摘要
目的探讨某市煤工尘肺合并下呼吸道感染支气管肺泡灌洗液(BALF)培养特点、病原菌分布及耐药性。方法选择2017年2月-2019年8月在新疆维吾尔自治区职业病医院就诊的煤工尘肺合并下呼吸道感染314例患者,患者均接受支气管肺泡灌洗液检查,根据《全国临床检验操作规程》第3版,细菌菌落数≥104 CFU/mL认定为病原菌。药敏试验采用纸片扩散法和E-Test法,药敏结果参照美国临床实验室标准化委员会(CLSI)2015年版指南及FDA标准。结果314份支气管肺泡灌洗液样本中有203份样本分离出病原菌总计261株,检出率为64.65%。其中革兰阴性菌126株,占48.28%;革兰氏阳性菌51株,占19.54%;真菌84株,占32.18%。药敏结果显示,肺炎克雷伯菌、铜绿假单胞菌、产酸克雷伯菌对头孢类、磺胺类和呋喃类药物耐药较为明显,对碳青霉烯类较为敏感。肺炎链球菌对万古霉素、利福平敏感,对复方新诺明、红霉素、克林霉素、青霉素、四环素耐药严重;粉肠球菌对利奈唑胺、万古霉素敏感,对红霉素、青霉素、庆大霉素、四环素、左氧氟沙星、奎奴普丁/达福普汀耐药严重。结论支气管肺泡灌洗液具有较高的病原菌株检出率。该市煤工尘肺合并下呼吸道感染患者真菌检出率高,革兰氏阳性菌和阴性菌均有严重耐药性,应予以重视。BALF病原菌培养对指导临床选择敏感抗菌药物具有重要临床价值。
Objective To investigate the pathogenic bacteria culture and drug resistance of bronchoalveolar lavage fluid(BALF)in coal workers’pneumoconiosis(CWP)with lower respiratory tract infection.Methods The patients with CWP and lower respiratory tract infection who were examined with BALF in Xinjiang Uygur Autonomous Region Occupational Disease Hospital from February 2017 to August 2019 were studied.According to the third edition of the national code of practice for clinical examination,bacterial colony count≥104 CFU/mL was identified as pathogenic bacteria.The paper diffusion method and E-Test method were used for drug sensitivity test.The drug sensitivity results referred to the guidelines of CLSI 2015 and FDA standards.Results A total of 261 strains of pathogenic bacteria were isolated from 203 samples of 314 BALF samples,and the detection rate was 64.65%.Among them,126 were Gram-negative bacteria,accounting for 48.28%;51 were Gram-positive bacteria,accounting for 19.54%;84 were fungi,accounting for 32.18%.Klebsiella pneumoniae,pseudomonas aeruginosa and klebsiella acidogenes were resistant to cephalosporins,sulfonamides and furans,and sensitive to carbapenems.Streptococcus pneumoniae was sensitive to vancomycin and rifampicin,and resistant to compound neoforman,erythromycin,clindamycin,penicillin and tetracycline;enterococcus powdery was sensitive to linezolid and vancomycin,and resistant to erythromycin,penicillin,gentamicin,tetracycline,levofloxacin and quinupdine/daptoptin.Conclusions BALF had a high detection rate of pathogenic bacteria.The detection rate of fungi in CWP patients with lower respiratory tract infection was high,Gram-positive bacteria and Gram-negative bacteria had serious drug resistance.The pathogenic bacteria culture of BALF had an important clinical value in guiding clinical selection of sensitive antibiotics.
作者
潘健
窦红
PAN Jian;DOU Hong(Xinjiang Uygur Autonomous Region Occupational Disease Hospital,Urumqi,Xinjiang 830000,China)
出处
《职业卫生与应急救援》
2020年第6期634-637,656,共5页
Occupational Health and Emergency Rescue
基金
新疆乌鲁木齐市科技局科学技术计划项目(G161310018)。
关键词
煤工尘肺
下呼吸道感染
支气管肺泡灌洗液
病原菌
耐药性
coal workers’pneumoconiosis
lower respiratory tract infection
bronchoalveolar lavage fluid
pathogenic bacteria
drug resistance