支气管肺泡灌洗液细菌培养及药敏试验在儿童难治性肺炎诊治中的价值  

Value of bacteria culture and antimicrobial susceptibility test of bronchoalveolar lavage fluid in diagnosis and treatment of refractory pneumonia in children

作　　者：任立歆[1] 郭伟[1] 董汉权[1] 付卓[1] 宁静[1] 夏宇靖[1] 万莉雅[1] 

机构地区：[1]天津市儿童医院呼吸科,300074

出　　处：《中华实用儿科临床杂志》2013年第4期258-260,共3页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨支气管肺泡灌洗液（BALF）细菌培养及药敏试验在儿童难治性肺炎治疗中的应用价值。方法选取2010年8月至2011年12月在天津市儿童医院呼吸科治疗，对常规抗感染治疗超过2周仍无效的难治性肺炎患儿368例进行纤维支气管镜检查，并行支气管肺泡灌洗，BALF做细菌培养和药敏试验。结果181例患儿BALF细菌培养阳性，获得分离菌195株。其中革兰阳性菌10株（肺炎链球菌7株，金黄色葡萄球菌3株），占5．1％；革兰阴性菌48株，占24．6％，以铜绿假单胞菌为主（23株，占11．8％），其次为黏质沙雷菌、嗜麦芽窄食单胞菌（各6株，占3．1％）；其中产酶菌2株，分别为金黄色葡萄球菌13内酰胺酶阳性及荧光假单胞菌AmpC酶阳性；白色念珠菌1株，占0．5％；寄生菌136株，占69．7％。革兰阳性菌对红霉素、青霉素、头孢呋辛均有较高的耐药性，对氯霉素、左氧氟沙星、万古霉素较敏感；革兰阴性菌对氨苄西林、头孢唑啉、头孢呋辛、头孢噻肟普遍耐药，对阿米卡星、头孢吡肟、头孢哌酮舒巴坦、美罗培南、亚胺培南、左氧氟沙星、头孢他啶、哌拉西林较敏感。73．2％的患儿存在混合感染，同时混合肺炎支原体感染最多。结论经支气管镜取BALF培养致病菌，可获得相对准确的培养结果，药敏结果对临床治疗难治性肺炎有指导意义。Objective To evaluate the value of bacteria culture and antimicrobial susceptibility test of bronchoalveolar lavage fluid （BALF） in diagnosis and treatment of refractory pneumonia in children. Methods Three hundred and sixty-eight patients who failed to a 2 weeks,routine antibiotic therapy, hospitalized in Department of Respiration,Tianjin Children＇s Hospital from Aug. 2010 to Dec. 2011, were diagnosed as refractory pneumonia. They were examined with fiberoptic bronehoscopy, BALF was collected, and bacteria culture and antimierobial susceptibility test in BALF were performed. Results One hundred and ninety-five stains of bacteria were identified from BALF of 181 cases. There were 10 （5.1% ） gram-positive stains （7 Streptococcus pneumonia and 3 Staphylococcus aureus） ,48 stains （24, 6% ） were gram-negative bacterial, and the predominant were Pseudomonas aeruginosa （23 stains, 11.8 % ）, followed by Serratia marcescens and Stenotrophomonas maltophilia （6 stains respectively,3.1% ）. There were 1 Staphylococcus aureus with positive beta-lactamases and 1 Pseudomonas fluorescens with positive AmpC enzyme. There were 1 fungi （0.5 % ）and 136 parasitic bacteria stains （69.7%）. Gram-positive stains were universally resistant to Erythromyein, Penicillin, Cefuroxime, and susceptible to Chloramphenicol, Levofloxacin, Vancomyein. Gram-negative stains were universally resistant to Ampieillin, Cefazolin, Cefuroxime, Cefotaxime, and susceptible to Amikacin, Cefepime, Cefoperazone sulbaetam, Meropenem, Imipenem, Levofloxaein, Ceftazidime, Piperacillin. There were mixed infection in most children and the predominant pathogen was Mycoplasma pneumoniae. Conclusions Bacteria culture of BALF is relatively reliable and instructively recommended for the treatment of refractory pneumonia in children, meanwhile, it can help choose the antibiotics reasonably.

关 键 词：细菌 药敏试验 支气管肺泡灌洗液 难治性肺炎 JL童 

分 类 号：R446.5[医药卫生—诊断学]