慢性鼻-鼻窦炎的细菌培养与药敏分析

目的　分析慢性鼻-鼻窦炎的细菌学特点与药敏试验结果,为临床治疗提供依据。方法　鼻内镜下采集中鼻道脓液进行细菌培养及药敏试验。结果　43例标本中,37例培养出细菌,细菌培养阳性率为86.04%;需氧菌株占91.90%,厌氧菌株占8.10%;共培养出20种细菌,主要为表皮葡萄球菌、铜绿假单胞菌、金黄色葡萄球菌。抗生素药 敏试验显示抗菌活性较高的广谱抗生素为头孢哌酮舒巴坦钠、头孢呋辛钠。结论　慢性鼻-鼻窦炎以需氧菌感染为主,应用抗生素宜先进行细菌培养和药敏试验,如情况不允许,可选择广谱的耐β-内酰胺酶类抗生素,如头孢哌酮舒巴坦钠、头孢呋辛钠等。     

单发性鼻窦炎细菌学检测及药敏试验结果分析

目的：了解单发性鼻窦炎细菌分布及对常用抗生素敏感情况。方法：对９４例上颌窦炎和４１例筛窦炎,蝶窦炎患者行功能性鼻窦内窥镜手术,将取出的窦腔分泌舶和粘膜进行细菌培养分离和常用抗生素的药敏试验。结果：１３５份标本中,有菌生长１１９份（８８．１５％）,共分离细菌１９２株,混合细菌生长６２份,厌氧菌７５株,分离菌株对青霉素的总敏感度为５３．１２％。头孢唑啉钠总敏感度为８７．５０％〉厌氧菌对甲硝唑的总敏感度     

317例慢性化脓性中耳炎的细菌学及药物敏感性分析

目的了 解慢性化脓性中耳炎脓性分泌物的细菌分布及药物敏感性，以指导临床用药。方法 取慢性化脓性中耳炎的鼓室内脓液作细菌培养和药敏试验，取得细菌分离率的排序，致病菌的药物敏感度及耐药率。结果 317耳中培养有微生物生长301耳，其中细菌293耳，真菌8耳；无细菌生长16耳。细菌检出率依次为：凝固酶阴性葡萄球菌89耳（占28．1％），金黄色葡萄球菌83耳（占26．2％），铜绿假单胞菌46耳（占14．5％），奇异变形杆菌24耳（占7.6％）；敏感药物因菌种而异。结论 慢性化脓性中耳炎活动期患耳脓性分泌物的细菌分布以凝固酶阴性葡萄球菌，金黄色葡萄球菌，铜绿假单胞菌，奇异变形杆菌为主。药敏试验对指导临床用药有指导意义。     

成人慢性上颌窦炎的细菌学研究及药敏观察

为研究成人慢性上颌窦炎的细菌分布及分离菌株对常用抗生素的敏感性，对４２例成人慢性上颌窦炎患者的单侧病窦粘膜进行细菌培养，药敏试验及产β－内酰胺酶细菌（βＬＰＢ）鉴定，结果发现８５．７１％标本有细菌生长，９例（２１．４３％）分离出厌氧菌，３３例（７８．５７％）分离出需氧菌。βＬＰＢ阳性率高达４０％，和细菌的耐药性有关。分离细菌对含β－内酰胺酶抑制剂的抗生素、三代头孢菌素类药物及三代喹诺酮类药物有较高     

静止期慢性化脓性中耳炎的细菌培养与药敏试验结果分析

目的：了解静止期慢性化脓性中耳炎患者中耳腔的细菌分布及其耐药性特征,以指导I型鼓室成形术后的临床合理用药。方法：取广东省人民医院诊断为慢性化脓性中耳炎静止期,均已干耳1个月以上的148例住院患者的中耳鼓室黏膜表面分泌物,行细菌培养及药敏试验,分析检测结果。结果：共培养出16种细菌,主要为金黄色葡萄球菌、铜绿假单胞菌、山羊葡萄球菌等;细菌培养阳性率为33．1％,其中革兰阳性菌为69．4％,革兰阴性菌为30．6％。药物敏感试验显示对革兰阳性菌抗菌活性较高的抗生素是万古霉素、利奈唑胺、替考拉宁、利福平等;对革兰阴性菌抗菌活性较高的抗生素是哌拉西林（他唑巴坦）、头孢哌酮（舒巴坦）等。结论：拟行I型鼓室成形术的患者术前虽已干耳,但仍存在潜在的致病菌,术前细菌培养及药敏试验可以指导术后临床用药,防治感染。     

慢性扁桃体炎的细菌学研究

对得发性慢性扁桃体炎（ＲＣＴ）、迁延性慢性扁桃体炎（ＰＣＴ）及可疑病灶性扁桃体炎（ＦＣＴ），３组共４０例患者的扁桃体进行了细胞培养和组织学观察。细菌培养；平均每个扁桃体检出菌数为６．８株：需氧菌３．６株，厌氧菌３．２株。金葡菌在需氧致病菌中占首位，厌氧菌第一位为类明，慢性扁桃体炎是由需氧菌和厌氧菌共同参与的多微生物的混合感染。并对产黑素类杆菌的致病机理进行了讨论。     

慢性化脓性中耳炎病原学研究及其临床应用

目的：分析慢性化脓性中耳炎的致病菌种类及其药物敏感性。方法：取108例慢性化脓性中耳炎的外耳道深部或中耳脓液作细菌培养及药敏试验。结果：108例中培养分离出9 种细菌,其中铜绿假单胞菌占26.85%，金黄色葡萄球菌23.15%, 变形杆菌20.37%, 其他25.92%，混合感染2.78%。铜绿假单胞菌感染的病例中,亚胺培南和多粘菌素敏感试验均为阳性。结论：为避免产生耐药菌株，应根据药敏试验结果合理应用抗生素。     

鼻内镜鼻窦手术后迁延性鼻窦炎的细菌学研究

目的：探讨慢性鼻窦炎鼻内镜鼻窦手术（ESS）后迁延不愈者鼻窦分泌物的细菌学特征。方法：对143例慢性鼻窦炎患者行ESS,术中取筛寞分泌物做细菌培养和药物敏感试验（术前组）,术后随访6个月以上,对其中未达治愈标准的49例在鼻内镜下取筛窦分泌物做细菌培养和药物敏感试验（术后组）,2组结果进行比较分析。结果：术前组检出细菌153株,术后组检出细菌65株,2组均以G^＋球菌为主,其差异无统计学意义;术后组G^-杆菌检出率显著高于术前组;而厌氧菌检出率显著低于术前组;对常用抗生素耐药的菌株比例在术后组显著高于术前组。结论：细菌感染是慢性鼻窦炎术后迁延不愈的原因之一,其致病菌仍以G^＋球菌为主,但G^-杆菌的感染较术前增多,而厌氧菌的感染较术前减少;术后致病菌的耐药性增加。因此,对鼻内镜鼻窦手术后迁延性鼻窦炎的抗生素治疗,应建立在细菌培养和药敏试验的基础上。     

成人慢性鼻窦炎的细菌学研究

随着医学影像学和鼻窦内窥镜手术的开展，对慢性耳窦炎有了进一步的认识。70至SO年代的文献报告慢性鼻窦炎主要有厌氧菌感染引起，近来研究发现厌氧菌在慢性鼻窦炎中的作用不大，尤其在1［童患者。为此，需要对厌氧菌在成人慢性易窦炎中的作用进行研究。该作者前瞻性研究了76倒成人保守治疗无效而计划行易窦内窥镜手术的慢性鼻窦炎患者，术中取筛窦组织送细菌培养，发现58例（7．3％）有细菌生长，其中40例为单一细菌生长，18例有两种或以上细菌生长，46例有凝血酶阴性的葡萄球菌，12例有金黄色葡萄球菌；18例（23．7％）无细菌生长。IO例…     

慢性中耳炎细菌生物膜形成与细菌培养结果的相关性分析

目的：探讨慢性中耳炎细菌生物膜形成与细菌培养之间的相关性。方法：对32例慢性化脓性中耳炎及中耳胆脂瘤患者术中取得的样本进行扫描电镜检查，并对中耳分泌物行细菌培养；分析慢性中耳炎细菌生物膜形成与细菌培养结果之间的关系。结果：慢性化脓性中耳炎（活动期）与中耳胆脂瘤细菌生物膜形成率分别为87．5％、81．3％（P〉0．05）。慢性中耳炎扫描电镜细菌生物膜结果与细菌培养结果之间比较，灵敏度为70．37％，特异度为60.00％，误诊率为40．00％，漏诊率为29．63％，阳性预测值为90．46％，阴性预测值为27．27％，正确率为68．75％，约登指数为30．37％，Pearson相关系数为0．232（P〉0．05）。结论：慢性化脓性中耳炎（活动期）与中耳胆脂瘤均有较高的生物膜形成率，但中耳分泌物常规细菌培养结果不能反应慢性中耳炎患者细菌生物膜的形成情况，需要探索更为可靠的细菌学实验方法来准确反映慢性中耳炎的感染情况。     

慢性鼻窦炎的需氧菌分析

目的分析慢性鼻窦炎的需氧菌分布及对常用抗生素敏感情况,为临床药物治疗慢性鼻窦炎提供依据。方法在鼻内镜手术中以无菌方式取215个慢性鼻窦炎的鼻窦内容物(实验组),进行需氧菌培养和常用抗生素的药敏试验,并与正常人群60例中鼻道分泌物(对照组)的细菌培养结果对比。结果实验组中检出单一细菌者占92%,2种细菌混合感染者占8%;对照组均检为单一细菌。实验组单菌感染的G 菌占54.7%,G-菌占45.3%;对照组G 菌占73.3%,G-菌占26.7%。蝶窦、筛窦以G 菌感染为主;额窦、上颌窦以G-菌感染为主。实验组需氧菌耐药情况严重。结论慢性鼻窦炎需氧菌感染以单一细菌为主,G 菌占大多数,但G-菌的肠道菌群感染比例较高。不同的鼻窦中需氧菌种类不同。慢性鼻窦炎需氧菌耐药性严重。临床围手术期应用抗生素治疗宜先进行细菌培养与药物敏感试验。     

Bacteriological findings and antimicrobial susceptibility in chronic sinusitis with nasal polyp

CONCLUSIONS: We recommend amoxacillin/clavulanate, cephalosporins and macrolides rather than penicillin as the first-line drug in chronic sinusitis with nasal polyps. In cases where there is no improvement of symptoms, cultures should be taken from the middle meatus, followed by appropriate selection of second-line antibiotics according to the sensitivity test results. OBJECTIVE: To investigate the causative bacteria and the antimicrobial susceptibility in patients with chronic sinusitis and nasal polyps in Korea. MATERIALS AND METHODS: The bacteriology and antimicrobial susceptibility of maxillary sinus aspirates from 81 patients were evaluated. RESULTS: Aerobes were isolated from 58.0% of the cultures from the middle meatus and from 48.1% of those from the maxillary sinus. Staphylococcus aureus, Haemophilus influenzae, and Streptococcus pneumoniae were the most prevalent aerobic pathogens. Anaerobes were isolated from 8.6% of the cultures from the middle meatus and from 18.5% of the cultures from the maxillary sinus. The predominant anaerobic organisms were Prevotella and Peptostreptococcus in adults but none of them were cultured in children. A high rate of concordance of the middle meatus and maxillary sinus was noted. Monomicrobial infection was most commonly observed. Ampicillin-resistant H. influenzae isolates were cultured in 46% of the cases. Penicillin resistance rates were 93% for Staph. aureus; 25% of Strep. pneumoniae were intermediate and 25% were resistant.     

Bacteriological findings and antimicrobial susceptibility in chronic sinusitis with nasal polyp

Conclusions. We recommend amoxacillin/clavulanate, cephalosporins and macrolides rather than penicillin as the first-line drug in chronic sinusitis with nasal polyps. In cases where there is no improvement of symptoms, cultures should be taken from the middle meatus, followed by appropriate selection of second-line antibiotics according to the sensitivity test results. Objective. To investigate the causative bacteria and the antimicrobial susceptibility in patients with chronic sinusitis and nasal polyps in Korea. Materials and methods. The bacteriology and antimicrobial susceptibility of maxillary sinus aspirates from 81 patients were evaluated. Results. Aerobes were isolated from 58.0% of the cultures from the middle meatus and from 48.1% of those from the maxillary sinus. Staphylococcus aureus, Haemophilus influenzae, and Streptococcus pneumoniae were the most prevalent aerobic pathogens. Anaerobes were isolated from 8.6% of the cultures from the middle meatus and from 18.5% of the cultures from the maxillary sinus. The predominant anaerobic organisms were Prevotella and Peptostreptococcus in adults but none of them were cultured in children. A high rate of concordance of the middle meatus and maxillary sinus was noted. Monomicrobial infection was most commonly observed. Ampicillin-resistant H. influenzae isolates were cultured in 46% of the cases. Penicillin resistance rates were 93% for Staph. aureus; 25% of Strep. pneumoniae were intermediate and 25% were resistant.     

Microbiology of acute and chronic maxillary sinusitis associated with an odontogenic origin

OBJECTIVES:: To study the microbiology of sinusitis associated with odontogenic origin. METHODS:: Aspirates of 20 acutely and 28 chronically infected maxillary sinuses that were associated with odontogenic infection were processed for aerobic and anaerobic bacteria. RESULTS:: A total of 66 isolates were recovered from the 20 cases of acute sinusitis (3.3/specimen), 16 aerobic and facultatives, and 50 anaerobic. Aerobes alone were recovered in 2 (10%) specimens, anaerobes only in 10 (50%), and mixed aerobic and anaerobic bacteria in 8 (40%). The predominant aerobic were alpha-hemolytic streptococci (5), microaerophilic streptococci (4), and Staphylococcus aureus (2). The predominant anaerobes were anaerobic Gram-negative bacilli (22), Peptostreptococcus (12), and Fusobacterium spp. (9). A total of 98 isolates were recovered from the 28 cases of chronic sinusitis (3.5/patient): 21 aerobic and facultatives and 77 anaerobic. Aerobes were recovered in 3 (11%) instances, anaerobes only in 11 (39%), and mixed aerobic and anaerobic bacteria in 14 (50%). The predominant aerobes were alpha-hemolytic streptococci (7), microaerophilic streptococci (4), and S. aureus (5). The predominant anaerobes were Gram-negative bacilli (41), Peptostreptococcus (16), and Fusobacterium spp. (12). Thirteen beta-lactamase-producing bacteria (BLPB) were recovered from 10 (50%) patients with acute sinusitis and 25 BLPB from 21 (75%) patients with chronic sinusitis. No correlation was found between the predisposing odontogenic conditions and the microbiological findings. CONCLUSIONS:: These data illustrate the similar microbiology of acute and chronic maxillary sinusitis associated with odontogenic infection where anaerobic bacteria predominate in both types of infections.     

The bacteriology of acute maxillary sinusitis

Sinus secretions obtained by antral aspiration from 347 patients with acute maxillary sinusitis were examined bacteriologically. Special attention was paid to the method by which anaerobic bacteria could be recovered. On the total, 485 sinus secretion samples were examined, of these 336 were aspirates, 149 yields of injection-aspirations. Aerobic bacteria were cultured from 263 aspirates and from 100 injection-aspiration samples. Only anaerobes were recovered from 6 sinuses. Bacterial culture was negative in 115 sinuses (24%). The most common pathogens isolated were Haemophilus influenzae (50.5%), Streptococcus pneumoniae (18.5%), Streptococcus pyogenes (5%) and Branhamella catarrhalis (1.5%). A true anaerobic infection was considered to be present in only 7 sinuses (1.5%) indicating that anaerobes are not a significant cause of acute maxillary sinusitis. According to this study the most common pathogen in acute maxillary sinusitis in young adults is H. influenzae. From this follows that in such patients aminopenicillins may be a more appropriate choice than conventional penicillin in the antimicrobial treatment of acute maxillary sinusitis.     

Bacteriology of chronic sinusitis and acute exacerbation of chronic sinusitis

OBJECTIVE: To establish the microbiological characteristics of acute exacerbation of chronic sinusitis (AECS). SETTING: Academic medical center. PATIENTS: Thirty-two patients with chronic sinusitis and 30 patients with AECS. MAIN OUTCOME MEASURE: The aerobic and anaerobic microbiology of maxillary AECS and chronic maxillary sinusitis. RESULTS: A total of 81 isolates (33 aerobic and 48 anaerobic) were recovered from the 32 cases (2.5 per specimen) with chronic sinusitis. Aerobes alone were recovered in 8 specimens (25%), anaerobes only were isolated in 11 (34%), and mixed aerobes and anaerobes were recovered in 13 (41%). The predominant aerobic and facultative bacteria were Enterobacteriaceae and Staphylococcus aureus. The predominant anaerobic bacteria were Peptostreptococcus subspecies, Fusobacterium subspecies, anaerobic gram-negative bacilli, and Propionibacterium acnes. Twenty-one beta-lactamase-producing bacteria were recovered from 17 specimens (53%). A total of 89 isolates (40 aerobic and facultatives, and 49 anaerobic) were recovered from the 30 patients (3.0 per specimen) with AECS. Aerobes were recovered in 8 instances (27%), anaerobes only in 11 (37%), and mixed aerobes and anaerobes were recovered in 11 (37%). The predominant aerobes were Streptococcus pneumoniae, Enterobacteriaceae, and S aureus. The predominant anaerobes were Peptostreptococcus subspecies, Fusobacterium subspecies, anaerobic gram-negative bacilli, and P acnes. Thirty-six beta-lactamase-producing bacteria were recovered from 28 specimens (53%). CONCLUSIONS: This study demonstrates that the organisms isolated from patients with AECS were predominantly anaerobic and were similar to those generally recovered in patients with chronic sinusitis. However, aerobic bacteria that are usually found in acute infections (eg, S pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis) can also emerge in some of the episodes of AECS.     

Microbiological spectrum of causative agents of rhinogenic and odontogenic chronic sinusitis and mucociliary activity of mucosal epithelium in the nasal cavity

The objective of the present work was to study peculiarities of microbiological spectra in patients with chronic rhinogenic and odontogenic sinusitis. The secondary objective was to elucidate disturbances of mucociliary activity of mucosal epithelium in the nasal cavity of patients with this pathology. A total of 38 inpatients were examined that were hospitalized for the treatment of chronic maxillary sinusitis. The aspirate from maxillary sinuses was used for bacteriological analysis. The mucociliary transport time was measured in all the patients. It was shown that non-clostridial anaerobic flora isolated in 19.2% of the cases plays a leading role in the development of rhinogenic pathology. Moreover, anaerobic bacteria were responsible for infectious inflammation in 66.7% of the cases with the odontogenic form of chronic sinusitis. The mucociliary transport time in patients with odontogenic sinusitis was significantly greater than in those with the rhinogenic form of the disease (48.9 +/- 4.3 min and 32.35 +/- 3.1 min respectively). It is hypothesized that these findings can be attributed to the action of non-clostridial anaerobic flora on the ciliary epithelium of endonasal mucosa.     

Microbiology of acute sinusitis of odontogenic origin presenting with periorbital cellulitis in children

OBJECTIVES: This study was undertaken to evaluate the aerobic and anaerobic microbiology of acute maxillary sinusitis of odontogenic origin presenting with periodontal infection in children. METHODS: Aspirates of 18 acutely infected maxillary sinuses that were associated with odontogenic infection in children who presented with periorbital cellulitis were processed for aerobic and anaerobic bacteria. RESULTS: A total of 54 isolates were recovered (3.0 per specimen): 13 aerobic and facultative (0.7 per specimen) and 41 anaerobic (2.3 per specimen). The number of isolates per specimen varied from 1 to 4. Aerobic and facultative organisms alone were recovered in 2 specimens (11%), anaerobes only in 7 (39%), and mixed aerobic and anaerobic bacteria in 9 (50%). The predominant aerobic and facultative organisms were alpha-hemolytic streptococci (4), microaerophilic streptococci (3), and Streptococcus pyogenes and Staphylococcus aureus (2 each). The predominant anaerobic bacteria were anaerobic gram-negative bacilli (17), Peptostreptococcus spp (11), Fusobacterium spp (8), and Propionibacterium acnes (2). Twelve beta-lactamase-producing bacteria were recovered from 9 specimens (50%). CONCLUSIONS: This study demonstrates the unique aerobic and anaerobic microbiological features of acute maxillary sinusitis of odontogenic origin presenting with periorbital cellulitis in children.