贵州地区中耳胆脂瘤与慢性化脓性中耳炎致病菌及药物敏感性分析

目的 研究贵州地区中耳胆脂瘤与慢性化脓性中耳炎病原菌，分析其药物敏感性，以指导临床用药。方法 收集2015年7月~2017年7月在院的慢性化脓性中耳炎及中耳胆脂瘤患者238例，取患者的耳道分泌物行常规细菌分离培养、细菌鉴定与药敏试验分析，两组之间相互比较，并进行统计学分析。结果 238例患者耳部分泌物标本中，有158例培养出病原菌，检出率为66.39%，其中细菌140例，真菌18例。慢性中耳炎患者检出率为65.55%，细菌以G+菌为主，检出主要病原菌为凝固酶阴性葡萄球菌（31.03%）、金黄色葡萄球菌（25.86%）、铜绿假单胞菌（13.79%）、变形杆菌（10.34%）。中耳胆脂瘤检出率为68.70%，细菌以G-菌为主，检出主要病原菌为铜绿假单饱菌（25.61%）、变形杆菌（18.29%）、金黄色葡萄球菌（14.63%）、凝固酶阴性葡萄球菌（14.63%）。敏感药物因菌种而异。结论 慢性化脓性中耳炎（活动期）与中耳胆脂瘤的G+菌、G-菌的检出率不同，主要致病菌为铜绿假单胞菌、金黄色葡萄球菌、凝固酶阴性葡萄球菌、变形杆菌；真菌及混合感染不容忽视。临床常用抗菌药物在两种中耳炎中的敏感度有差别，临床医师应根据细菌培养和药敏结果进行用药。

Analysis of Pathogenic Bacteria and Drug Sensitivity of Middle Ear Cholesteatoma and Chronic Suppurative Otitis Media in Guizhou Area

Abstract:Objective To study the pathogenic bacteria of middle ear cholesteatoma and chronic suppurative otitis media in Guizhou and analyze their drug sensitivity so that guide clinical drug use.Methods From July 2015 to July 2017,238 patients with chronic suppurative otitis media and cholesteatoma of middle ear were collected and their ear canal secretions were collected for routine bacterial isolation,bacterial identification and drug sensitivity analysis.The two groups were compared and statistically analyzed.Results Out of 238 cases of ear secretion samples,158 cases were cultured pathogenic bacteria,the detection rate was 66.39%,among which 140 cases were bacteria,18 cases were fungi.And the positive rate was 65.55% in patients with chronic otitis media,the main bacteria were G+bacteria.The main pathogens were coagulase negative staphylococci(31.03%),staphylococcus aureus(25.86%),pseudomonas aeruginosa(13.79%),bacillus proteus(10.34%).The positive rate of middle ear cholesteatoma was 68.70%,and the main bacteria were G-bacteria.The main pathogens were pseudomonas aeruginosa(25.61%),proteus(18.29%),staphylococcus aureus (14.63%), coagulase negative staphylococcus(14.63%).Sensitive drugs were different from strains.Conclusion The positive rate of G+and G- bacteria in chronic suppurative otitis media(active stage)is different from that in cholesteatoma of middle ear.The main pathogenic bacteria were pseudomonas aeruginosa,staphylococcus aureus,coagulase negative staphylococcus,proteus,fungi and mixed infection. Clinicians should use drugs based on bacterial culture and drug sensitivity.