老年人肺部感染支气管肺泡灌洗液细菌培养及药敏的意义

Diagnosis Value of Quantitative Cultures and Antibiotics Tests of Bronchoalveolar Lavage Fluids in Elderly Patients with Respiratory Tract Infection

目的 探讨支气管肺泡灌洗液（bronchoalveolar lavage fluids,BALF） 细菌培养及药敏试验在老年人肺部感染病原诊断和指导抗生素治疗的价值.方法 常规方法分离培养2010~2011年度91例住院的肺部感染老年患者痰和BALF病原菌,应用半自动细菌鉴定分析仪鉴定到种,药敏试验方法按CLSI规定的标准进行.结果 91例肺部感染老年患者痰和BALF标本共分离出71株铜绿假单胞菌、21株肺炎克雷伯菌、15株大肠埃希菌和14株鲍曼不动杆菌.BALF病原菌检出率为92.3%,明显高于痰培养（76.9%,χ2=10.90,P〈0.01）.药敏结果显示铜绿假单胞菌和肺炎克雷伯菌对氨曲南、头孢吡肟和左氧氟沙星耐药,耐药率分别为81.1%,64.9%,86.5%和75.0%,66.7%,75.0%;铜绿假单胞菌对阿米卡星、庆大霉素和妥布霉素敏感;肺炎克雷伯菌对替卡西林/克拉维酸、阿米卡星和亚胺培南敏感.28例病原菌检出阳性结果患者根据药敏结果指导抗生素治疗后BALF和痰培养阳性率分别下降到35.7%和21.4%.结论 BALF细菌培养和药敏试验可明显提高老年肺部感染患者病原诊断率,可更好地指导临床选择有效抗菌药物.

Objective To explore the diagnosis value of quantitative cultures and antibiotics sensitivity test of bronchoalveolar lavage fluids （BALF） in elderly patients with respiratory tract infection. Methods Cultures of BALF and sputum from 91 elderly inpatients with respiratory tract infection during 2010-2011 were performed by routine methods and identified by the semi-automatic bacteria analysis system. The antibiotics sensitivity tests were carried out according to Clinical and Laboratory Standard Institute （CLSI） standards. Results There were strains of 71 P. Aeruginosa,21 of Klebsiella Pneumoniae, 15 E. coli and 14 Bauman Acinetobacter isolated in cultures of BALF and sputum from 91 patients. Quantitative cultures of BALF were positive in 84 of 91 cases （92. 3%）,which was significant higher than that of sputum cultures （76.9%, x^2 = 10. 90, P〈0. 01）. The antibiotics sensitivity monitoring results showed that both P. Aeruginosa and Klebsiella Pneumoniae were highly resistant against Aztreonam, Cefepime and Levofloxacin with resistance rate 81.1%, 64.9%, 86.5% and 75.0%,66.7% ,75.0% ,respectively. P. Aeruginosa was susceptibile to Amikacin,Gentamicin and Tobramycin. Klebsiella Pneumoniae was susceptibile to Ticarcillin/clavulanate, Amikaein and Imipenem. Cultures of BALF and sputum from 28 patients after treatment with optional antibiotics from the BALF sensitivity test were reduced to 35.7% and 21.4%, respectively. Conclusion These results indicate that the quantitative cultures and antibiotics sensitivity tests of BALF are valuable for the diagnosis and antibiotics therapy for the elderly patients with respiratory tract infection.