肺泡灌洗液、纤支镜刷出物及痰病原菌培养对下呼吸道感染的诊断价值

The diagnostic value of the pathogenic bacteria cultures of bronchoalveolar lavage fluid,protected specimen brush sample and sputum for lower respiratory infection

目的探讨肺泡灌洗液(BLAF)、纤维支气管镜防污染毛刷(PSB)刷出物和痰病原菌培养对下呼吸道感染的诊断价值,为临床抗感治疗提供依据。方法回顾2015年1月-2017年10月本院呼吸内科292例疑似下呼吸道感染患者的BLAF、PSB刷出物和痰病原菌培养结果,比较三种标本的诊断符合率及检测结果的一致性,并对BLAF病原菌分布和耐药性特点进行回顾分析。结果 BLAF诊断符合率最高,其次为PSB刷出物,痰最低。PSB刷出物与BLAF检测结果的一致性非常好,痰与BLAF的一致性比较满意。BLAF共培养出致病菌261株,革兰阴性杆菌占61.3%,对抗菌素耐药性较高;革兰阳性球菌占11.9%,耐药性两极分化;酵母样真菌占26.4%,对多数抗真菌药物敏感。结论诊断下呼吸道感染,应将BLAF和痰培养有机结合,便于临床开展并提高确诊率。

Objective To explore the diagnostic value of the pathogenic bacteria cultures of bronchoalveolar lavage fluid(BLAF),protected specimen brush(PSB)sample and sputum culture for lower respiratory infection,and to provide the basis for clinical anti-infection treatment.Methods Reviewed the pathogenic bacteria culture results of the BLAF, PSB sample and sputum in 292 patients with suspected lower respiratory infection in the department of respiratory medicine in our hospital from January 2015-2017 October,and compared the diagnostic coincidence rates and consistency of the results of the three kinds of specimen,and retrospective analysed the distribution and drug resistance characteris- tic of the pathogenic bacteria of the BLAF.Results The diagnostic coincidence rate of the BLAF was the highest,the second was PSB sample,and the lowest was sputum.The results of the PSB sample are in good consistency very much with those of BLAF,and the consistency of the sputum and the BLAF was more satisfactory.261 strains of pathogenic bacteria were cultured from the BLAF,the Gram-negative bacilli accounted for 61.3%,and the drug resistance of them to the antibiotics was higher,The Gram-positive cocci accounted 11.9%,and the drug resistance of them was in two differentiation)The yeast like fungi accounted for 26.4% ,and they were sensitive to most antifungal drugs.Conclusion We should combine BLAF with sputum culture organically in the diagnosis of lower respiratory infection.It is easy for carrying out in clinic and improving the rate of diagnosis.