初始治疗无效肺炎患者肺部灌洗液病原菌构成及血清CRP、PCT研究

Distribution of bacterial pathogens in BALF and serum CRP and PCT in patients with pneumonia unresponsive to initial treatment

目的研究初始治疗无效肺炎患者支气管肺泡灌洗液(BALF)病原菌构成及BALF与血清CRP、PCT相关性。方法选取2017年1月至2019年3月本院收治初始治疗无效的细菌性肺炎患者作为观察组(n=117)。分别收集患者痰液及BALF进行细菌学检查,观察两种标本中病原菌分布及细菌耐药情况。另选取同期于本院体检合格健康者作为对照组(n=110)。采集两组静脉血检测血清CRP与PCT水平。通过Spearman相关分析法分析BALF中病原菌分布与血清中CRP、PCT相关性。结果痰液中检出69株细菌,革兰阳性菌占18.84%(13/69)、革兰阴性菌占59.42%(41/69),其它菌占24.64%(17/69)。BALF中检出124株细菌,革兰阳性菌占27.42%(34/124)、革兰阴性菌占62.10%(77/124)、其它菌占18.84%(13/69)。金黄色葡萄球菌对万古霉素、呋喃妥因、左氧氟沙星、庆大霉素耐药率较低,肺炎链球菌对万古霉素、庆大霉素、呋喃妥因、左氧氟沙星耐药率较低;铜绿假单胞菌对头孢吡肟、阿米卡星、环丙沙星耐药率较低,鲍曼不动杆菌对米诺环素、阿米卡星、庆大霉素耐药率较低。BALF中主要病原菌分布与血清中的CRP、PCT均呈正相关(P<0.05)。结论细菌性肺炎患者BALF中革兰阴性菌分布较多,BALF中病原菌分布与血清CRP及PCT呈正相关。对于初始治疗无效的细菌性肺炎患者,检测BALF中病原菌分布较普通痰液检查而言更直观反映患者肺局部感染菌种病情情况,血清检测CRP及PCT能反应患者的全身炎症反应严重性,具有避免误诊、漏诊的优势。

Objective To investigate the distribution of bacterial pathogens in bronchoalveolar lavage fluid(BALF)and its correlation with serum C-reactive protein(CRP)and procalcitonin(PCT)in patients with pneumonia unresponsive to initial treatment.Methods Included in this study were patients with bacterial pneumonia who failed initial treatment and were admitted to our hospital between January 2017 and March 2019,assigned to the study group(n=117).The distribution of bacterial pathogens and drug resistance in sputum and BALF specimens were investigated.A contemporary cohort of health checkup subjects in our hospital were selected as the control group(n=110).The venous blood levels of CRP and PCT in the two groups were detected.The correlation between the distribution of pathogenic bacteria in BALF and serum CRP and PCT levels was analyzed by Spearman correlation analysis.Results A total of 69 bacteria strains were detected in sputum,including Gram-positive strains in 18.84%(13/69),Gram-negative strains in 59.42%(41/69),and other strains in 24.64%(17/69)of all specimens.A total of 124 bacteria strains were detected in BALF,including Gram-positive strains in 27.42%(34/124),Gram-negative strains in62.10%(77/124),and other strains in 18.84%(13/69)of all specimens.Low resistance was found with Staphylococcus aureus to Vancomycin,Furantoin,Levofloxacin and Gentamicin;Streptococcus pneumoniae to Vancomycin,Gentamicin,Furantoin,and Levofloxacin;Pseudomonas aeruginosa to Cefepime,Amikacin and Ciprofloxacin;Acinetobacter baumannii to Minocyclin,Amikacin,and Gentamicin.The distribution of major bacterial pathogens in BALF was positively correlated with serum CRP and PCT levels(P<0.05).Conclusion In patients with bacterial pneumonia unresponsive to initial treatment,the BALF is predominated by Gram-negative bacteria.Distribution of bacterial pathogens in BALF is positively correlated with serum CRP and PCT levels.Compared with sputum test,BALF detection of bacteria pathogens may offer more intuitive clues to the bacteria causative of local infection in the lungs.Serum tests of CRP and PCT may reflect the severity of systemic inflammation in patients,and therefore are useful to avert incorrect and missed diagnoses.