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目的:了解下呼吸道感染患儿支气管肺泡灌洗液(BALF)中病原菌种类及耐药情况,为临床合理用药提供参考。方法:采集2012-2014年在我院儿科住院给予纤维支气管镜支气管肺泡灌洗治疗的368例患儿的BALF,采用美国Micro Scan Walk Away 40型微生物分析仪及中国DL微生物分析仪对细菌进行鉴定并做药敏试验。结果:368份BALF共培养分离病原菌213株,其中革兰阴性菌197株(92.5%),革兰阳性菌10株(4.7%),白色念珠菌6株(2.8%)。主要细菌依次是肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌。常规检测主要细菌对12种抗菌药物的耐药情况显示,鲍曼不动杆菌耐药性较低,对各抗菌药物的耐药率均<30%;铜绿假单胞菌对替卡西林/克拉维酸、哌拉西林/他唑巴坦、头孢他啶、亚胺培南、阿米卡星、环丙沙星、左氧氟沙星的耐药率均<20%;肺炎克雷伯菌、大肠埃希菌对亚胺培南的耐药率为0,对其他抗菌药物不同程度耐药。结论:下呼吸道感染患儿BALF中主要细菌为革兰阴性杆菌,不同细菌对不同抗菌药物的耐药性不同,合理用药是控制感染的关键。
Objective: To understand the types and drug resistance of pathogens in bronchoalveolar lavage fluid (BALF) in children with lower respiratory tract infection, and to provide reference for clinical rational drug use. Methods: The BALFs of 368 children hospitalized in our hospital from 2012 to 2014 with bronchial bronchoalveolar lavage were collected, and the bacteria were identified by the Micro Scan Walk Away 40 Microbial Analyzer and the China DL Microbial Analyzer And drug sensitivity test. Results: A total of 213 pathogenic bacteria were isolated from 368 BALF strains, of which 197 (92.5%) were Gram-negative bacteria, 10 (4.7%) were Gram-positive bacteria and 6 (2.8%) were Candida albicans. The main bacteria followed by Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, Escherichia coli. Routine tests of the resistance of major bacteria to 12 antimicrobial agents showed that Acinetobacter baumannii was less resistant to all antibacterials and its resistance rate to each antibiotic was <30%. Pseudomonas aeruginosa to ticarcillin / carat The resistance rates of Victavie, piperacillin / tazobactam, ceftazidime, imipenem, amikacin, ciprofloxacin and levofloxacin all were less than 20%. The rates of Klebsiella pneumoniae and Escherichia coli were Imipenem resistance rate of 0, to varying degrees of resistance to other antibacterial drugs. Conclusion: The main bacteria in BALF of children with lower respiratory tract infection are Gram-negative bacilli. Different bacteria have different resistance to different antibacterials. Rational use of drugs is the key to infection control.