小儿难治性肺炎147例支气管肺泡灌洗液细菌培养及药敏分析

目的分析经纤维支气管镜(纤支镜)采样的支气管肺泡灌洗液细菌分离病原学及耐药性特点,及其在难治性肺炎诊治中的意义。方法2004-01—2006-04,对重庆医科大学附属儿童医院呼吸科住院的147例病程迁延、疗效不佳、病因不明的难治性肺炎患儿在静脉复合麻醉下行纤支镜术,进行支气管肺泡灌洗,收集标本进行培养,并与入院时痰培养结果比较。结果147例灌洗液标本中分离出细菌86株/80例。其中革兰阴性(G-)菌36株,前3位为肺炎克雷伯菌(8株)、铜绿假单胞菌(7株)、大肠埃希菌(6株),产超广谱β-内酰胺酶菌株12株,多重耐药株15株;革兰阳性(G )菌1株;真菌15株;咽部正常菌群34株。余67例无菌生长。147例患儿在入院时行痰培养,分离出细菌115株/109例,其中G-菌67株,前3位为副流感嗜血杆菌、卡他布兰汉菌、流感嗜血杆菌;G 分离菌15株;真菌7株;咽部正常菌群26株。38例无菌生长。痰液和灌洗液二者培养结果一致25例(17%)。结论对于病情复杂迁延、疗效不佳的下呼吸道感染,及早进行支气管肺泡灌洗对明确病原、指导抗生素的合理应用有重要意义。

Bacterial distribution in 147 BALF specimen and its drug sensitivity

Objective To analyze the bacterial distribution and drug-sensitivity in BALF specimen,and investigate the value of flexible bronchoscopy for children patients with lower respiratory tract infection.Methods For diagnosis and treatment,under general anesthesia,213 children of respiratory disorders were examined by flexible bronchoscopy in Chongqing Children Hosptial from January,2004 to April,2006.Totally 147 child patients with respiratory tract infection underwent bronchotrachoalveolar larvage,and the BALF specimen were collected.Results A total of 86 strains were isolated from 80 cases,the Gram-negative bacteria were 36 strains,of which klebsiella pneumoniae rated the first,followed by Pseudomonas aeruginosa and Escherichia coli.ESBLs were detected in isolates of 12 Gram-negative bacteria;multidrug-resistant isolates were 15 strains;fungi were 15 strains;normal flora in oropharynx were 34 strains.A total of 115 strains were isolated from 109 cases,the Gram-negative bacteria were 67 strains,of which Haemophilus parainfluenzae rated the first,followed by Branhamella catarrhalis and Bacterium aegyptiacum;fungi were 7 strains;normal flora in oropharynx were 26 strains.Conclusion Use of protected bronchoalveolar lavage is recommended in the children with refractory difficult-to-control lower respiratory tract infection of unknown origin;it can help choose the antibiotics reasonably.