支气管扩张症合并支气管哮喘患者支气管肺泡灌洗液病原菌培养及药敏状况研究

Study of pathogen culture and drug susceptibility status of bronchoalveolar lavage fluid in patients withbronchiectasis and bronchial asthma

目的探讨支气管肺泡灌洗液（bronchoalveolarlavagefluids，BALF）病原菌培养及药敏试验在支气管扩张症合并支气管哮喘治疗中的临床应用价值。方法选择90例支气管扩张症合并支气管哮喘的住院患者，收集其BALF标本进行病原菌培养及药敏试验。结果90例患者病原菌检出阳性55例（61．1％），共57株。革兰阴性杆菌54株（94．7％），以铜绿假单胞菌为主，鲍曼不动杆菌次之；真菌2株（3．5％），为曲霉菌；革兰阳性球菌1株（1．8％），为金黄色葡萄球菌。混合菌感染2例，为鲍曼不动杆菌合并金黄色葡萄球菌1例、施氏假单胞菌合并铜绿假单胞菌1例。药敏试验发现，53株革兰阴性杆菌对妥布霉素、头孢哌酮舒巴坦、亚胺培南最敏感，对头孢噻肟、复方新诺明、左旋左氧氟沙星耐药性最高；嗜麦芽寡养食单胞菌对左旋左氧氟沙星、米诺环素及复方新诺明100％敏感；曲霉菌对两性霉素B、伊曲康唑、伏立康唑100％敏感；革兰阳性球菌只检出1株，药敏结果代表性不强，未给予深入研究。结论支气管扩张症合并支气管哮喘患者BALF病原菌培养出细菌以革兰阴性杆菌为主，真菌感染率亦显现，革兰阳性球菌少；2种或2种以上混合细菌感染虽然占少数，但混合菌感染的出现说明各病原菌对多种抗菌药物的耐药性可能增加；药敏结果对临床治疗支气管扩张症合并支气管哮喘有重要指导意义；BALF取样部位针对性强，提供结果较可靠，培养阳性率高，临床应用价值较大；通过肺泡灌洗将有助于支气管扩张症的感染性分泌物清除，改善患者支气管阻塞，降低局部病原菌数量和浓度，有助于改善其喘息症状，并有助于控制感染。

Objective To explore the clinical value of bronchoalveolar lavage fluid （BALF） pathogen culture and drug susceptibility testing in the treatment of bronchiectasis accompany with bronchial asthma. Methods Select 90 cases inpatients with bronchiectasis and bronchial asthma. Collect their BALF for pathogens culturing and antibiotic susceptibility testing. Results 55 of the 90 cases patients is positive in pathogen detection（61.1 %）, and 57 strains in all. 54 strains Gram-negative bacilli （94.7 % ）, mainly in P. aeruginosa, followed by Acinetobacter baumannii, 2 strains fungi （3.5 %）, both Aspergillus, 1 strains Gram-positive cocci （1.8%）, Staphylococcus aureus. Two cases are mixed infection, Acinetobacter baumannii merging Staphylococcus aureus and Amur Pseudomonas merging Pseudomonas aeruginosa. Results of the Susceptibility test： 53 strains Gram-negative bacilli are most sensitive to tobrapaycin, cefoperazone sulbactam, imipenem, and are most resistant to cefotaxime, cotrimoxazole, L levofloxacin, maltophilia oligotrophic food Aeromonas is 100% sensitive to L levofloxacin, minocycline and cotrimoxazole, Aspergillus is 100% sensitive to amphotericin B,itraconazole, voriconazole, there is only 1 strains Gram-positive cocci, not deeply studied due to weak results of drug susceptibility. Conclusions The main pathogens cultured of BALF in patients with bronchiectasis accompany with bronchial are Gram negative bacilli, fungal infection also reveals, and Gram-positive cocci is less,although two kinds or more than two kinds of mixed bacterial infection is few, mixed culture infection is an indication of pathogens that a variety of antimicrobial agents may be increased,the results of drug sensitive for clinical treatment of bronchiectasis combined bronchial asthma have important guiding significance; there will be a larger clinical application value because of targeted sampling site, providing reliable results, and high cultivating positive rate. At the same time, bronchoalveolar lavage can help clear infectious secretion, improving bronchial obstruction and reducing local pathogen quantity and concentration, and also help improve their breathing symptoms and control the infection.