311例腺样体肥大合并分泌性中耳炎患者鼻咽部菌群特征及耐药性分析

The bacteriological characteristics and drug resistance of the nasopharyngeal region in 311 cases of adenoid hypertrophy with secretory otitis media

目的:分析腺样体肥大合并分泌性中耳炎患者鼻咽部菌群分布及耐药性特征,明确病原菌分布情况,为临床治疗提供抗生素用药指导和依据。方法:回顾性分析2013年2月—2020年1月在青岛大学附属医院耳鼻咽喉头颈外科行手术治疗的腺样体肥大合并分泌性中耳炎的311例患者,按年龄分为A组(0~5岁),B组(6~10岁),C组(11~16岁)。手术中采集腺样体深部靠近患耳咽鼓管处分泌物进行细菌培养和耐药性分析。结果:采样标本分离培养出病原菌142株,检出率为45.66%。以金黄色葡萄球菌(63株)、肺炎链球菌(15株)、化脓性链球菌(13株)、卡他莫拉菌(28株)为主要菌种。金黄色葡萄球菌对青霉素、红霉素和克林霉素具有较高耐药率;肺炎链球菌和化脓性链球菌对红霉素、克林霉素、四环素耐药率高;卡他莫拉菌对氨苄西林和复方新诺明的耐药率较高。结论:腺样体肥大合并分泌性中耳炎患者所检出病原菌主要为金黄色葡萄球菌、肺炎链球菌、化脓性链球菌和卡他莫拉菌,不同病原菌间耐药性有较大差异,建议开展广泛的细菌学检测,根据合理用药原则及耐药性试验结果选择使用抗生素,以达到良好的治疗效果。

Objective:To analyze the bacteriological distribution and drug resistance of nasopharynx in patients with adenoid hypertrophy complicated with secretory otitis media,and to clarify the distribution of pathogenic bacteria,so as to provide guidance and basis for antibiotic use in clinical treatment.Methods:A retrospective analysis was performed on 311 patients with adenoid hypertrophy and secretory otitis media who underwent surgical treatment in the department of otolaryngology head and neck surgery,Affiliated Hospital of Qingdao University from February 2013 to January 2020.They were divided into 3 groups by age:Group A(0-5 years old),Group B(6-10 years old),and Group C(11-16 years old).The secretions from deep adenoid near the eustachian tube of the affected ear were collected during the surgery for bacterial culture and drug resistance analysis.Results:One hundred and forty-two strains of pathogenic bacteria were isolated and cultured,with a detection rate of 45.66%.Staphylococcus aureus(63 strains),streptococcus pneumoniae(15 strains),streptococcus pyogenes(13 strains)and moraxella cachinella(28 strains)was the main strain.Staphylococcus aureus had high drug resistance rate to penicillin,erythromycin and clindamycin.Streptococcus pneumoniae and Streptococcus pyogenic had high resistance rates to erythromycin,clindamycin and tetracycline.The resistance rate of Moraxella catarrhalis to ampicillin and co-trimoxazole was higher.Conclusion:The main pathogens detected in patients with adenoid hypertrophy complicated with secretory otitis media are staphylococcus aureus,streptococcus pneumoniae,streptococcus pyogenes and moraxella catarrhalis.Drug resistance of different pathogens is quite different.So it is recommended to carry out extensive bacteriological detection,and select antibiotics according to the principle of rational drug use and the results of drug resistance test,so as to achieve good therapeutic effect.