儿童下呼吸道感染痰涂片与痰培养结果一致性研究

Coincidence of sputum smear and culture results of children with lower respiratory tract infection

摘要:

目的比较儿童下呼吸道感染痰涂片与痰培养结果，了解痰涂片的实验室诊断价值，同时对痰培养感染病原菌的分布及耐药性进行分析，以指导临床合理用药。方法收集2014年3—5月某院915份下呼吸道感染住院患儿的合格痰标本，涂片后进行革兰染色，同时对痰标本进行细菌培养、鉴定及药敏试验，将革兰染色镜检结果与培养结果进行比较。结果痰涂片与痰培养结果总体符合率为67.43%(617份),痰培养阳性率为65.90%（603份）；分离病原菌730株,其中居前3位者分别是副流感嗜血杆菌(36.17%)、肺炎链球菌(24.38%)、卡他莫拉菌(13.29%)。产β-内酰胺酶率:副流感嗜血杆菌、流感嗜血杆菌、卡他莫拉菌分别为44.70%（118/264）、45.83%（11/24）、93.81%（91/97）。肺炎链球菌对大多数抗菌药物较敏感，对红霉素、四环素、复方磺胺甲口恶唑耐药率高，未发现对万古霉素、利奈唑胺、莫西沙星耐药的菌株。结论痰涂片具有一定的实验室诊断价值，痰培养同时应做涂片革兰染色，临床医生可根据常见病原菌的药敏结果合理用药，减少耐药菌的产生。

Abstract:

ObjectiveTo compare sputum smear  and culture results in children with lower respiratory infection，realize the laboratory diagnostic value of sputum smear, and analyze the distribution and antimicrobial resistance of cultured pathogens in infection, so as to guide rational antimicrobial use in clinic.MethodsQualified sputum specimens collected from hospitalized children with lower respiratory tract infection from March to May 2014 were conducted gramstaining after smeared, meanwhile, bacterial culture, identification and antimicrobial susceptibility testing of sputum specimens were performed, gramstaining microscopic examination and culture results were compared.ResultsThe overall coincidence rate of sputum smear and culture results was 67.43%(n=617), positive rate of sputum culture was 65.90%(n=603); 730 pathogenic strains were isolated， the top 3 isolated pathogens were Haemophilus parainfluenzae(36.17%), Streptococcus pneumoniae(24.38%), and Moraxella catarrhalis(13.29%).βlactamaseproducing rates of Haemophilus parainfluenzae, Haemophilus influenzae, and Moraxella catarrhalis were 44.70%（118/264）,45.83%（11/24）,and  93.81%（91/97）respectively. Streptococcus pneumoniae were susceptible to most antimicrobial agents, while resistant rates to erythromycin, tetracycline, and compound sulfamethoxazole were high， vancomycin,  linezolid, and/or moxifloxacinresistant strains were not found.ConclusionSputum smear has certain laboratory diagnostic value, gramstaining is recommended  while sputum culture is performed, antimicrobial agents should be used rationally according to antimicrobial susceptibility testing results， so as to reduce the emergence of antimicrobialresistant organisms.