儿童化脓性中耳炎分泌物细菌培养及药敏分析

目的通过研究本地区儿童化脓性中耳炎的主要致病菌与耐药情况,指导临床合理用药。方法对161例儿童化脓性中耳炎的耳分泌物进行细菌培养鉴定与药物敏感试验。结果 161耳脓液标本中142耳培养出病原菌,检出率为88.20%,其中6份检出2种病原菌,共分离出致病菌148株。其中细菌类138株(93.24%),金黄色葡萄球菌54株(MRSA 17株),肺炎链球菌52株,化脓链球菌7株,表皮葡萄球菌6株,其它19株;真菌类10株(6.76%)。MRSA对克林霉素、青霉素、红霉素耐药率很高,对夫西地酸、庆大霉素、左氧氟沙星、米诺环素、诺氟沙星耐药率低,MSSA对青霉素、红霉素耐药率高,对其余抗菌药物的耐药率较低,二者均未发现对呋喃妥因、万古霉素、替考拉宁、利福平、奎奴普丁/达福普汀耐药的菌株;肺炎链球菌对氯霉素、左氧氟沙星、喹奴普汀/达福普汀、万古霉素敏感,对克林霉素、四环素、复方新诺明、红霉素耐药。结论本地区儿童化脓性中耳炎的主要致病菌是金黄色葡萄球菌、肺炎链球菌,临床医生应根据药敏结果合理使用抗生素。

Objective To guide proper clinical medication through analysing the main pathogen and the drug resistant situation of suppurative otitis media of the local children. Methods Making the bacterial culture and antibiotic susceptibility tests with the ear secretion collected randomly of 161 children with suppurative otitis media. Results Among the 161 cases, pathogen were found in 142 cases, as the detectable rate was 88.20%, with that 2 kinds of pathogen were found in 6 eases, and 148 pathogenic germs were separated totally. Among them, 138 were bacterial （93.24%）, of 54 staphylococcus aureus （17 multi-drug resistant to oxacillin）, 52 streptococcus pneumoniae, 7 streptococcus pyogenes, 6 staphylococcus epidermidis, and 19 others, and 10 were fungi（6.67%）.MRSA has a high resistance rate to clidamycin, penicillin and erythrocin, while a low rate to fusidic acid, gentamicin, levofloxacin, minocycline and norfloxacin. MSSA has a high resistance rate to penicillin and erythrocin, while a low rate to the other antimicrobial. And there is no found of resistance to macrodantin, vancomycin, teicoplanin, rifampicin, quinupristin/dalfopristin in both of them two. Streptococcus pneumoniae is susceptible to chloramphenicol, levofloxacin, quinupristin/dalfopristin and vancomycin, while is resistant to clindamycin, tetracycline, sulfamethoxazole and erythromycin. Conclusion The main pathogen of the local children suppurative otitis media are staphylococcus aureus and streptococcus pneumoniae. The clinicians should use antibiotics reasonably according to the antimicrobial susceptibility results.