气管导管生物膜培养对病原学检出率的影响  

The value of the detection of pathogens by culturing biofilms from endotracheal tubes in patients on ventilators

作　　者：吕峻峰[1] 邹志慧[1] 杨冰岩[1] 陈志君[1] 叶永青[1] 潘丽怡[1] 谭南[2] 

机构地区：[1]中山市博爱医院新生儿科,广东中山528403 [2]中山市博爱医院检验科,广东中山528403

出　　处：《中国微生态学杂志》2014年第11期1279-1281,1287,共4页Chinese Journal of Microecology

基　　金：中山市科技计划项目(20122A060)

摘　　要：目的探讨机械通气危重儿气管导管细菌生物膜对提高病原菌检出率的作用。方法选择2013年入住新生儿科需要机械通气的新生儿,根据机械通气的时间将研究对象分为3组：≤72 h组、73~168 h组及〉168 h组,以漩涡振荡器振荡气管导管末端,振荡液培养,与同时送检的深部痰培养结果进行统计学比较。结果在机械通气时间≤72 h组、73~168 h组中,漩涡振荡器振荡液与深部痰培养的阳性率高度一致,Kappa值分别为0.799、0.710,P值分别为0.000及0.000;在〉168 h组中,二者中度一致,Kappa值为0.651,P值为0.001。两种方法分离的菌株以产ESBL酶肺炎克雷伯杆菌最多见,产ESBL酶大肠杆菌次之,两种方法间菌株的构成及耐药性差异无统计学意义。结论以漩涡振荡器法获取气管导管细菌生物膜不能提高机械通气患儿的病原学检测阳性率,对临床用药无明显指导意义。Objective To explore the value of biofilms culturing to the detection rate of pathogens in high-risk newborns on ventilators. Methods 90 neonates who needed ventilation and were admitted in the neonatology department in 2013 were recruited and devided into three groups,≤72 h group,73-168 h group and 〉168 h group.The remote end of the endotracheal tubes in normal saline were oscillated through an oscillator,then the fluid was cultured. Meanwhile,deeply aspirated sputum were also cultured. The results were statistically compared. Results There was a high consistency（ Kappa = 0. 799,0. 710,P = 0. 000,0. 000） between the two detecting methods in ≤72 h group and 73-168 h group. A certain consistency was seen between the two detecting methods in 〉168 h group（ Kappa = 0. 651,P = 0. 001）. Klebsiella pneumoni with positive ESBL was a predominant pathogen in both testing methods. Escherichia coli was the second prevalent pathogen. Resistance of all pathogens was not statistically different between the two methods. Conclusion Biofilm obtained from the remote endotracheal tubes using oscillator can not improve the detection rate of pathogens in patients on ventilators. Therefore this testing method may have no significant value for clinical medication.

关 键 词：生物膜 病原学 气管导管 

分 类 号：R378[医药卫生—病原生物学]