Atypical Pathogen Distribution in Chinese Hospitalized AECOPD Patients: A Multicenter Cross-Sectional Study

Chenye Feng; Mingtao Xu; Jian Kang; Fuqiang Wen; Yahong Chen; Jing Zhang; Wei Xiao; Zhonghe Zhang; Lan Yang; Jianmin Huo; Jie Cao; Li Zhao; Shuyue Xia; Yan Yin; Wei Wang

doi:10.2147/COPD.S300779

Atypical Pathogen Distribution in Chinese Hospitalized AECOPD Patients: A Multicenter Cross-Sectional Study

Int J Chron Obstruct Pulmon Dis. 2021 Jun 9:16:1699-1708. doi: 10.2147/COPD.S300779. eCollection 2021.

Authors

Chenye Feng¹, Mingtao Xu¹, Jian Kang¹, Fuqiang Wen², Yahong Chen³, Jing Zhang⁴, Wei Xiao⁵, Zhonghe Zhang⁶, Lan Yang⁷, Jianmin Huo⁸, Jie Cao⁹, Li Zhao¹⁰, Shuyue Xia¹¹, Yan Yin¹, Wei Wang¹

Affiliations

¹ Department of Pulmonary and Critical Care Medicine, Institute of Respiratory Diseases, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.
² Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Disease, State Key Laboratory of Biotherapy of China, Chengdu, Sichuan, People's Republic of China.
³ Department of Respiratory and Critical Care Medicine, Peking University, Third Hospital, Beijing, People's Republic of China.
⁴ Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
⁵ Department of Pulmonary Medicine, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China.
⁶ Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaonign, People's Republic of China.
⁷ Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, People's Republic of China.
⁸ Department of Respiratory, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People's Republic of China.
⁹ Respiratory Department, Tianjin Medical University General Hospital, Tianjin, People's Republic of China.
¹⁰ Department of Pulmonary and Critical Care Medicine, Institute of Respiratory Diseases, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.
¹¹ Department of Pulmonary Medicine, Central Hospital Affiliated with Shenyang Medical College, Shenyang, People's Republic of China.

Abstract

Purpose: The proportion of atypical pathogens in patient with AECOPD within mainland China is unknown. The objectives of this study were to determine the distribution of atypical pathogens among Chinese patients with AECOPD, to evaluate the clinical characteristics of different atypical pathogen infections, and to compare different detection methods for atypical pathogens.

Patients and methods: Specimens were collected from patients with AECOPD from March 2016 to November 2018 at eleven medical institutions in eight cities in China. Double serum, sputum, and urine samples were obtained from 145 patients. Serological and nucleic acid tests were used to assess for Mycoplasma pneumonia and Chlamydia pneumoniae; serological, urinary antigen, and nucleic acid tests were applied to detect Legionella pneumophila. The clinical characteristics of atypical pathogen-positive and -negative groups were also compared.

Results: The overall positivity rate for Mycoplasma pneumoniae was 20.69% (30/145), with the highest rate being 20.00% (29/145) when determined by passive agglutination.The overall positive rates for Chlamydia pneumoniae and Legionella pneumophila were 29.66% (43/145) and 10.34% (15/145), respectively. The most common serotype of Legionella pneumophila was type 6. The maximum hospitalized body temperature, ratio of eosinophils, C-reactive protein (CRP) level, and procalcitonin (PCT) level of the Mycoplasma pneumoniae-positive group were significantly higher than those of the Mycoplasma pneumoniae-negative group. Patients in the Chlamydia pneumoniae-positive group smoked more, had higher proportions of comorbidities and frequent aggravations in the previous two years than those in the Chlamydia pneumoniae-negative group. Furthermore, the forced expiratory volume in one second to forced vital capacity (FEV₁/FVC) ratio assessment of lung function was higher, and the concentration of arterial blood bicarbonate (HCO₃^-) was lower in the Legionella pneumophila-positive group than in the Legionella pneumophila-negative group.

Conclusion: Overall, atypical pathogens play an important role in AECOPD. Regarding the testing method, serological testing is a superior method to nucleic acid testing.

Keywords: COPD; Chlamydia pneumoniae; Legionella pneumophila; Mycoplasma pneumoniae; exacerbations.

Publication types

Multicenter Study

MeSH terms

China / epidemiology
Community-Acquired Infections*
Cross-Sectional Studies
Humans
Mycoplasma pneumoniae
Pneumonia, Mycoplasma* / diagnosis
Pneumonia, Mycoplasma* / epidemiology
Pulmonary Disease, Chronic Obstructive*