慢性化脓性中耳炎的细菌学监测和药物敏感性动态分析

 【摘要】目的：动态地对慢性化脓性中耳炎脓性分泌物的细菌分布及药物敏感性进行检测，以了解慢性化脓性中耳炎致病菌的变化趋势和指导临床合理用药。方法：取近三年慢性化脓性中耳炎住院患者的鼓室内脓液作细菌培养和药物试验，取得细菌分离率的排序，致病菌的药物敏感度、各类抗生素的最小抑菌浓度和相应的抑菌株数。并与本课题组在2002年-2005年间同样题材的研究进行比较分析。结果：（1）近三年369耳中培养有微生物生长254耳，其中细菌231耳、真菌23耳，一例患耳合并细菌和真菌感染；无菌生长115耳。细菌检出率依次为：凝固酶阴性葡萄球菌71耳（占30.74%），铜绿假单胞菌53耳（占22.94%），金黄葡萄球菌44耳（占19.05%），奇异变形杆菌12耳（占5.19%）；（2）胆脂瘤型中耳炎以奇异变形杆菌和铜绿假单胞菌感染为主，非胆脂瘤型中耳炎中以凝固酶阴性葡萄球菌感染为主。绿脓杆菌感染耳中骨质破坏以中或重度为主，凝固酶阴性葡萄球菌感染耳骨质破坏相对较轻，金黄葡萄球菌和奇异变形杆菌感染耳的骨质破坏介乎两者之间。（3）铜绿假单胞菌对哌拉西林/他唑巴坦、头孢他啶、头孢吡肟、环丙沙星、庆大霉素、妥布霉素和亚胺培南敏感；奇异变形杆菌对实验药物的敏感度都很高；凝固酶阴性葡萄球菌和金黄葡萄球菌对喹努普汀/达福普汀、替考拉宁、万古霉素、莫西沙星、庆大霉素、环丙沙星都敏感。环丙沙星和莫西沙星的浓度在0.5 mcg/ml时上述四种细菌有90%以上的抑菌作用。（4）近三年与2002年-2005年期间的药物敏感试验相比，四种常见致病菌的药物敏感度基本相似。 结论：近年来慢性中耳炎活动期患者分泌物的致病菌分布以凝固酶阴性葡萄球菌、铜绿假单胞菌、金黄葡萄球菌、奇异变形杆菌为主；四种常见细菌在慢性化脓性中耳炎临床分型和骨质破坏中各有特点；药敏实验对临床用药有指导作用。

Dynamic Analysis of Bacteriology and Drug Sensitivity of Chronic Suppurative Otitis Media

【Objective】 To detect dynamically the bacterial distribution and drug sensitivity of the secretion of chronic supperative otitis media,and to get the message of pathogens trends and clinical medication of chronic otitis media.【Methods】 Tympanic pus were collected and cultured from hospitalized patients in the last three years with chronic suppurative otitis media,the data of pathogenic bacteria,drug sensitivity,minimum inhibitory concentration and the number of corresponding inhibited strains were statistics and compared with the data from 2002-2005.【Results】(1) There were 254 strains of microbes isolated from 369 ears.23 of them were fungi,231 were bacteria.Coagulase-negative staphylococci(in 71 of 231 ears,30.74%),Pseudomonas aeruginosa(in 53 of 231 ears,22.94%),Staphylococcus aureus(in 44 of 231 ears,19.05%),Proteus mirabilis(in 12 of 231 ears,5.19%) were the most frequently insolated pathogens.(2)The cholesteatoma otitis media were mainly infected by Proteus mirabilis and Pseudomonas aeruginosa,and the non-cholesteatoma otitis media were mainly infected by Coagulase-negative staphylococci.The level of bone destruction might be related to pathogenic bacteria.Pseudomonas aeruginosa caused relatively severe bone destruction.(3)Pseudomonas aeruginosa were sensitivated to piperacillin/tazobactam,ceftazidime,cefepime,ciprofloxacin,gentamicin,tobramycin,and imipenem;Proteus mirabilis were sensitive to all experimental drugs;Coagulase-negative staphylococcus and Staphylococcus aureus were sensitivated to quinoline Nupu Ting/dalfopristin,teicoplanin,vancomycin,moxifloxacin,gentamicin,ciprofloxacin.Ciprofloxacin and moxifloxacin could inhibit more than 90% bacteria when their concentration were 0.5 μg/mL.(4)Compared with the drug sensitive trail of four common pathogens during 2002-2005,the result were similar.【Conclusion】 Coagulase-negative staphylococci,Pseudomonas aeruginosa,Staphylococcus aureus and Proteus mirabilis are the main pathogenic bacteria of chronic supperative otitis media,and these four bacteria have their own characteristics in clinical classification and bone destruction of chronic supperative otitis media.Sensitivity test plays a guiding role in clinical treatment.