108例中耳炎患者患耳分泌物病原菌培养鉴定及药敏试验结果分析

Culture and identification of main pathogenic bacteria and analysis of drug sensitivity results from ear secretions in 108 patients with otitis media

目的分析108例中耳炎患者患耳分泌物病原菌培养鉴定及药敏试验结果,为抗菌药物的合理使用提供参考。方法收集108例中耳炎患者[慢性化脓性中耳炎(CSOM)患者62例,中耳胆脂瘤46例]患耳分泌物标本,利用梅里埃的质谱仪对标本进行菌株培养鉴定,利用梅里埃的vitekII对菌株进行药敏试验。结果108例中耳炎患者中80例检出病原菌,培养出病原菌86株;44例CSOM患者检出病原菌,其中革兰阳性菌19株(金黄色葡萄球菌12株、凝固酶阴性葡萄球菌7株、其他革兰阳性菌0株),革兰阴性菌21株(铜绿假单胞菌14株、其他革兰阴性菌7株),真菌7株;36例中耳胆脂瘤患者检出病原菌,其中革兰阳性菌22株(金黄色葡萄球菌15株、凝固酶阴性葡萄球菌4株、其他革兰阳性菌3株),革兰阴性菌15株(铜绿假单胞菌7株、其他革兰阴性菌8株),真菌2株。金黄色葡萄球菌药敏结果显示庆大霉素、利福平、奎奴普丁/达福普汀、苯唑西林、万古霉素、复方新诺明、利奈唑胺等药物敏感性高,红霉素、青霉素G敏感性较低。铜绿假单胞菌药敏结果显示哌拉西林/他唑巴坦、阿米卡星、哌拉西林、亚胺培南、头孢吡肟、头孢他啶等药物敏感性高,庆大霉素、左旋氧氟沙星、环丙沙星药物敏感性略低;其他革兰阴性菌药敏结果显示哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、美罗培南、头孢吡肟、头孢他啶等药物敏感性高,复方新诺明、左旋氧氟沙星、环丙沙星等药物敏感性相对较低。结论CSOM和中耳胆脂瘤患耳内分泌物病原菌均以金黄色葡萄球菌和铜绿假单胞菌最多见,不同病原菌对常用抗菌药物敏感性不同。

Objective To analyze the pathogenic bacteria and drug sensitivity results from ear secretions of 108 patients with otitis media,and to explore a more reasonable use of antibiotics.Method The secretion samples of 108 patients with otitis media[62 patients with chronic suppurative otitis media(CSOM),and 46 patients with middle ear cholesteatoma]were collected.The cultured strains were identified by mass spectrometer of bioMerieux,and the drug sensitivity test was carried out by bioMerieux vitekII.Results Among the 108 patients with otitis media,80 cases had pathogenic bacteria and 86 strains were cultured;pathogenic bacteria were found in 44 patients with CSOM,including 19 strains of Gram-positive bacteria(12 Staphylococcus aureus,7 coagulase negative Staphylococcus and 0 other G+bacteria),21 strains of Gram-negative bacteria(14 Pseudomonas aeruginosa,7 other G-bacteria),and 7 strains of fungi;pathogenic bacteria were found in 36 patients with middle ear cholesteatoma,including 22 strains of G+bacteria(15 Staphylococcus aureus,4 coagulase negative staphylococcus,and 3 other G+bacteria),15 strains of G-bacteria(7 Pseudomonas aeruginosa,8 other G-bacteria),and 2 fungi.The drug sensitivities of Staphylococcus aureus to gentamycin,rifampicin,quinoline nuputing/dalfoprostin,oxacillin,vancomycin,trimethoprim-sulfmethoxazole and linezolid were high,while its drug sensitivities to erythromycin and penicillin G were low.The drug sensitivities of Pseudomonas aeruginosa to piperacillin/tazobactam,amikacin,piperacillin,imipenem,cefepime and ceftazidime were high,while to gentamicin,levofloxacin and ciprofloxacin were slightly lower.Other G-bacteria drug sensitivity results showed that their sensitivities to piperacillin/tazobactam,cefoperazone/sulbactam,meropenem,cefepime and ceftazidime were high,and to trimethoprim-sulfmethoxazole,levofloxacin,and ciprofloxacin were relatively low.Conclusion Staphylococcus aureus and Pseudomonas aeruginosa are the most common pathogens of chronic suppurative otitis media and cholesteatoma,and different pathogens have different sensitivities to commonly used antibiotics.