495例肺炎患儿支气管肺泡灌洗液与痰液细菌培养对比研究

Comparative study on bacterial culture of bronchoalveolar lavage fluid and sputum in 495 children patients with pneumonia

目的探讨肺炎患儿支气管肺泡灌洗液(BALF)与痰液细菌培养的阳性率差异。方法采集2015年3月～2017年11月我院综合内科诊断为肺炎,住院期间既取痰液又取支气管肺泡灌洗液行细菌培养和鉴定的患儿495例,比较痰液及支气管肺泡灌洗液培养阳性率的差异。结果 495例患儿支气管肺泡灌洗液培养阳性者34例,阳性率为6.9%,居前三位者分别为:肺炎链球菌16例(47.1%),肺炎克雷伯菌11例(32.4%),大肠埃希菌4例(11.8%),其他3例(8.7%);培养结果与病情相符者32例,符合率94.1%。痰培养阳性者41例,阳性率为8.3%,居前三位的细菌分别为:肺炎链球菌21例(51.2%),金黄色葡萄球菌9例(22.0%),流感嗜血杆菌5例(12.2%),其他6例(14.6%);培养结果与病情相符者28例,符合率68.3%。结论支气管肺泡灌洗液与痰液细菌培养阳性率无明显差异,但支气管肺泡灌洗液培养结果有更高的临床符合率,结果更可靠,对抗生素使用的指导意义大于痰液。

Objective To investigate the difference in the positive rate of bacterial culture of bronchoalveolar lavage fluid （BALF） and sputum in the children patients with pneumonia. Methods 495 children patients who were diagnosed with pneumonia in the department of comprehensive internal medicine in Kunming Children＇s Hospital from March 2015 to November 2017 were collected. During the hospitalization, all of them were given bacterial culture and identification of collected sputum and bronchoalveolar lavage fluid. The differences in the positive rate of sputum and bronchoalveolar lavage fluid culture were compared. Results Of the 495 children patients, 34 were positive for bronchoalveolar lavage fluid culture. The positive rate was 6.9%, and the top three bacteria were： 16 cases（47.1%） of Streptococcus pneumoniae, 11 cases（32.4%） of Klebsiella pneumoniae, 4 cases（11.8%） of Escherichia coli, and 3 cases（8.7%） of other bacteria; the results of the culture consistent with the disease were in 32 cases, with the coincidence rate of 94.1%. 41 cases were positive in sputum culture, with the positive rate of 8.3%. The top three bacteria were： Streptococcus pneumoniae in 21 cases（51.2%）, Staphylococcus aureus in 9 cases（22.0%）, Haemophilus influenzae in 5 cases （12.2%）, and others in 6 cases（14.6%）; the results of the culture consistent with the disease were in 28 cases, with the coincidence rate of 68.3%. Conclusion There is no significant difference in the positive rate of bacterial culture of bronchoalveolar lavage fluid and sputum. However, the culture results of bronchoalveolar lavage fluid have a higher clinical coincidence rate, the results are more reliable, and the guiding significance for antibiotic use is greater than that of sputum.