330例儿童急性化脓性中耳炎分泌物病原菌分布和耐药性分析

Analysis of the Distribution and Drug Resistance of Pathogenic Bacteria in the Secretions of 330 Children with Acute Suppurative Otitis Media

目的探究不同年龄段儿童急性化脓性中耳炎(AOM)分泌物病原菌分布特点和耐药性分析。方法回顾性分析2015年9月至2019年3月唐山市第三医院330例确诊为AOM的0~6岁患儿完整资料,按照年龄分为≤3岁组以及>3岁组,无菌操作下取中耳脓液进行细菌、真菌以及支原体的培养、鉴定并进行药敏抗药性试验。结果330例患儿中培养分离出14种病原菌,其中肺炎链球菌所占比例最高,为36.67%,金黄色葡萄球菌次之,为23.03%,真菌类为3.33%。330例患儿中,≤3岁组儿童感染肺炎链球菌的比例最高,为46.26%,而在>3岁组肺炎链球菌占15.53%,差异具有统计学意义(P<0.05);在>3岁组金黄色葡萄球菌占38.83%,而在≤3岁组占15.86%,两组比较差异具有统计学意义(P<0.05)。肺炎链球菌对氯霉素、阿莫西林、头孢曲松、氧氟沙星以及万古霉素的敏感性较高,对红霉素以及阿奇霉素的耐药性较高。金黄色葡萄球菌对替考拉宁、头孢西丁、复方新诺明、四环素、万古霉素以及妥布霉素的敏感性较高,对红霉素以及青霉素G的耐药性较高。结论不同年龄段儿童发生AOM的病原菌存在差异性,3岁以内儿童更易感染肺炎链球菌,3~6岁儿童更易感染金黄色葡萄球菌。治疗肺炎链球菌引起的AOM时,可使用氯霉素、阿莫西林、头孢曲松、氧氟沙星以及万古霉素;治疗金黄色葡萄球菌引起的AOM时,可使用替考拉宁、头孢西丁、复方新诺明、四环素、万古霉素以及妥布霉素。

Objective To explore the distribution and drug resistance analysis of pathogens of acute suppurative otitis media(AOM)secretions in children of different age groups.Methods A retrospective analysis of 330 children diagnosed with AOM and complete clinical data in our hospital from September 2015 to March 2019 was divided into≤3 years old group and>3 years old group.Under aseptic operation,the middle ear pus was taken for bacterial,fungal,and mycoplasma culture and the drug sensitivity test was performed.Results The isolated pathogenic bacteria were isolated in 330 children.Among them,streptococcus pneumonia accounted for the highest proportion at 36.67%,followed by staphylococcus aureus at 23.03%and fungi at 3.33%.Among the 330 children,the proportion of children infected with streptococcus pneumonia in the≤3 years group was the highest,which was 46.26%,while in the group of>3 years,streptococcus pneumonia accounted for 15.53%,the difference was statistically significant(P<0.05).Staphylococcus aureus accounted for 38.83%in the>3 years old group and 15.86%in the≤3 years group,the difference was statistically significant(P<0.05).Streptococcus pneumonia was more sensitive to chloramphenicol,amoxicillin,ceftriaxone,ofloxacin,and vancomycin,and it was more resistant to erythromycin and azithromycin.Staphylococcus aureus had a higher sensitivity rate to teicoplanin,cefoxitin,compound monoamine,tetracycline,vancomycin,and tobramycin,and high resistance to erythromycin and penicillin G.Conclusion There are certain differences in the pathogenic bacteria in children of different ages in the occurrence of acute suppurative otitis media.Children under 3 years old are more susceptible to streptococcus pneumoniae,and children 3 to 6 years old are more susceptible to staphylococcus aureus.When treating AOM caused by streptococcus pneumoniae,chloramphenicol,amoxicillin,ceftriaxone,ofloxacin,and vancomycin can be used.When treating AOM caused by staphylococcus aureus,teicoplanin and cephalosporin can be used.Cetin,compound trimethoprim,tetracycline,vancomycin and tobramycin.