痰液培养定植菌与病原菌判断方法的探讨

Evaluation of pathogenicity of bacteria acquired from sputum specimen by germiculture

目的探讨一种咳痰标本培养定植菌与病原菌判断方法。方法296例培养生长潜在病原菌的标本,直接涂片革兰染色细胞学计数,同时观察白细胞和潜在病原菌之间的免疫病理现象,并收集患者相关临床资料,综合三方面对所生长的潜在病原菌进行判断。以患者依据药物敏感实验结果用药后的疗效以及有无感染症状体征为判断依据。结果296例标本中,单纯依据培养鉴定确定的病原菌与临床的符合率为48.3%;合格、可接受标本234份(79%),所培养的细菌感染率显著高于不合格标本(60.3%vs3.2%,P<0.005);234份合格标本中,白细胞吞噬细菌或与细菌并存现象的标本121份,所培养的细菌均确定为感染病原菌,感染率显著高于未观察到免疫病理现象的标本(100%vs21.2%,P<0.005);肺炎链球菌、流感嗜血杆菌、卡他布兰汉菌(50株),葡萄球菌(22株),肠杆菌科细菌(86株),非发酵菌(138株)四类不同的细菌感染率之间存在显著差异,依次为100%、59.1%、49.3%、29.7%(P<0.005)。结论实验室对咳痰标本培养出的条件致病菌不可单纯依据生长情况选择细菌进行鉴定和药物敏感实验,而必须综合患者的临床资料、直接涂片的微观现象(细胞学状态及免疫病理现象)和培养生长情况三个方面来确定感染病原菌。

Objective To explore a method for evaluating the colonization or infection of bacteria acquired from sputum specimen by germicuhere. Methods 296 sputum speciments, generally bacterial culture and smera with Gram stain（leucocyte and squamous cell coumting and phenomena of bacteria be phagocytized or accompanied by leucocytes） were preceded, and clinical data of the patients was gleaned at the same time. Then, suspicious pathogenic bacteria acquired by cuhure were evaluated on the base of the combination of above three factors. Results Among 296 specimens, there were 234 accepted specimens and 62 unqualified speciments. Bacteria acquired from accepted specimens had fled specimens（60.3% vs 3.2%, P 〈 0.005）; mens which had the phenomena of bacteria p sighificant higher infection rate than from unquali fled specimens（60.3% vs 3.2%, P 〈 0.005）; In 234 accepted specimens, there were 121 specimens which had the phenomena of bacteria phagocytized or accompanied by leucocytes, and all bacteria isolated from this kind of specimen could be comfirmed as pathogenic bacteria （100%）. But the infection rate of bacteria isolated from the other 143 specimens was only 21.2%（P 〈0.005）; The infection rate showed sighifieantly different between Streptococcus pneumounia ＆ Haemophilus influenzae ＆ Branhamela catarrhalis（50 strains）, Staphylococcus（22 strains）, Enterobactericaeae（86 strains） and nonfermenters（138 strains）（P 〈 0.005）. Conclusions For opportunistic pathogen isolated from sputum specimen, whether should be identifieated and proceeded with drug sensitive test is not determined only according to the results of cuhure. Pathogenicity of opportunistic pathogen should be determined on the basis of the combination of the results of culture, microphenomena of smear Gram stain （leucocyte and squamous cell counting and immune pathological phenomena）, and the clinical data of the patient.