儿童腺样体肥大细菌培养及药敏分析

Bacterial culture and drug sensitivity analysis of adenoid hypertrophy in children

目的分析腺样体肥大患儿的腺样体实质与表面分泌物中菌群分布及药敏特征,探讨细菌在儿童腺样体肥大及相关疾病发病机制中的作用。方法选取自2013年8月至2014年8月就诊于北京儿童医院耳鼻咽喉头颈外科拟行腺样体切除术的101例患儿为研究对象,按照腺样体肥大程度将患者分为A组(腺样体增大阻塞后鼻孔0～50%,n=10)、B组(腺样体增大阻塞后鼻孔51%～75%,n=78)与C组(腺样体增大阻塞后鼻孔76%～100%,n=13)。取患者术前腺样体表面分泌物、术中腺样体组织行常规细菌培养及药物敏感性试验并对其结果进行分析,比较不同腺样体肥大程度的群菌种类检出情况。结果腺样体表面分泌物标本101份,细菌检出率为89. 1%(90/101),分离细菌139株。主要为流感嗜血杆菌46株(33. 1%),其次为金黄色葡萄球菌32株(23. 0%)、肺炎链球菌21株(15. 1%)、化脓链球菌14株(10. 1%)、卡他莫拉菌10株(7. 2%)等。50. 5%的标本中培养出两种以上细菌。腺样体组织标本101份,细菌检出率为89. 1%(90/101),分离细菌132株。主要为流感嗜血杆菌38株(28. 8%),其次为金黄色葡萄球菌32株(24. 2%)、肺炎链球菌25株(18. 9%)、化脓链球菌14株(10. 6%)、卡他莫拉菌8株(6. 1%)等。49. 5%的标本中培养出两种以上细菌。腺样体表面分泌物与腺样体组织菌群分布比较,差异无统计学意义(P> 0. 05)。以上常见细菌对喹诺酮类、β-内酰胺酶抑制剂复合药物较敏感,对非β-内酰胺酶抑制剂普遍耐药,而对头孢菌素类、大环内酯类抗生素耐药性差异较大。腺样体不同肥大程度的各组间菌群种类数分布比较,差异有统计学意义(P <0. 05)。结论腺样体表面分泌物可间接反映腺样体实体组织菌群分布与药敏特征。儿童腺样体中的不同菌种耐药性差异较大,治疗腺样体肥大及其相关疾病时,应根据鼻咽分泌物病原菌检测及耐药性分析,选择正确抗生素予以治疗,避免抗生素滥用。不同程度肥大腺样体中,菌群种类数分布有差异,考虑多种细菌混合感染可能是导致腺样体肥大的重要因素。

Objective To investigate the bacteriologic profiles in the surface and core of adenoid,and analyze the role of bacteria in children adenoid hypertrophy and its related diseases.Methods A retrospective study was performed on 101 cases of children who underwent otolaryngology head neck surgery from August 2013 to August 2014.According to the degree of adenoid hypertrophy,patients were divided into the Group A（adenoidectomy increase blocking nostrils after 0 to 50%, n =10）,Group B（after adenoidectomy increase blocking nostrils 51% to 75%, n =78）and Group C（adenoidectomy increase blocking nostrils after 76% to 100%, n =13）.Routine bacterial culture and drug sensitivity tests were performed on the preoperative adenoid body surface secretions and the intraoperative adenoid body tissues,and the results were analyzed to compare the detection results of different adenoid body hypertrophy.Results There were 101 secretions on the surface of adenoids,and the detection rate of bacteria was 89.1%（90/101）,and 139 strains of bacteria were isolated.The main strains were 46 strains of haemophilus influenzae（33.1%）,followed by 32 strains of staphylococcus aureus（23.0%）,21 strains of streptococcus pneumoniae（15.1%）,14 strains of streptococcus pyogenes（10.1%）and 10 strains of catarrh（7.2%）.More than two species of bacteria were cultured from 50.5% of the specimens.There were 101 adenoid tissue specimens,and the detection rate was 89.1%（90/101）,with 132 isolated bacteria.It was mainly 38 strains of haemophilus influenzae（28.8%）,followed by 32 strains of staphylococcus aureus（24.2%）,25 strains of streptococcus pneumoniae（18.9%）,14 strains of streptococcus pyogenes（10.6%）,and 8 strains of catarrh（6.1%）.More than two types of bacteria were cultured from 49.5% of the specimens.There was no statistically significant difference（ P 〉0.05）in the distribution of bacteria on the surface of adenoids and adenoids.These common bacteria were more sensitive to quinolones and doxin-lactamase inhibitors,and generally resistant to non-doxin-lactamase inhibitors.Their resistance to cephalosporins and macrolides was statistically significant different（ P 〈0.05）.Conclusion Nasopharyngeal swab can nearly reflect species and drug resistance of the pathogens in the adenoid tissue.Some bacteria of adenoid in children are resistant to antibiotics commonly used in ENT department,antimicrobial treatment should base on routine aerobic cultures and antimicrobial susceptibility test in order to use sensitive antibiotics and avoid abuse of antibiotics.However,a significant association is found with adenoid size and the number of pathogens species which suggested co-infection may play an important role in pathogenesis of adenoid hypertrophy.