Objective: To evaluate the value of serum soluble triggering receptor expressed on myeloid cells-1(sTREM-1) on antibacterial agents useage in treatment of acute exacerbations of chronic obstructive pulmonary disease(AECOPD). Method: From August 2007 to February 2009,a total of 246 patients requiring hospitalization for AECOPD were randomly assigned into two groups:standard therapy group(n = 123) and sTREM-1-guided group(n = 123). Serum sTREM-1 levels of all patients were measured after hospital admission by enzme-linked immunosorbent assay. On the base of similarly normal treatment,standard therapy group received antibacterial agents according to guideline for antimicrobial drug useage,and sTREM-1-guided group were treated with antibacterial agents according to serum sTREM-1 levels:antibacterial agents treatment was applied when sTREM-1 level≥20ng/ml and was discouraged when sTREM-1 level < 20 ng/ml and CRP< 5 mg/L. Length of hospitalization,clinical efficacy,costs of hospitalization and antibacterial agents,hospital mortality,rate of exacerbation and rehospitalization within 1 year were observed. Results: Clinical efficacy,hospital mortality,length of hospitalization,rate of exacerbation and rehospitalization within 1 year were similar in two groups(P = 0.621-0.734,0.571,0.793 and 0.883);costs of antibacterial agents and hospitalization of sTREM-1-guided group were lower than that of standard therapy group(P = 0.000和0.026). Conclusion: sTREM-1 could be detected as a reference for guiding the use of antibacterial agents for AECOPD treatment which may reduce the costs of antibacterial agents and hospitalization.