支气管肺泡灌洗液细菌培养阳性患儿165例临床分析

目的：分析支气管肺泡灌洗液（BALF）细菌培养阳性患儿的临床特征、病原谱及药敏结果，为儿童下呼吸道感染临床诊治提供依据。方法：回顾性分析2013年1月-2015年12月送检BALF培养的1?159例住院患儿的临床资料、病原学检查及药敏试验结果等。结果：检出致病菌株165例，其中男99例（占60.0%），女66 例（占40.0%）。临床诊断肺炎最多见，为116例（占70.4%），其中支气管肺炎91例，大叶性肺炎25例；其次是毛细支气管炎合并细菌感染19例（占11.5%），迁延性细菌性支气管炎（PBB）12例（占7.3%）。165株细菌革兰染色阳性112株（占67.9%），其中肺炎链球菌最多见，为102株，其次为金黄色葡萄球菌8株；革兰染色阴性53株（占32.1%），其中以流感嗜血杆菌最多见，为14株，其次为铜绿假单胞菌13株，大肠埃希菌8株。65例（占39.4%）患儿存在基础疾病，其中呼吸道畸形最多见，共22例，主要为气管和（或）支气管软化、狭窄，其次是支气管哮喘，共14例。102株肺炎链球菌药敏结果显示对青霉素敏感25株，对青霉素中介35株，对青霉素耐药42株，提示以青霉素不敏感菌株为主（占75.5%）。金黄色葡萄球菌中以耐甲氧西林菌株为主，但无耐万古霉素及利奈唑胺菌株。流感嗜血杆菌对青霉素及二代头孢菌素耐药率高，对三代头孢菌素仍较敏感。大肠埃希菌8株，其中产超广谱β内酰胺酶5株。肺炎克雷伯菌5株，其中产超广谱β内酰胺酶3株。结论：BALF细菌培养阳性患儿临床诊断以肺炎最多见，其次是毛细支气管炎合并细菌感染和迁延性细菌性支气管炎；细菌病原以肺炎链球菌及流感嗜血杆菌为主。

Clinical analysis of 165 cases whose bronchoalveolar lavage fluid bacterial culture were positive

Objective: To investigate the clinical characteristics, pathogen spectrum and antibiotic drug sensitive test of patients whose bronchoalveolar lavage fluid culture were positive. To provide the theory basis for clinical diagnosis and treatment for lower respiratory infection in children. Methods: A retrospective review was performed on 1 159 hospitalized cases from January 1, 2013 to December 31, 2015. The information of the patients whose BLAF were sent to lab including clinical data, bacterial culture and drug sensitivity was analyzed. Results: The bacterial culture of BALF in 165 cases were positive, among whom 99(60.0%) were male and 66(40.0%) female. Overall, 70.4% cases were suffered from pneumonia, especially bronchopneumonia. 19 cases (11.5%) were diagnosed as bronchiolitis and combined with bacterial infection. And 12 cases (7.3%) had protracted bacterial bronchitis. One hundred and sixty five organisms from BALF were collected in the survey period, including 112(67.9%) gram-positive bacteria and 53(32.1%) gram-negative bacteria. The five most frequently isolated pathogens were Streptococcus pneumoniae (102 strains), Haemophilus influenza (14 strains), Pseudomonas aeruginosa (13 strains), Escherichia coli (8 strains) and Straphylococcus aureus (8 strains). Sixty five cases (39.4%) had underlying disease and the most common one was deformity of respiratory tract (22 cases) such as malacia, stenosis of trachea or bronchus. There were 14 cases suffered from bronchial asthma. Among 102 Streptococcus pneumoniae strains, there were 25 strains penicillin-sensitive S. pneumoniae, 35 strains penicillin-intermediate S. pneumonia and 42 penicillin-resistant S. pneumonia. Most Staphylococcus aureus strains were methicillin-resistant and there was no vancomycin and linezolid-resistant strain. The drug resistant rates of Haemophilus influenzae to penicillin and the second generation of cephalosporin were high. However, it was sensitive to the third generation of cephalosporin. There were 8 strains of Escherichia coli and five strains produced extended spectrum β-lactamase (ESBL). And 3 of 5 strains of Klebsiella pneumonia were ESBL positive. Conclusion: The most common diagnosis of patients whose bronchoalveolar lavage fluid culture were positive was pneumonia, followed with bronchiolitis which combined with bacterial infection and protracted bacterial bronchitis. The predominant bacteria were Streptococcus pneumonia and Haemophilus influenza.