New Strain Acquisition of Klebsiella spp, Enterobacter spp,肺炎克雷伯菌属新菌株感染肠杆菌属.pptVIP

New Strain Acquisition of Klebsiella spp, Enterobacter spp, and Escherichia coli in COPD is Not Associated with Exacerbations.  Presenter: Jiyeon Jung, MD Research Attending: Sanjay Sethi, MD A Case Vignette A 68-year-old former heavy smoker with a history of chronic obstructive pulmonary disease (COPD) presents to the ED with a two-day history of worsened shortness of breath and increased sputum. Chest radiography shows hyperinflation and no acute infiltrates. A Case Vignette House staff ordered sputum culture in ED. Sputum culture came back positive for Klebsiella spp. How should this patient be treated? History Since 1994, the study has been conducted in WNY VA to reveal a relationship between bacterial infection and COPD exacerbation. History The role of bacterial pathogens in COPD exacerbation was controversial. The rate of bacterial isolation from sputum was found to be similar in stable COPD and during exacerbations. On the basis of these observations, a seminal review in 1975 indicated that bacterial pathogens do not cause exacerbations and that their presence in sputum is due to chronic colonization.1 History New molecular, cellular, immunologic techniques in the past two decades. Possible to differentiate strains of bacterial pathogens over time from the patients with molecular typing. History Bacterial infections trigger COPD exacerbations. Four Major pathogens. A new bacterial strain plays a central role in the pathogenesis of an Exacerbation. History Example Sputum culture(+) for H. influenza in stable phase Sputum culture(+) for H. influenza in exacerbation New strain of H. influenza in molecular typing. History Sputum cultures are often not useful for identifying bacterial infection in patients with COPD exacerbations. Gram stain and culture of sputum are similar during exacerbations and stable disease. They do not distinguish between true pathogens and colonizing flora. As per 2007 G