复发性急性鼻-鼻窦炎细菌学分析

The bacteriologic features of recurrent acute rhinosinusitis

目的:分析复发性急性鼻-鼻窦炎(RAR)细菌学特征。方法:29例RAR患者,鼻内镜下获取中鼻道和(或)嗅裂区脓性分泌物行细菌培养及药敏试验。结果:29例送检标本中,25例(86.2%)标本检测为阳性,共分离出细菌32株,其中需氧菌或兼性厌氧菌25株,厌氧菌7株。需氧菌或兼性厌氧菌以肺炎链球菌、流感嗜血杆菌、卡他莫拉菌以及金黄色葡萄球菌为主。厌氧菌以脆弱类杆菌及丙酸杆菌为主。药敏试验结果显示,25株需氧或兼性厌氧菌中,对大环内酯类(红霉素、阿奇霉素)及喹诺酮类(左旋氧氟沙星)抗生素耐药率分别为88%和92%;对β-内酰胺酶类抗生素(青霉素、氨苄青霉素和头孢唑啉)耐药率大于90%(100%、92%和92%);对三代头孢联合β-内酰胺酶抑制剂(头孢哌酮/舒巴坦)耐药率为20%。分离培养出的7株厌氧菌,6株对奥硝唑敏感。结论:肺炎链球菌、流感嗜血杆菌、卡他莫拉菌及金黄色葡萄球菌等需氧菌或兼性厌氧菌是复发性急性鼻-鼻窦炎的主要致病菌,且其中大部分细菌对目前常用抗生素耐药。

Objective：To investigate the bacteriologic characteristics of recurrent acute rhinosinusitis（RAR）.Method：Twenty-nine patients（29 with RAR）from outpatient clinic in our hospital between June 2010 and May2016 were enrolled in the study.Specimens of the middle meatus or olfactory cleft area using the sinus endoscopy through were transported to the laboratory for bacterial culture.Result：Twenty-five specimens out of 29 were bacterial culture positive（culture positive rate was 86.2%）.A total of 32 isolates（25 aerobic or facultative and 7 anaerobic）were recovered from the 29 cases of RAR.The predominant aerobic or facultative bacteria were Streptococcus pneumoniae,Haemophilus influenzae,Moraxella catarrhalis,and Staphylococcus aureus.The predominant anaerobic bacteria were Bacteroides fragilis and Propionibacterium.Antibiotic susceptibility tests showed that the resistance rate of these aerobic or facultative bacteria to Macrolides（Erythromycin and Azithromycin）and quinolones（Levofloxacin）was 88% and 92%,respectively.Similarly,the resistance rate of bacteria toβ-lactamase antibiotics（penicillin,ampicillin,and cefazolin）was also greater than 90%（100%,92%,and 92%,respectively）.But the drug resistance of these bacteria to the third-generation cephalosporin combined with beta lactamase inhibitors（Cefoperazone/sulbactam）was 20%.Among the 7 strains of anaerobic bacteria,6 strains were sensitive to ornidazole.Conclusion：The major pathogens of RAR are the aerobic and facultative bacteria Streptococcus pneumoniae,Haemophilus influenzae,Moraxella catarrhalis,and Staphylococcus aureus,most of which are resistant to commonly used antibiotics.