224例慢性化脓性中耳炎患者耳分泌物培养结果及多重耐药菌感染分析

Analysis of antibiotic resistant bacteria and multidrug-resistant organisms isolated from patients with chronic suppurative otitis media

目的:调查慢性化脓性中耳炎(chronic suppurative otitis media,CSOM)患者中多重耐药菌及其他病原菌的感染分布,并分析其耐药情况,为临床治疗提供依据。方法:收集2016年1月至2020年3月期间224例CSOM患者的临床资料,对其耳分泌物微生物培养及药敏试验结果进行分析。结果:177例患者的标本培养结果呈阳性(78.57%),共检出215株菌株,其中革兰阳性球菌有72株(72/215,33.49%),革兰阴性杆菌19株(19/215,8.84%),真菌124株(124/215,57.67%);检出多重耐药菌共36株(36/215,16.74%),其中金黄色葡萄球菌20株(20/36,55.56%),凝固酶阴性葡萄球菌(coagulase negative Staphylococcus,CoNS)12株(12/36,33.33%),铜绿假单胞菌2株(2/36,5.56%)等。金黄色葡萄球菌及CoNS对青霉素耐药率最高(分别为95.10%及64.29%),铜绿假单胞菌对左氧氟沙星耐药率最高(62.50%)。Logistic回归分析提示经验性抗生素治疗是多重耐药菌感染的独立危险因素(P<0.05),真菌感染与经验性抗生素治疗及患者的性别、年龄间均无相关性。结论:本地区CSOM患者以真菌感染为主,提示抗感染治疗前应进行细菌和真菌培养及药敏试验;临床医师应避免经验性使用抗生素,以减少多重耐药菌的产生。

Objective To investigate the distribution of multidrug-resistant organisms(MDRO)and other pathogens in the patients with chronic suppurative otitis media(CSOM)to provide evidence for prevention and treatment of CSOM.Methods:A total of 224 patients with CSOM were enrolled from January 2016 to March 2020.The samples of ear secretion were obtained for bacterial culture and isolating pathogen,and the test of drug sensitivity was conducted.Results:The samples from 177 patients(78.57%)were positive in bacterial culture and a total of 215 strains were detected,inclu-ding 72 strains of gram-positive bacteria(72/215,33.49%),19 strains of gram-negative bacteria(19/215,8.84%),124 strains of fungi(124/215,57.67%).Among 215 strains,36 strains of MDRO(36/215,16.74%)were isolated,including 20 strains of Staphylococcus aureus(20/36,55.56%),12 strains of coagulase negative Staphylococcus(CoNS)(12/36,33.33%)and 2 strains of Pseudomonasaeruginosa(2/36,5.56%).Staphylococcus aureus and CoNS had highest resistant rate to penicillin(95.10%and 64.29%),while Pseudomonas aeruginosa had highest resistant rate to levofloxacin(62.50%).The statistical analysis revealed that empirical antibiotic treatment was an independent risk factor of MDRO infection(P<0.05),and the fungal infectionin patients had no relationship with empirical antibiotic treatment,gender or age.Conclusions:Fungal infection is the main cause for local CSOM.The bacterial culture combined with the test of drug sensitivity are essential for treatment of CSOM,and empirical antibiotic treatment should be avoided to use to reduce MDRO infection.