儿童与成人OSAHS患者的口咽部菌群特征及药敏学分析

目的 分析儿童与成人阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者口咽部菌群的差异及其药敏学结果,为临床OSAHS患者术后合理选择抗生素提供参考依据。 方法 选取青岛大学附属医院耳鼻咽喉头颈外科2018年1月—2021年10月经多导睡眠监测确诊并行手术治疗的OSAHS患者为研究对象,根据年龄分为儿童组和成人组,入院后取2组患者口咽部分泌物及时送检行细菌培养及药敏学分析,比较儿童OSAHS患者与成人OSAHS患者的口咽部菌群差异及药敏学结果。 结果 211例患者中66例分离培养出病原菌共78株,阳性率为31.28%,其中革兰氏阳性球菌55株(70.51%),以金黄色葡萄球菌29株(37.18%)、肺炎链球菌18株(23.08%)为主;革兰氏阴性杆菌19株(24.36%),以流感嗜血杆菌15株(19.23%)为主。儿童组与成人组相比,致病菌检出率差异有统计学意义;肺炎链球菌2组间比较,差异有统计学意义,儿童组肺炎链球菌的检出率高于成人组;金黄色葡萄球菌、流感嗜血杆菌2组间比较,差异均无统计学意义。肺炎链球菌对四环素、克林霉素、红霉素具有较高的耐药率;金黄色葡萄球菌对青霉素的耐药率较高;流感嗜血杆菌对氨苄西林、头孢克洛、复方新诺明、头孢呋辛的耐药率较高。 结论 OSAHS术后经验性应用抗生素预防和治疗感染,儿童患者与成人患者应区别对待,并应根据药敏结果及时调整抗菌药物方案,减缓耐药菌的产生。

The bacteriological characteristics and drug sensitivity of the oropharyngeal region in children and adults with OSAHS

Objective To analyze the difference of oropharyngeal flora between children and adults with obstructive sleep apnea hypopnea syndrome(OSAHS)and the results of drug sensitivity, so as to provide reference basis for rational selection of antibiotics in OSAHS patients after surgery. Methods OSAHS patients diagnosed by polysleep monitoring and treated by surgery in the Department of Otolaryngology Head and Neck Surgery of the Affiliated Hospital of Qingdao University from January 2018 to October 2021 were selected as the research objects. They were divided into children group and adults group according to age. After admission, some oropharyngeal secretions of the two groups were timely sent for bacterial culture and drug sensitivity analysis, to compare the oropharyngeal flora and drug sensitivity between children with OSAHS and adults with OSAHS. Results A total of 78 strains of pathogenic bacteria were isolated and cultured in 66 of 211 patients, with a positive rate of 31.28%, including 55 strains of Gram-positive cocci(70.51%), 29 strains of Staphylococcus aureus(37.18%)and 18 strains of Streptococcus pneumoniae(23.08%)were the main strains; there were 19 strains of Gram-negative bacilli(24.36%), mainly 15 strains of Haemophilus influenzae(19.23%). There was significant difference in detection rate of pathogenic bacteria between children group and adults group. There was significant difference in Streptococcus pneumoniae between the two groups, the detection rate of Streptococcus pneumoniae in children group was higher than that in adults group; there was no significant difference between Staphylococcus aureus and Haemophilus influenzae in the two groups. Streptococcus pneumoniae had high resistance rate to tetracycline, clindamycin and erythromycin. The resistance rate of Staphylococcus aureus to penicillin was high, and the drug resistance rates of Haemophilus influenzae to ampicillin, cefaclor, cotrimoxazole and cefuroxime were high. Conclusion The empirical application of antibiotics to prevent and treat infection after OSAHS surgery should be treated differently between children and adults patients, and the antimicrobial regimen should be adjusted according to the drug sensitivity results to slow down the production of drug-resistant bacteria.