慢性化脓性中耳炎患者细菌感染及药物敏感性分析  

Analysis of bacterial infection and drug sensitivity in patients with chronic suppurative otitis media

作　　者：刁桐湘 张丽媛 刘雅芬[2] 夏瑞明[1] 余力生[1] 郑宏伟[1] 马鑫[1] 韩琳[1] DIAO Tongxiang;ZHANG Liyuan;LIU Yafen;XIA Ruiming;YU Lisheng;ZHENG Hongwei;MA Xin;HAN Lin(Department of Otolaryngology,People’s Hospital,Peking University,Beijing,100044,China;Department of Infection,People’s Hospital,Peking University)

机构地区：[1]北京大学人民医院耳鼻咽喉科,北京100044 [2]北京大学人民医院感染科

出　　处：《临床耳鼻咽喉头颈外科杂志》2021年第10期870-874,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：北京大学人民医院研究与发展基金资助(No:RDY2019-04)。

摘　　要：目的:探究慢性化脓性中耳炎的病原菌分布及药物敏感性情况。方法:以2019年1月1日—2021年5月1日于北京大学人民医院耳鼻喉科住院待手术的慢性化脓性中耳炎患者为研究对象,对其进行外耳道深部分泌物培养,并对病原菌进行分离,统计分析病原菌分布及其药物敏感性情况。结果:共纳入126例患者,其中培养阳性者53例,共分离出细菌57株,包括革兰阳性球菌47株、革兰阴性杆菌10株。革兰阳性球菌中甲氧西林敏感金黄色葡萄球菌(MSSA)24株,耐甲氧西林金黄色葡萄球菌(MRSA)7株,凝固酶阴性葡萄球菌14株,屎肠球菌1株,耳炎苏黎世菌1株,革兰阴性杆菌中铜绿假单胞菌4株(4/10)。其中MSSA对左氧氟沙星、莫西沙星、克林霉素、庆大霉素有较高的耐药率,对苯唑西林、万古霉素、利奈唑胺、利福平的敏感性高,MRSA对除万古霉素、利福平、利奈唑胺外的常用抗生素均有较高的耐药性,而革兰阴性杆菌对左氧氟沙星、氨曲南、环丙沙星、头孢他啶以及哌拉西林/他唑巴坦有较高的耐药率,对美罗培南、亚胺培南、阿米卡星、头孢匹肟、头孢哌酮/舒巴坦及妥布霉素较敏感。单因素及多因素分析结果表明,年龄以及合并细菌感染为是否干耳的独立相关因素,病史长短为其非独立相关因素。结论:慢性化脓性中耳炎患者合并的病原菌感染以MSSA、MRSA及铜绿假单胞菌为主。年龄及合并细菌感染为慢性化脓性中耳炎是否干耳的独立相关因素,因此应结合药敏结果尽早进行特异性抗生素治疗或手术干预,避免病程迁延或严重的感染性并发症发生。Objective: To explore the distribution of pathogenic bacteria and drug sensitivity among patients with chronic suppurative otitis media. Methods: Patients with chronic suppurative otitis media who were hospitalized in the Department of Otolaryngology, People’s Hospital, Peking University for surgery from January 1, 2019 to May 1, 2021 were enrolled as the subjects, then take the deep secretions of the external auditory canal for bacterial culture. Finally, the distribution and drug sensitivity of the pathogenic bacteria are analyzed. Results: A total of 126 patients were enrolled, of which 53 were culture-positive, and 57 strains of bacteria were isolated, including 47 strains of Gram-positive cocci, 10 strains of Gram-negative bacilli. Among Gram-positive cocci, 24 methicillin-sensitive staphylococcus aureus(MSSA) strains, 7 methicillin-resistant staphylococcus aureus(MRSA) strains, 14 coagulase-negative staphylococcus strains, 1 strain enterococcus faecium, and 1 strain otitis Zurich. 4 strains(4/10) of pseudomonas aeruginosa among Gram-negative bacilli. Among them, MSSA has a high resistance rate to levofloxacin, moxifloxacin, clindamycin, and gentamicin, and high sensitivity to oxacillin, vancomycin, linezolid, and rifampin. MRSA is highly resistant to common antibiotics except vancomycin, rifampicin, and linezolid. The Gram-negative bacilli have higher resistance rates to levofloxacin, aztreonam, ciprofloxacin, ceftazidime, and piperacillin/tazobactam, and to meropenem, imipenem, amika star, cefepoxime, cefoperazone/sulbactam, and tobramycin are more sensitive. The results of univariable and multivariable analysis showed that age and bacterial infection were independent factors related to dry ears, and the duration of the disease history was a non-independent factor. Conclusion: The main pathogenic bacteria infections in patients with chronic suppurative otitis media are MSSA, MRSA, and pseudomonas aeruginosa. Whether it is combined with bacterial infection and age are independent factors related to whethe

关 键 词：中耳炎 化脓性 病原菌 抗生素类 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]