218例外耳道真菌病病原菌分布及临床特征分析  

Analysis of pathogen distribution and clinical characteristics of 218 cases of otomycosis

作　　者：范鹏超 刘文芝[1] 柳雯悦 FAN Pengchao;LIU Wenzhi;LIU Wenyue(Department of Disease Prevention and Hospital Infection Control,the Second Hospital of Dalian Medical University,Dalian 116027,China;Department of Otolaryngology,the Second Hospital of Dalian Medical University,Dalian 116027,China)

机构地区：[1]大连医科大学附属第二医院疾病预防与医院感染控制部,辽宁大连116027 [2]大连医科大学附属第二医院耳鼻喉科,辽宁大连116027

出　　处：《大连医科大学学报》2024年第6期508-513,共6页Journal of Dalian Medical University

基　　金：大连市社科院2024年研究课题项目(2024dlsky055);“感”动中国医疗机构感染预防与控制科研项目(GY2023043)。

摘　　要：目的分析218例外耳道真菌病病原菌分布及相关感染因素。方法收集2021年7月至2024年7月就诊于大连医科大学附属第二医院,临床及实验室诊断为外耳道真菌病218例患者的临床资料,分析患者一般资料、病原菌分布特征、药敏情况以及曲霉菌与念珠菌感染相关诱因等。结果218例患者平均年龄(46.11±3.68)岁,共检出221例次真菌菌种,以曲霉菌感染为主(75.57%),其次为念珠菌(19.00%);检出的167例曲霉菌中黄曲霉、土曲霉及烟曲霉对两性霉素B(95.65%、100.00%、75.00%)、氟康唑(98.55%、97.96%、83.33%)及伏立康唑(60.87%、32.65%、37.50%)呈现出较高的耐药率,黑曲霉对5-氟胞嘧啶耐药率较高(66.67%);在曲霉菌与念珠菌感染中,不同年龄和不同耳部清理情况间差异均有统计学意义(P<0.05)。长时间佩戴耳机可能导致曲霉菌感染概率增加,频繁游泳可能导致念珠菌感染概率增加;相较于非此类情况患者,差异均有统计学意义(P<0.05)。结论曲霉菌和念珠菌为外耳道真菌病的主要致病菌,对于高危感染人群要及时开展主动筛查与监测,临床上对于外耳道真菌病的治疗要合理选择抗菌药物。Objective To analyze the distribution of pathogenic fungi and related infectious factors in 218 cases of otomycosis.Methods A retrospective analysis was conducted on the case data of 218 patients who were clinically and laboratory diagnosed with otomycosis externa in the Second Hospital of Dalian Medical University from July 2021 to July 2024.The general information of the patients,the distribution characteristics of pathogenic bacteria,the drug sensitivity situation,and the related predisposing factors for Aspergillus and Candida infections were analyzed.Results A total of 218 patients were included,with an average age of(46.11±3.68)years.Totally 221 strains of fungal species were detected,with Aspergillus infection being the most common(75.57%),followed by Candida(19.00%).Among the 167 Aspergillus cases,Aspergillus flavus,Aspergillus terreus and Aspergillus fumigatus exhibited high drug resistance rates to amphotericin B(95.65%,100.00%,75.00%),fluconazole(98.55%,97.96%,83.33%)and voriconazole(60.87%,32.65%,37.50%).Aspergillus niger showed a high resistance rate to 5-fluorocytosine(66.67%).In patients with Aspergillus and Candida infections,statistically significant differences were observed in different age and ear cleaning status groups(P<0.05).Long-term use of earphones appeared increasing the probability of Aspergillus infection,and frequent swimming appeared increasing the probability of Candida infection,with both differences being statistically significant compared to patients with non-such conditions(P<0.05).Conclusion Aspergillus and Candida are the main pathogenic fungi for otomycosis.For high-risk populations,active screening and monitoring should be carried out in a timely manner.Clinically,appropriate antimicrobial drugs should be reasonably selected for the treatment of otomycosis.

关 键 词：外耳道真菌病 菌种分布 感染风险 曲霉菌 

分 类 号：R763[医药卫生—耳鼻咽喉科]