肺泡灌洗液细菌培养及药敏结果分析  

Analysis of bacterial culture and susceptibility test results in irrigating solution of pulmonary alveoli

作　　者：邹单东[1] 韦柳华[1] 程红革[1] 

机构地区：[1]广西医科大学第四附属医院检验科,广西柳州545005

出　　处：《重庆医学》2012年第27期2854-2856,共3页Chongqing medicine

摘　　要：目的了解下呼吸道感染患者的肺泡灌洗液中细菌种类及耐药情况,为临床合理用药提供依据。方法采用美国Microscan Autoscan-4微生物分析仪对251例下呼吸道感染患者肺泡灌洗液中分离到的195株细菌作鉴定及药敏试验。结果 251例患者灌洗液细菌培养阳性率为56.2%(141/251);慢性阻塞性肺疾病(COPD)伴肺部感染、肺脓肿、肺部感染、创伤合并肺不张的细菌培养阳性率分别为57.7%、57.1%、55.0%、55.3%,差异无统计学意义(P>0.05)。195株细菌中革兰阴性菌占90.8%,革兰阳性菌占9.2%;主要细菌依次是铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌。主要革兰阴性菌对亚胺培南耐药率为0.0%～15.1%,大肠埃希菌、肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)阳性率为62.5%、64.1%,耐甲氧西林金黄色葡萄球菌(MRSA)检出率为60.0%,细菌多药耐药现象严重。结论纤维支气管肺泡灌洗检查对下呼吸道感染的病原学诊断有较高价值。不同细菌对抗菌药物的耐药性不同,灌洗液细菌培养及药敏试验可为临床合理用药提供依据。Objective To understand the types of bacteria and the susceptibility test results in pulmonary alveoli irrigating solution of the patient with lower respiratory tract infections（LRTI） ,and to provide basis for clinical rational drug use. Methods The Microscan Autoscan-4 microorganisms analyzer was adopted to perform the identification and susceptibility test in 195 strains of bacteria isolated from the pulmonary alveoli irrigating solution in 251 cases of LRTI. Results Among 251 cases,the positive rate of bacterial culture in irrigating solution was 56.2% （141/251）. In COPD with pulmonary infection,lung abscess, pulmonary infection and trauma complicating atelectasis, the positive rates were 57.7 %, 57.1 %, 55.0 %, 55.3 %, respectively, without statistical differences among them（P〈0.05）. Gram-negative bacteria accounted for 90.80%o of these 195 strains of bacteria and Gram-positive bacteria accounted for 9.2 %. The main types of these bacteria were Pseudomonas aeruginosa,Klebsiella pneumoniae and Acinetobacter baumannii. The resistance rate to imipenem in main Gram-negative bacteria was 0.0%- 15.1%. The positive rates of ESBLs produ cing Klebsiella pneumoniae and Acinetobacter baumanii were 62.5 % and 64.1%, respectively. The detection rate of methicillin-re sistant Staphylococcus aureus（MRSA） was 60.0%. The phenomenon of multidrug resistance was very serious. Conclusion The detection of pulmonary alveoli irrigating solution has a higher value to pathogenic diagnosis of IRTI. The drug resistances of bacteria to different antibaclerial drugs are different. The bacterial culture and susceptibility test of irrigating solution can provide basis for rational drug use in clinic.

关 键 词：支气管肺泡灌洗液 细菌 多药耐药 

分 类 号：R446.5[医药卫生—诊断学]