对1例结肠癌术后多次鲍曼不动杆菌培养阳性痰标本临床指导意义的解读

Clinical Significance Interpretation of Positive Sputum Samples from One Patient with Acinetobacter Baumanni Infection after Colon Cancer Surgery

目的:探讨鲍曼不动杆菌(AB)培养阳性痰标本的结果判读及其临床指导意义。方法:分析1例结肠癌术后入住ICU继发肺部感染患者的抗感染治疗,讨论AB培养阳性痰标本的判读及其临床指导意义。结果:虽然多次痰培养结果提示阳性,但痰标本质量不高培养结果可信度低,且由抗菌药选择压力而筛选出多重耐药鲍曼不动杆菌(XDR-AB)的可能性小,再结合患者临床感染症状不重和ICU使用亚胺培南/西司他丁治疗有效的情况辩证分析,认为患者具备定植AB感染的高危因素,分离到的XDR-AB不是致病菌。结论:当呼吸道标本AB培养阳性时,首先应通过涂片结果评价标本质量、留意是否存在白细胞吞噬或伴行的现象,再分析是否存在抗菌药选择压力筛选的可能、分析患者是否具备定植菌感染高危因素,最后结合患者临床感染症状、药敏结果出来前的抗感染治疗疗效来综合评价其是否为致病菌,然后再确定下一步抗感染治疗方案。

Objective： To discuss the results interpretation and clinical significance of Acinetobacter Baumanni （AB） positive spu- tum samples. Methods： The anti-infection treatment of one patient with lung infection after colon cancer surgery in ICU was analyzed, and the results interpretation and clinical significance of AB positive sputum samples were discussed. Results： Although the culture re- suits of sputum samples were positive, the quality of sputum samples was low and the credibility was poor. The possibility of multiple drug resistance AB （XDR-AB） screened by antibiotics selective stress was small. Meanwhile, the clinical infection symptoms were mild, and the treatment with imipenem was effective. Although the patient had high risk factors for the colonization of Baumanni infec- tion, XDR-AB was not a pathogen. Conclusion： When respiratory samples are AB positive, the quality of samples should be evaluated by smear results firstly, especially the existence of white blood cell phagocytosis or accompanying should be paid attention to , and then the possibility of AB screened by antibiotics selective stress and high risk factors for colonization should be analyzed. Finally, combined with the clinical symptoms of patients and the treatment efficacy before drug sensitivity tests, whether XDR-AB is pathogenic bacteria should be judged, and then the corresponding anti-infection treatment plan should be determined.