儿童中耳感染病原菌分布与耐药性分析

Distribution and drug resistance of pathogens causing middle ear infections in children

目的调查与分析儿童中耳感染病原菌分布及其耐药性,为合理使用抗菌药物提供参考依据。方法收集2011年1月-2013年5月收治的180例中耳炎患儿耳分泌物标本进行病原学检测及药敏试验;采用SPSS13.0统计软件对数据进行分析。结果 180例中耳感染患儿中125例耳分泌物标本中检出病原菌,阳性率为69.4%,其中10例为复合菌感染,占8.0%;在患儿的耳分泌物标本中共培养分离出病原菌135株,革兰阳性菌为95株占70.4%,革兰阴性菌为15株占11.1%,真菌25株占18.5%;各年龄段患儿的病原菌检出率的差异无统计学意义;婴儿期患儿或幼儿期患儿的肺炎链球菌分离率显著高于学龄前期患儿或学龄期患儿(P<0.05);肺炎链球菌对红霉素、克林霉素、四环素、磺胺甲噁唑/甲氧苄啶及美罗培南的耐药率较高,>80.0%,金黄色葡萄球菌对青霉素、克林霉素、红霉素的耐药率较高,>45.0%,两种病原菌对左氧氟沙星、万古霉素、利奈唑胺均较敏感,耐药率<10.0%。结论肺炎链球菌、金黄色葡萄球菌等革兰阳性球菌仍然是引发儿童中耳炎的主要病原菌,随着患儿年龄的增长,肺炎链球菌的感染率呈现下降的趋势,儿童中耳炎的主要病原菌对传统抗感染药物的耐药率均较高,而对万古霉素等新型抗感染药物较敏感。

OBJECTIVE To observe the distribution and drug resistance of the pathogens causing middle ear infections in the children so as to provide guidance for reasonable use of antibiotics.METHODS The ear secretions specimens were collected from the children with otitis media who were treated in the hospital from Jan 2011 to May2013,then the etiological examination was carried out,the drug susceptibility testing was performed,and the statistical analysis of data was performed with the use of SPSS13.0software.RESULTS The pathogens were detected positive in the ear secretions specimens of 125 of 180children with middle ear infections,with the positive rate of69.4%,and 10 cases had mixed bacterial infections,accounting for 8.0%.A total of 135 strains of pathogens were isolated from the ear secretions specimens,including 95（70.4%）strains of gram-positive bacteria,15（11.1%）strains of gram-negative bacteria,and 25（18.5%）strains of fungi.There was no significant difference in the isolation rates of pathogens among the various age groups of children.The isolation rate of the Streptococcus pneumoniae was significantly higher in the infancy or babyhood children than in the preschool age children or school age children（P〈0.05）.The drug resistance rates of the S.pneumoniaeto erythromycin,clindamycin,tetracycline,sulfamethoxazole-trimethoprim,and meropenem were more than 80.0%.The drug resistance rates of the Staphylococcus aureus to penicillin,clindamycin,and erythromycin were more than 45.0%.The drug resistance rates of the two species of pathogens to levofloxacin,vancomycin,and linezolid were less than 10.0%.CONCLUSION The gram-positive cocci such as S.pneumoniae and S.aureus remain dominant among the pathogens causing otitis media in the children.The incidence of S.pneumoniaeinfection shows a downward trend with the increase of age.The major species of pathogens causing the otitis media are highly resistant to the traditional antibiotics but are susceptible to the novel antibiotics such as vancomycin.