66例慢性化脓性中耳炎患者耳道分泌物细菌培养及药敏试验结果对抗菌药物合理使用的影响

Influence of Ear Canal Secretion's Bacterial Culture and Drug Sensitivity Test Results on Rational Usage of Antimicrobial Agents in 66 Patients with CSOM

目的:分析老年慢性化脓性中耳炎(chronic suppurative otitis media,CSOM)患者耳道分泌物的细菌培养及药敏试验结果对抗菌药物合理使用的影响。方法:选取医院2018年1月—2019年10月收治的CSOM患者66例病历资料,分析其耳道分泌物的细菌培养和药敏试验结果以及分泌物中病原菌的分布及其对常用抗菌药物(青霉素、红霉素、利福平、万古霉素等)的耐药特点。结果:66例CSOM患者分泌物中培养出病原菌70株,其中革兰阳性菌占44.29%、革兰阴性菌占41.43%和真菌占14.28%;革兰阳性菌中主要病原菌(表皮葡萄球菌、金黄色葡萄球菌)对万古霉素、利福平、替加环素、利奈唑胺、呋喃妥因均具有较高的敏感率;而主要革兰阴性菌(铜绿假单胞菌、肺炎克雷伯菌)对亚胺培南、美罗培南、头孢他啶、哌拉西林-他唑巴坦钠、头孢哌酮-舒巴坦钠均有较高的敏感率;主要真菌(白假丝酵母、曲霉菌)对5-氟胞嘧啶、制霉菌素、两性霉素B等也有一定的敏感率。结论:CSOM感染病原菌主要为表皮葡萄球菌、金黄色葡萄球菌、铜绿假单胞菌、肺炎克雷伯菌、白假丝酵母和曲霉菌,临床可根据这些病原菌的药敏试验结果选择敏感率较高的抗菌药物治疗,以确保其治疗效果。

Objective:To analyze the influence of ear canal secretion's bacterial culture and drug sensitivity test results on rational usage of antimicrobial agents in 66 elderly patients with chronic suppurative otitis media(CSOM).Methods:The medical records of 66 elderly patients with CSOM admitted to our hospital from January 2018 to October 2019 were selected.The bacterial culture and drug sensitivity test results of ear canal secretions were calculated,and the distribution of pathogenic bacteria in the secretions and the characteristics of drug resistance to common antibacterial drugs(penicillin,erythromycin,rifampicin,vancomycin,etc.)were analyzed.Results:70 strains of pathogenic bacteria were cultured from the secretions of 66 CSOM patients,of which 44.29%were Gram-positive bacteria,41.43%were Gram-negative bacteria and 14.28%were fungi.In the Gram-positive bacteria,the main pathogens(Staphylococcus epi-dermidis and Staphylococcus aureus)were highly sensitive to vancomycin,rifampicin,tigecycline,linezolid and furan-toin.The main Gram-negative bacteria(Pseudomonas aeruginosa and Klebsiella pneumoniae)were highly sensitive to imipenem,meropenem,ceftazidime,piperacillin-tazobactam and cefoperazone/sulbactam.The main fungi(Candida albicans and Aspergillus)were also sensitive to 5-fluorocytosine,nystatin,amphotericin B,etc..Conclusion:The main pathogens of CSOM infection were Staphylococcus epidermidis.Staphylococcus aureus,Pseudomonas aeruginosa,Klebsiella pneumoniae,Candida albicans and Aspergillus.In clinical treatment,antibacterials with high sensitivity rate could be selected based on the drug sensitivity test results of these pathogens to ensure the clinical efficacy.