下呼吸道感染患儿支气管肺泡灌洗液病原菌分布及耐药性分析

目的:了解下呼吸道感染患儿支气管肺泡灌洗液(BALF)中病原菌种类及耐药情况,为临床合理用药提供参考。方法:采集2012-2014年在我院儿科住院给予纤维支气管镜支气管肺泡灌洗治疗的368例患儿的BALF,采用美国MicroScan WalkAway 40型微生物分析仪及中国DL 微生物分析仪对细菌进行鉴定并做药敏试验。结果:368份BALF共培养分离病原菌213株,其中革兰阴性菌197株(92.5%),革兰阳性菌10株(4.7%),白色念珠菌6株(2.8%)。主要细菌依次是肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌。常规检测主要细菌对12种抗菌药物的耐药情况显示,鲍曼不动杆菌耐药性较低,对各抗菌药物的耐药率均<30%;铜绿假单胞菌对替卡西林/克拉维酸、哌拉西林/他唑巴坦、头孢他啶、亚胺培南、阿米卡星、环丙沙星、左氧氟沙星的耐药率均<20%;肺炎克雷伯菌、大肠埃希菌对亚胺培南的耐药率为0,对其他抗菌药物不同程度耐药。结论:下呼吸道感染患儿BALF中主要细菌为革兰阴性杆菌,不同细菌对不同抗菌药物的耐药性不同,合理用药是控制感染的关键。

Bacterial Distribution and Drug Sensitivity of Bronchoalveoar Lavage Fluid in Children with Lower Respiratory Tract Infection

Objective: To understand the types of bacteria and drug sensitivity in bronchoalveoar lavage fluid (BALF) of children with lower respiratory tract infection, and to provide basis for clinical rational drug use. Methods: The BALF of three hundreds and sixty eight children who treated with fiber bronchoscope were collected in 2012 to 2014. The identification and drug susceptibility testing for bacteria were performed using MicroScan WalkAway 40 analyzer from America and DL analyzer from China. Results: Two hundreds and thirteen strains of pathogenic bacteria were isolated. Among them, gram-negative bacilli accounted for 92. 5%, gram-positive bacilli accounted for 4.7%, Candida albicans accounted for 2.8%. The main types of these bacteria were Klebsiella pneumoniae, Pseudomons aeruginosa, Acinetobacter baumannii, Escherichia coli. The results of drug susceptibility testing showed that the drug resistance of Acinetobacter baumannii to 12 kinds of antibiotis was generally low, the drug resistance rates to every tested antibiotis was less than 30%. The drug resistance rates of Pseudomonas aeruginosa to ticarcillin/clavulanic acid, piperacillin/tazobactam, ceftazidime, imipenem, amikacin, ciprofloxacin, levofloxacin were less than 20%. The drug resistance rates of Klebsiella pneumoniae and Escherichia coli to imipenem were 0, and to other tested antimicrobial agents showed varying degrees of resistance. Conclusion: The main pathogenic bacteria isolated from bronchoalveoar lavage fluid are gram-negative bacilli, the drug resistance of bacteria to different antibacterial drug are different, and reasonable use of antiotics is the key of infection controlling.