Đặc điểm lâm sàng, cận lâm sàng và vi khuẩn ở bệnh nhân đợt cấp giãn phế quản nhập viện=Clinical, paraclinical and bacteriological characteristics in hospitalized patients with acute exacerbation of bronchiectasis

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Tác giả: Hữu Ý Lê, Minh Hải Nguyễn, Tuệ Minh Nguyễn, Văn Sơn Nguyễn, Xuân Dũng Nguyễn, Thị Duyên Thi

Ngôn ngữ: vie

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Thông tin xuất bản: Tạp chí Y dược lâm sàng 108, 2024

Mô tả vật lý: tr.17-24

Bộ sưu tập: Metadata

ID: 244867

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Mô tả đặc điểm lâm sàng, cận lâm sàng và đặc điểm vi khuẩn ở bệnh nhân (BN) đợt cấp giãn phế quản (GPQ) nhập viện. Đối tượng và phương pháp: Nghiên cứu mô tả, cắt ngang trên 122 BN chẩn đoán xác định đợt cấp GPQ, trong đó 60 BN được soi, lấy dịch rửa phế quản và nuôi cấy. BN cũng được lấy đờm, nuôi cấy và so sánh với kết quả cấy dịch phế quản. Kết quả: BN nam giới chiếm tỷ lệ 51,6%, độ tuổi trung bình là 68,09 ± 10,86. BN có tiền sử lao phổi và bệnh lý kết hợp chiếm tỷ lệ cao. Các triệu chứng phổ biến gồm ho khạc đờm, khó thở, khám phổi ran nổ. Số đợt cấp phải nhập viện trung bình trong 1 năm là 1,88 ± 1,43. Tổn thương lan toả trên HRCT chiếm ưu thế với tỷ lệ 82,8%. Số BN có ≥ 2 đợt cấp/năm ở nhóm có bệnh kết hợp và tổn thương lan toả trên HRCT cao hơn có ý nghĩa thống kê so với nhóm không có bệnh kết hợp và tổn thương khu trú với p<
0,05. Tỷ lệ nuôi cấy dương tính là 86,7% với mẫu dịch phế quản và 96% với mẫu đờm. Trong đó vi khuẩn Gram âm chiếm ưu thế, phổ biến là Pseudomonas aeruginosa, Escherichia coli và Acinetobacter baumannii. Không có sự khác biệt về đặc điểm vi khuẩn giữa nhóm BN có ≥ 2 và <
2 đợt cấp/năm. Kết luận: BN đợt cấp GPQ nhập viện có tiền sử lao phổi và bệnh lý kết hợp chiếm tỷ lệ cao, nhập viện nhiều lần/năm, chủ yếu là tổn thương lan toả. Vi khuẩn Gram âm chiếm ưu thế, còn nhạy cảm với một số loại kháng sinh.To describe the clinical and laboratory features, as well as the bacteriological characteristics in bronchoaveolar lavage fluid in hospitalized patients with acute exacerbation of bronchiectasis. Subject and method: A descriptive cross-sectional study was conducted involving 122 patients diagnosed with acute exacerbation of bronchiectasis. Among them, bronchoscopy was performed in 60 patients to collect bronchoaveolar lavage fluid for microbiological culture analysis. Additionally, sputum samples were collected, cultured, and compared with the results of bronchoaveolar lavage fluid cultures. Result: Male patients accounted for 51.6%, with an average age of 68.09 ± 10.86 years. Patients presented a notable prevalence of history of pulmonary tuberculosis and underlying comorbidities. Common symptoms included cough, sputum, dyspnea, and crackles upon lung examination. On average, patients experienced 1.88 ± 1.43 exacerbations per year requiring hospitalization. HRCT revealed diffuse dilatation involvement in 82.8% of cases. Patients with underlying diseases and diffuse lesion on HRCT had a significantly higher frequency of ≥ 2 exacerbations per year compared to those without comorbidities and local lesion on HRCT with p<
0.05. Microbiological analysis demonstrated positive culture rates of 86.7% in bronchoaveolar lavage fluid samples and 96% in sputum samples. Gram-negative bacteria were isolated, with Pseudomonas aeruginosa, Escherichia coli, and Acinetobacter baumannii being the most frequently identified pathogens. There was no significant differences in bacteriological distribution between patients experiencing ≥ 2 exacerbations per year compared to those with fewer exacerbations. Conclusion: Patients experiencing acute exacerbations of bronchiectasis upon hospitalization commonly exhibit a history of pulmonary tuberculosis and a significant prevalence of underlying diseases, mainly with diffuse lesions, frequently require multiple hospitalizations per year. Gram-negative bacteria were most frequently identified pathogens, and still sensitive to several types of antibiotics.

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