糖尿病合并肺炎的病原菌分布及支气管肺泡灌洗的价值分析

目的 :探讨糖尿病合并社区获得性肺炎 (CAP)在病原菌方面的特殊性及耐药性 ,以及支气管肺泡灌洗液(BAL F)在糖尿病患者病原菌诊断上的意义。方法 :对深圳地区 73例合并肺炎的糖尿病患者进行了痰及 (或 )肺泡灌洗液的支原体、衣原体抗体检测、涂片检查及细菌培养 ,分析病原菌分布、耐药性以及与糖尿病控制的关系。结果 :痰液细菌培养的阳性率明显低于肺泡灌洗液 (2 6 .6 % vs4 2 .9% ,P<0 .0 1) ;血糖控制不良者培养阳性率较高 ;以 G- 杆菌多见 ,占 5 0 .0 % ,以流感嗜血杆菌、肺炎克雷伯杆菌、大肠埃希菌及铜绿假单胞菌为多 ;G+球菌 39.7% ,真菌 10 .3% ;支原体抗体和衣原体抗体阳性分别占 10 .9%和 8.2 %。其中 ,G+ 球菌对氨苄西林、苯唑西林等均有较高耐药性 ,对万古霉素最敏感 ;G- 菌对氨苄西林的耐药性最高 ,对氨基糖甙类、喹诺酮类及部分第三代头孢菌素较为敏感 ,对亚胺培南、哌拉西林 /他佐巴坦最敏感。结论 :糖尿病合并 CAP的常见致病菌有其特殊性 ,以 G-杆菌为主且耐药性较高 ;支气管肺泡灌洗液培养是一种简单而高效的检查手段 ,有助于病原学诊断和指导抗生素的选用.

Analysis of Value on Distribution of Pathogen and Bronchoalveolar Lavage Fluid in Diabetic Patients with Community Acquired Pneumonia

Objective:To study the speciality and medicine resistanc e of pathogeni c bacterium and the diagnostic value of bronchoalveolar lavage fluid(BALF) on th e pathogenic bacterium in diabetic patients with community acquired pneumonia (C AP).Methods:73 cases of diabetes complicated with pneumonia in Shenzhen were stu died.The chlamydiales and myocoplasma antibodies, smear examination, and bacteri um culture were carried out.The relationship between the distribution of bacteri um as well as drug resistance and the management of diabetes were analyzed. R esults:The positive rate of sputum culture was significantly higher than that of BALF(26.6%vs42.9%,P<0.01).The patients whose blood g lucose was not well control led had higher positive culture rate,and Gbacillus was found mostly,account ed for 50.0%;Influnza hemophylus bacillus, Klebsiella pneumonia,Escherichia bacil lus coli and bacillus pyocyaneus were found mostly.G + coccobacteria was coun ted for 39.7%,fungus 10.3%,and chlamydiales antibody and myocoplasma antibody positi ve were counted for 10.9% and 8.2%, respectively. Among them,G + coccobacteri a had higher drug resistance to ampincillium,benzylpenicillin and was most sensitive to vancomycin.Gbacteria showed the highest drug resistance to ampicillin an d was mor e sensitive to aminoglycosides, quinolones and a part of the third generation of cephalosporins. It was most sensitive to imipenem,piperacillin/tazobactam. Conc lusion:It is believed that the common pathogenic bacterium in diabetes complica t ed with CAP have their speciality.Gbacillus is mostly found and has higher dru g resistance.BALF culture is a simple and most effective measure of examination. It is beneficial to the pathogenic diagnosis and the direction of antibiotic pr actice.