慢性鼻-鼻窦炎患者鼻腔灌洗液细菌学研究

Bacteriological study of nasal lavage in chronic rhinosinusitis

目的探讨慢性鼻-鼻窦炎(CRS)患者鼻腔灌洗液中细菌分布和耐药性特征,为临床治疗用药提供依据。方法收集90例CRS患者(CRS组)和40名健康受试者(对照组)的双侧鼻腔灌洗液进行细菌培养、鉴定和药物敏感试验。结果CRS组鼻腔灌洗液中细菌培养阳性率为80%(72/90),全部为需氧菌,未检出厌氧菌,常见菌种为凝固酶阴性葡萄球菌、草绿色链球菌、肺炎克雷伯菌、奈瑟氏球菌,对照组鼻腔灌洗液中细菌培养阳性率为77.5%(31/40),细菌种类与CRS组一致,无显著性差异(P>0.05)。CRS组菌株对2种或2种以上抗生素耐药的比例显著高于对照组(P<0.05)。结论CRS患者鼻腔灌洗液中检出细菌菌谱广,属条件致病菌且菌群耐药性较高,提示临床应动态监测细菌谱的变化,选择抗生素治疗时不能经验用药,应以药物敏感试验结果为依据。

OBJECTIVE To explore the bacterial distribution and drug resistance characteristics of nasal lavage fluid in patients with chronic sinusitis(CRS)and to provide evidence for clinical treatment.METHODS Bilateral nasal lavage fluids from 90 CRS patients(CRS group)and 40 healthy subjects(control group)were collected for bacterial culture,identification and drug sensitivity tests.RESULTSThe positive rate of bacterial culture in the nasal lavage fluid of the CRS group was 80%(72/90),all of which were aerobic bacteria and no anaerobic bacteria were detected,mainly including coagulase negative staphylococcus,grass green streptococcus,klebsiella pneumoniae and neisseria.The positive rate of bacterial culture in the nasal lavage fluid of the control group was 77.5%(31/40).The type of bacteria was the same as that of the CRS group,and there was no significant difference(P>0.05).The proportion of strains resistant to two or more antibiotics in the CRS group was significantly higher than that in the control group(P<0.05).CONCLUSIONThe nasal lavage fluid of CRS patients has a broad spectrum of bacteria,which is conditionally pathogenic and has high drug resistance.The bacterial spectrum should be monitored dynamically and the selected antibiotics should be based on the drug sensitivity test results.