儿童慢性化脓性中耳炎病原菌分布及耐药性分析

目的探讨儿童慢性化脓性中耳炎病原菌分布及耐药性,为临床合理用药提供参考。方法以2015年1月至2019年12月郑州大学附属儿童医院耳鼻喉科收治的儿童慢性化脓性中耳炎患者401例(418耳)为研究对象,男163例,女238例,年龄2月21天~15岁,平均2.41±2.31岁。取中耳分泌物行细菌培养及药敏试验,采用WHONET 5.6软件进行药物敏感性分析。结果418耳慢性化脓性中耳炎中共391耳检出病原菌,排除取材时污染的7耳,共384耳,病原菌检出率为91.87%(384/418),其中细菌感染372耳,真菌感染12耳,革兰阳性菌检出率较高,为329株(85.68%);主要检出菌株依次为金黄色葡萄球菌168(43.75%)、肺炎链球菌106(27.60%)、表皮葡萄球菌26(6.77%)、铜绿假单胞菌19(4.95%)、嗜血杆菌13(3.39%)、真菌12(3.13%)株。常见致病菌对抗菌药物的敏感性因菌种而异,金黄色葡萄球菌对青霉素G、红霉素耐药率均>85%,肺炎链球菌对克林霉素、红霉素耐药率达100%,铜绿假单胞菌耐药率较高的依次为氨曲南和头孢吡肟。结论本组慢性化脓性中耳炎患儿的主要致病菌为金黄色葡萄球菌、肺炎链球菌、铜绿假单胞菌,临床上应根据致病菌的药敏试验结果合理选择抗菌药物,以确保患儿用药合理、安全、有效。

Distribution and Drug Resistance of Pathogenic Bacteria in Children with Chronic Suppurative Otitis Media

Objective To investigate the culture and drug resistance of pathogenic bacteria in children with chronic suppurative otitis media,and to provide a basis for the rational choice of drugs for clinical use.Methods From January 2015 to December 2019,401 patients with chronic suppurative otitis media(418 ears)admitted to the Department of Otorhinolaryngology of the Children's Hospital of Zhengzhou University were used as the research object.Among the 401 patients,163 were males and 238 were females,aged 2 months 21 days~15 years old with average of 2.41±2.31 years old.Bacterial culture and drug sensitivity test analysis of middle ear secretions were used.WHONET 5.6 software was used to analyze drug sensitive data.Results A total of 391 pathogenic bacteria were detected in 418 ears with chronic suppurative otitis media,384 of which were obtained(7 contaminated were excluded).The positive rate of pathogenic bacteria was 91.87%,including 372 cases of bacterial infection and 12 cases of fungal infection.The detection rate of Gram-positive bacteria was 329(85.68%).The main detected strains were S.aureus 168(43.75%),S.pneumoniae 106(27.60%),S.epidermidis 26(6.77%),and aeruginosa.pseudomonas 19(4.95%),haemophilus 13(3.39%),and fungus 12(3.13%).The sensitivity of common pathogenic bacteria to antimicrobials varies by species.Conclusion The main pathogenic bacteria of chronic suppurative otitis media in our hospital are staphylococcus aureus,streptococcus pneumoniae,and pseudomonas aeruginosa.The antibacterial drugs should be reasonably selected clinically based on the results of drug susceptibility tests of pathogenic bacteria to ensure reasonable,safe and effective medication for children.