慢性鼻窦炎患者鼻腔(脓性)分泌物的细菌谱及其药敏分析  

Analysis of bacterial spectrum and drug sensitivity of chronic suppurative sinusitis

作　　者：苟立华 胡韫科[1] 白成祥[1] 

机构地区：[1]成都市龙泉驿区第一人民医院耳鼻喉科,四川成都610100

出　　处：《川北医学院学报》2015年第6期834-837,共4页Journal of North Sichuan Medical College

摘　　要：目的:探讨慢性化脓性鼻窦炎的菌种分布情况及药物敏感性。方法:收集89例慢性化脓性鼻窦炎患者的鼻腔脓性分泌物,进行培养基培养,采用纸片扩散法(Kirby-Bauer,KB法)进行药物敏感性监测,分析这些菌株对头孢唑啉、头孢他啶、头孢吡肟、亚胺培南、美罗培南、头孢哌酮舒巴坦、环丙沙星等抗菌药物的敏感性,万古霉素用MIC法进行定量分析。结果:89例慢性化脓性鼻窦炎患者的鼻道黏脓性分泌物标本经送检分析发现,80例患者检出细菌,阳性检出率为89.89%(80/89);80例患者中共检出82株细菌,共计15种细菌,其中1例患者的鼻道黏脓性分泌物标本检出2株细菌。排除院内感染,在检出的15种细菌中金黄色葡萄球菌、大肠埃希杆菌、表皮葡萄球菌、铜绿假单胞菌、产气肠杆菌等5种细菌占据前5位,分别占18.29%、14.63%、14.63%、13.41%、10.98%。金黄色葡萄球菌的药敏检查结果显示所有的金黄色葡萄球菌对万古霉素敏感,敏感率为100.00%;而对头孢唑啉、头孢他啶、头孢吡肟、亚胺培南、美罗培南、头孢哌酮舒巴坦、环丙沙星等抗菌的敏感率均为0.00%。所有的表皮葡萄球菌对亚胺培南、美罗培南、万古霉素、头孢哌酮舒巴坦均敏感,敏感率为100.00%;其次是头孢唑啉,敏感率为83.33%,而对头孢他啶、头孢吡肟、环丙沙星的敏感率较差,均在30.00%以下。大肠埃希杆菌、铜绿假单胞菌及产气肠杆菌等革兰氏阴性菌均对亚胺培南、美罗培南敏感,敏感率为100.00%。结论:慢性化脓性鼻窦炎患者多伴有细菌感染,主要致病菌包括表金黄色葡萄球菌、大肠埃希杆菌、表皮葡萄球菌、铜绿假单胞菌、产气肠杆菌等,细菌培养阳性对万古霉素、亚胺培南、美罗培南、头孢哌酮舒巴坦、头孢唑啉等抗菌药物敏感,在进行抗菌治疗前应密切监测抗菌谱的改变,以便及时调整用药。Objective： To investigate the bacterial distribution and drug sensitivity characteristics of chronic suppurative sinusitis. Methods： This study collected nasal secretions of 89 cases chronic suppurative sinusitis patients before operation,and nasal secretions were culture in medium. Disk diffusion method（ Kirby-Bauer,K-B） was used for drug sensitivity test. Sensitivity of bacteria strain to cefazolin,ceftazidime,cefepime,imipenem,meropenem,vancomycin,cefoperazone Shubatan,ciprofloxacin and other antibiotics were analyzed. Results： After the submission of purulent secretion specimens of nasal meatus in 89 cases chronic suppurative sinusitis patients with sticky,we found that 80 of the patients were detected bacteria. Exclusion of Streptococcus / yellow Neisseria nasal flora,the positive rate was 89. 89%（ 80 /89）. 80 patients were detected in 82 strains of bacteria,a total of 15 species,of which 1case of nasal meatus sticky purulent secretion specimens there were 2 strains of bacteria. 15 kinds of Staphylococcus aureus were detected bacteria,Escherichia coli,Pseudomonas,Staphylococcus aureus,Enterobacter aerogenes,5 kinds of bacteria occupy the top 5,respectively,accounted for 18. 29%,14. 63%,14. 63%,13. 41% and 10. 98%. Drug sensitivity test of Staphylococcus aureus showed that all of the Staphylococcus aureus was sensitive to vancomycin,the sensitivity was 100%; the sensitivity of cefazolin,ceftazidime,cefepime,imipenem,meropenem,cefoperazone sulbactam,ciprofloxacin and other antibiotics were 0%. All the Staphylococcus epidermidis were sensitive to imipenem,meropenem,vancomycin,cefoperazone sulbactam,the sensitivity was 100%; followed by cefazolin,the sensitivity was 83. 33%,and to ceftazidime,cefepime,ciprofloxacin sensitive,were all below 30%. Escherichia coli,Pseudomonas aeruginosa and Enterobacter aerogenes and other gram negative bacteria were sensitive to imipenem,meropenem,the sensitivity was 100%. Conclusion： The bacterial infection in patients with chronic suppurative sinusitis pathogens,

关 键 词：慢性化脓性鼻窦炎 菌种 抗生素 敏感率 

分 类 号：R765.4[医药卫生—耳鼻咽喉科]