.
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Monso E，Garcia-Aymerich J，Soler N，et al.Bacterial infection in exacerbated COPD with changes in sputum characteristics.Epidemiol Infect，2003，131：799-804.
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Leophonte P.Infections in chronic obstructive pulmonery disease.Bull Acad Natl Med，2004，188：47-64.
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Lieberman D，Lieberman D.Pseudomonal infections in patients with COPD：epidemiology and management.Am J Respir Med，2003，2：459-468.
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郭光云，陈功，杨力，等.慢性阻塞性肺疾病患者急性发作期的细菌学分析.中国现代医学杂志，2006，16：1213-1215.
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王永兴，曹家月，郭梅，等.慢性阻塞性肺病急性加重期呼吸道病原菌分布及耐药性分析.第四军医大学学报，2004，25：1874-1876.
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王扬，夏丽萍，李艳玲，等.慢性阻塞性肺疾病急性发作期病原菌感染及耐药性分析.中国实用内科杂志，2004，24：692-693.
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El Amari EB，Chamot E，Auckenthaler R，et al.Influence of previous exposure to antibiotic therapy on the susceptibility pattern of Pseudomonas aeruginosa bacteremic isolates.Clin Infect Dis，2001，33：1859-1864.
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Lynch JP 3rd.Hospital-acquired pneumonia：risk factors，microbiology，and treatment.Chest，2001，119：373S-384S.
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Lee SO，Kim NJ，Choi SH，et al.Risk factors for acquisition of imipenem-resistant Acinetobacter baumannii：a case-control study.Antimicrob Agents Chemother，2004，48：224-228.
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杨利荣，单斌，王雪娟，等.昆明地区革兰阴性菌耐药性连续5年监测结果分析.中国呼吸与危重监护杂志，2005，4：298-302.
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- 1. 中华医学会呼吸病学分会.社区获得性肺炎诊断和治疗指南（草案）.中华结核和呼吸杂志，1999，22：201-203.
- 2. 刘又宁，赵铁梅.下呼吸道感染病原体组成、耐药现状及对策.国外医学呼吸系统分册，2003，23：281-283.
- 3. 苏欣，施毅，宋勇.社区获得性肺炎病原体流行病学、耐药性及诊断研究进展.中国呼吸与危重监护杂志，2005，4：321-326.
- 4. Angrill J，Agustí C，de Celis R，et al.Bacterial colonization in patients with bronchiectasis：microbiological pattern and risk factors.Thorax，2002，57：15-19.
- 5. Groenewegen KH，Wouters EF.Bacterial infections in patients requiring admission for an acute exacerbation of COPD；a 1-year prospective study.Respir Med，2003，97：770-777.
- 6. Papi A，Bellettato CM，Braccioni F，et al.Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations.Am J Respir Crit Care Med，2006，173：1114-1121.
- 7. Monso E，Garcia-Aymerich J，Soler N，et al.Bacterial infection in exacerbated COPD with changes in sputum characteristics.Epidemiol Infect，2003，131：799-804.
- 8. Leophonte P.Infections in chronic obstructive pulmonery disease.Bull Acad Natl Med，2004，188：47-64.
- 9. Lieberman D，Lieberman D.Pseudomonal infections in patients with COPD：epidemiology and management.Am J Respir Med，2003，2：459-468.
- 10. 郭光云，陈功，杨力，等.慢性阻塞性肺疾病患者急性发作期的细菌学分析.中国现代医学杂志，2006，16：1213-1215.
- 11. 王永兴，曹家月，郭梅，等.慢性阻塞性肺病急性加重期呼吸道病原菌分布及耐药性分析.第四军医大学学报，2004，25：1874-1876.
- 12. 王扬，夏丽萍，李艳玲，等.慢性阻塞性肺疾病急性发作期病原菌感染及耐药性分析.中国实用内科杂志，2004，24：692-693.
- 13. El Amari EB，Chamot E，Auckenthaler R，et al.Influence of previous exposure to antibiotic therapy on the susceptibility pattern of Pseudomonas aeruginosa bacteremic isolates.Clin Infect Dis，2001，33：1859-1864.
- 14. Lynch JP 3rd.Hospital-acquired pneumonia：risk factors，microbiology，and treatment.Chest，2001，119：373S-384S.
- 15. Lee SO，Kim NJ，Choi SH，et al.Risk factors for acquisition of imipenem-resistant Acinetobacter baumannii：a case-control study.Antimicrob Agents Chemother，2004，48：224-228.
- 16. 杨利荣，单斌，王雪娟，等.昆明地区革兰阴性菌耐药性连续5年监测结果分析.中国呼吸与危重监护杂志，2005，4：298-302.
