矽肺合并肺部感染患者支气管肺泡灌洗液病原菌菌群特征分析

Analysis of the characteristics of pathogenic bacteria in bronchoalveolar lavage fluid of patients with silicosis and pulmonary infection

目的分析矽肺合并肺部感染患者支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)病原菌菌群特征,为临床医师早期经验性抗感染处理提供依据。方法对2021年7月-2023年7月某院收治的272例矽肺合并肺部感染患者的痰液标本、BALF标本进行病原菌鉴定,比较不同标本的病原菌检出情况,同时分析BALF标本中主要致病菌的药敏试验结果。结果272例矽肺合并肺部感染患者的痰液标本中,共有62例检出病原菌,阳性检出占比为22.79%(62/272);BALF标本中,检出病原菌134例,阳性检出占比为49.26%(134/272),不同标本的阳性检出占比比较,差异有统计学意义(χ^(2)=41.346,P<0.01)。肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌对氨苄西林、阿莫西林、复方新诺明的耐药率高,对美罗培南、亚胺培南、阿米卡星的耐药率低。金黄色葡萄球菌对青霉素、红霉素、头孢唑林、四环素的耐药率高,对万古霉素、利奈唑胺、替考拉宁未呈现出耐药性;肺炎链球菌对青霉素、氨苄西林、红霉素、头孢唑林的耐药率高,对万古霉素、替考拉宁未呈现出耐药性。结论矽肺合并肺部感染患者BALF具有较高的病原菌检出率,革兰氏阴性菌为主要病原菌,且临床耐药情况严重,应依据药敏试验结果合理选用抗菌药物。

Objective To analyze the characteristics of pathogenic bacteria in bronchoalveolar lavage fluid(BALF)of patients with silicosis and pulmonary infection.Methods Pathogenic bacteria were identified on sputum and BALF samples from 272 patients with silicosis complicated with pulmonary infection admitted to our hospital from July2021 to July 2023,the detection of pathogenic bacteria in different specimens was compared,meantime;the drug sensitivity test results of the main pathogenic bacteria in BALF samples were analyzed.Results Out of 272 sputum samples from patients with silicosis and pulmonary infection,a total of 62 cases were found to have pathogenic bacteria,with a positive detection proportion of 22.79%(62/272);among the BALF specimens,a total of 134 pathogens were detected,with a positive detection proportion of 49.26%(134/272),the difference in positive detection proportions among different specimens was statistically obvious(χ^(2)=41.346,P<0.01).Klebsiella pneumoniae,Escherichia coli,and Pseudomonas aeruginosa had high resistance rates to ampicillin,amoxicillin,and compound sulfamethoxazole,but had low resistance rates to meropenem,imipenem,and amikacin.Staphylococcus aureus had a high resistance rate to penicillin,erythromycin,cefazolin,and tetracycline,but did not show resistance to vancomycin,linezolid,and teicoplanin;Streptococcus pneumoniae had a high resistance rate to penicillin,ampicillin,erythromycin,and cefazolin,but did not show resistance to vancomycin or teicoplanin.Conclusion Patients with silicosis combined with pulmonary infection have a high detection rate of pathogenic bacteria in BALF,with Gram-negative bacteria as the primary pathogen and severe clinical drug resistance.Therefore,antimicrobial drugs should be selected reasonably based on the results of drug sensitivity tests.