儿童难治性肺炎肺泡灌洗液病原学分布及药敏特点分析

目的探讨儿童难治性肺炎支气管肺泡灌洗液(BALF)的病原学分布及药敏特点。方法回顾性分析我科2010年1月～2012年6月病房送检70例BALF培养和药敏特点,分析疗效与BALF培养关系及组间年龄分布。结果难治性肺炎BALF培养以肺炎克雷伯菌、铜绿假单胞菌及大肠埃希菌居多。其中,肺炎克雷伯菌感染者1岁以内的小婴儿占76.9%(10/13),且占1岁以内感染细菌的43.5%,BALF培养阳性者主要集中在小年龄组;难治性肺炎显效46例,有效22例,无效2例;其中显效组BALF阳性32例,阴性24例,年龄(1.76±0.83)岁;有效组BALF阳性4例,阴性18例,年龄(1.33±0.97)岁;无效组BALF阳性0例,阴性2例,年龄(1.29±0.78)岁;疗效与BALF培养阳性率显著相关(P<0.01),而与年龄无显著相关(P>0.05)。结论难治性肺炎应及早行BALF培养,明确病原菌,提高疗效。

Analysis on the bacterial distribution and drug-sensitivity of bronchoalveolar lavage fluid in children with refractory pneumonia

Objective To observe the clinical significance of the bacterial distribution and drug-sensitivity of bronchoalveolar lavage fluid in children with refractory pneumonia. Methods A retrospective analysis was performed for 70 children, who had ever been hospitalized in our department for refractory pneumonia during the period from january 2010 to june 2012, then the relationship between clinical efficacy and culture results of bronehoalveolar lavage fluid, age distribution were analyzed. Results The major pathogens that those children with refractory pneumonia easily infected were klebsiella pneumoniae, pseudomonas acruginosa and eseherichia coll. In which, infants infected with klebsiella pneumoniae under 1 year of age accounted for 76.9% （10/13） of all patients, and accounted for 43.5% of patients infected with bacteria. The positive bronchoalveolar lavage fluid culturing was mainly found in the younger group. The numbers of excellence, efficiency and inefficiency of refractory pneumonia was 46 cases, 22 cases and 10 cases respectively. Among them, there were 32 positive and 24 negative in bronchoalveolar lavage fluid culture in excellence group that children with refractory pneumonia , with a mean age of （1.76±0.83） years old , there were 4 positive and 18 negative in bronchoalveolar lavage fluid culture in efficiency group, with a mean age of （1.33±0.97） years old , there were 0 positive and 2 negative in bronchoalveolar lavage fluid culture in inefficiency group, with a mean age of （1.29±0.78） years old ,there was significantly positive correlation between clinical efficacy and culture results （P 〈0.01 ）, while there was no significant correlation between age and clinical efficacy （P〉0.05）. Conclusion Bronchoalveolar lavage fluid culture should be performed as early as possible in patients with refractory pneumonia, which can identify the pathogen and improve the effect.