石家庄地区儿童急性中耳炎病原菌临床分布特征和主要病原菌耐药性分析

［摘要］目的分析石家庄地区儿童急性中耳炎主要病原菌分布及药物敏感性，为临床抗感染治疗提供依据。方法分析291例急性中耳炎患儿临床资料，收集中耳分泌物进行培养，应用梅里埃VITEK MS质谱仪鉴定菌株，用梅里埃VITEK2 Compact 、BD Phoenix 100并结合K-B法检测药物敏感性。结果耳脓性分泌物标本共291例，检出细菌211例，阳性率72.5%。其中革兰阳性菌株157株，检出率54.0%，占总阳性的74.4%；最常见的是肺炎链球菌68株，检出率为23.4%，占总阳性的32.2%；其次是金黄色葡萄球菌62株，检出率为21.3%，占总阳性的29.4%。检出革兰阴性杆菌42株，检出率14.4%，占总阳性的19.9%；最常见的是流感嗜血杆菌28株，检出率为9.6%，占总阳性菌株的13.3%。患儿在0~1岁、＞1~3岁、＞3~6岁、＞6岁4个年龄段的病原菌阳性检出率差异有统计学意义（P＜0.05），在0~1岁阳性检出率最高，在＞3~6岁阳性检出率最低。按发生时间，患儿在各个季度检出率差异有统计学意义（P＜0.05），第四季度检出率最高，第二季度检出率最低。耳分泌物来源的肺炎链球菌68株，对万古霉素、利奈唑胺均完全敏感，对红霉素完全耐药。耳分泌物来源的金黄色葡萄球菌62株，对左氧氟沙星、利福平、庆大霉素、莫西沙星、万古霉素和利奈唑胺均完全敏感，对红霉素、克林霉素和青霉素均完全耐药；耐甲氧西林金黄色葡萄球菌（Methicillin-resistant staphylococcus aureus,MRSA）34例，占金黄色葡萄球菌的54.8%。流感嗜血杆菌检出28株，对头孢他啶、头孢吡肟、美罗培南、亚胺培南、氨曲南和环丙沙星均完全敏感，对复方新诺明耐药性最高。结论石家庄地区儿童急性中耳炎的主要致病菌为肺炎链球菌、金黄色葡萄球菌和流感嗜血杆菌，临床常用的多种药物对其敏感性较高，临床可根据细菌培养及药敏试验结果选取合理的抗菌药物。

Analysis of clinical distribution and drug resistance of pathogenic bacteria in children with acute otitis media in Shijiazhuang area

［Abstract］ ObjectiveTo analyze the pathogen distribution and antimicrobial resistance in children with acute otitis media in Shijiazhuang area, and to provide evidence for clinical anti-infection treatment. 〖WTHZ〗MethodsThe clinical data of 291 children with acute otitis media were analyzed, the middle ear secretions were collected for culture. The strains were identified by biomerieux VITEK MS, and the antimicrobial sensitivity was detected by biomerieux VITEK2 Compact, BD Phoenix100 and K-B method. 〖WTHZ〗ResultsA total of 211 positive pathogen specimens were isolated from the purulent secretions in 291 samples with acute otitis media, and the positive rate was 72.5%, Among which 157 gram-positive strains were detected, the detection rate was 54.0%,and accounting for 74.4% of the total positive strains. The most common was streptococcus pneumonia(68), the detection rate and accounting for the total positive strains was 23.4% and 32.2% respectively. The second was staphylococcus aureus(62), the detection rate and accounting for the total positive strains was 21.3% and 29.4% respectively. The 42 strains of gram-negative bacilli accounting for 19.9% of the total positive strains were detected, the detection rate was 14.4%, in which the most common was haemophilus influenzae(28), with a detection rate of 9.6%, accounting for 13.3% of the total positive strains. There were statistically significant differences in the detection rates of pathogen in the four age groups of 0-1 year old, ＞1-3 years old, ＞3-6 years old and >6 years old(P＜0.05), and the highest positive detection rate at 0-1 year old, however the lowest positive detection rate at ＞3-6 years old. According to the time of occurrence, seasonal distribution had statistical differences(P＜0.05), with the highest detection rate in the fourth quarter and the lowest in the second quarter. The 68 strains of streptococcus pneumoniae from ear secretions were completely sensitive to Vancomycin and Linezolid, and completely resistant to Erythromycin, meanwhile the 62 strains of staphylococcus aureus were completely sensitive to Levofloxacin, Rifampicin, Gentamicin, Moxifloxacin, Vancomycin and Linezolid, and completely resistant to Erythromycin, Clindamycin and Penicillin, 34 strains of Methicillin-resistant staphylococcus aureus(MRSA) were found in Staphylococcus aureus, accounting for 54.8%. There were 28 strains of haemophilus influenzae, which were completely sensitive to Ceftazidine, Cefepime, Meropenem, Imipenem, Aztreonam and Ciprofloxacin, and higher resistance to cotrimoxazole. 〖WTHZ〗ConclusionStreptococcus pneumoniae, Staphylococcus aureus and haemophilus influenzae are the main pathogens of children′s acute otitis media in Shijiazhuang area. Many kinds of drugs commonly used in clinic are highly sensitive to them. In clinical, we can select reasonable antibiotics according to the results of bacterial culture and drug sensitivity test.