儿童中耳感染病原菌分布和耐药性分析

Analysis of etiology and antibiotic resistance of clinical bacterial isolates in pediatric patients with otitis media

目的研究引起儿童中耳炎感染的病原菌分布和耐药性特征。方法收集门诊就诊的164例中耳炎患儿的耳分泌物标本,分离鉴定病原菌,并进行药敏试验。按照2012年临床实验室标准化委员会(CLSI)推荐的抗菌药物敏感性试验标准,并使用WHONET5.6软件分析药敏结果。结果 164例中耳炎患儿中,121例的耳分泌物培养出病原菌,阳性率73.8%;其中复合菌感染者9例,占5.5%。共分离出病原菌130株,其中细菌占83.1%(108/130),真菌占16.9%(22/130)。细菌以肺炎链球菌最多,其次是金黄色葡萄球菌。真菌主要为念珠菌和曲霉菌。婴儿期和幼儿期患儿的肺炎链球菌检出率分别高于学龄前期和学龄期,差异有统计学意义(P<0.05)。对青霉素不敏感的肺炎链球菌76.0%,对甲氧西林耐药金黄色葡萄球菌14.3%。结论由于引起儿童中耳炎的病原菌不同,应对患儿耳分泌物进行细菌培养和药敏试验,并根据结果合理选用药物治疗。

Objectives To analyze the main pathogen of otitis media and antibiotics resistance of clinical bacterial isolates in pediatric patients. Methods Secretion specimens from 164 cases of otitis media were cultured. Antimicrobial susceptibility was determined. Results were analyzed according to the guidelines of Clinical and Laboratory Standard In- stitute （2012）. WHONET 5.6 software was used to analyse the data. Results Pathogens were cultivated in 121 ear secretion specimens from 164 cases of otitis media and the positive rate was 73.8%. There were 9 cases of mixed bacterial infection, accounting for 5.5%. 130 strains of pathogens were isolated from middle ear secretion and the main pathogens were bacteria （83.1%） and fungus （16.9%）. Among bacteria, 50 （46.3%） were Streptococcus pneumoniae and 21 （19.4%） Staphylococcus aureus. Among fungus, 17 （77.3%） were Candida spp and 5 （22.7%） Aspergillus spp. By age, the rates of infection caused by Streptococcus pneumoniae in infancy and early childhood were markedly higher than those in preschool and school-age, respectively （P〈0.05）. The no-susceptibility rate of Streptococcus pneumoniae to penicillin was 76.0%. The prevalence of meticillin-resistant Staphylococcus aureus （MRSA） was 14.3%. Conclusions Proper treatment depends on the secretionculture and drug sensitive test due to various pathogens of otitis media.