慢性化脓性中耳炎患者病原菌分布及耐药性分析

目的了解慢性化脓性中耳炎患者病原菌分布及其耐药性。方法选取2017年1月—2019年1月在我院行耳内镜手术治疗的176例慢性化脓性中耳炎患者作为研究对象,采集鼓室内、鼓膜穿孔处分泌物进行常规细菌培养和药物敏感性(药敏)试验。结果176例耳道分泌物标本中,162例培养出病原菌,同时感染2种病原菌的患者40例,共分离获得202株病原菌(检出率高达92.04%),其中细菌175株(占86.63%),包括革兰阳性菌91株(占52.00%),以金黄色葡萄球菌为主(40株,占22.86%);革兰阴性菌84株(占48.00%),以铜绿假单胞杆菌为主(38株,占21.71%);真菌27株(占13.37%),以光滑假丝酵母菌和曲霉菌为主。金黄色葡萄球菌和表皮葡萄球菌对青霉素G的耐药率均>80%,对红霉素的耐药率均>60%,未发现对万古霉素耐药的菌株。铜绿假单胞菌和变形杆菌对头孢唑林、头孢哌酮、头孢呋辛的耐药率均>65%,对头孢噻肟的耐药率均>50%,未发现对亚胺培南、头孢他啶耐药的菌株。结论耳内镜手术治疗慢性化脓性中耳炎患者耳分泌物检测出的感染病原菌以金黄色葡萄球菌、铜绿假单胞菌为主,临床应根据患者病原菌检测的种类和药敏试验结果合理选择抗菌药物进行治疗。

Pathogenic bacteria distribution and drug resistance analysis of patients with chronic suppurative otitis media

Objective To investigate the distribution of pathogenic bacteria and drug resistance of patients with chronic suppurative otitis media.Methods A total of 176 patients with chronic suppurative otitis media who received ear endoscopic surgery in our hospital from January 2017 to January 2019 were enrolled in the study.The secretions obtained from tympanic cavity and tympanic membrane perforation of the patients were used for conventional bacterial culture and drug susceptibility testing.Results Among 176 patients with ear canal secretions,the pathogenic bacteria were cultured from 162 cases,and 40 cases were simultaneously infected with 2 kinds of pathogenic bacteria.Totally 202 strains of pathogenic bacteria were isolated(detection rate up to 92.04%),including 175 strains of bacteria(86.63%),among which 91 strains(52.00%)were gram-positive,mainly Staphylococcus aureus(40 strains,22.86%);84 strains of gram-negative(48.0%),mainly Pseudomonas aeruginosa(38 strains,21.71%);and 27 strains of fungi(13.37%),mainly Candida glabrata and Aspergillus.The resistance rate of Staphylococcus aureus and Staphylococcus epidermidis to penicillin G was over 80%,and the resistance rate to erythromycin was over 60%.No vancomycin resistant strains were found.The drug resistance rate of Pseudomonas aeruginosa and Proteus to cefazolin,cefoperazone and cefuroxime was over 65%,and the drug resistance rate to cefotaxime was over 50%.No imipenem or ceftazidime resistant strains were found.Conclusions The pathogenic bacteria detected from ear secretions in patients with chronic suppurative otitis media treated by ear endoscopic surgery are mainly Staphylococcus aureus and Pseudomonas aeruginosa.Appropriate antibacterial drugs should be selected according to the type of pathogenic bacteria detected and drug sensitivity test results.