南宁地区儿童耳炎病原菌分布特征及药敏分析

Distribution and drug sensitivity of otitis pathogens of children in Nanning

本研究旨在探讨南宁地区儿童耳炎病原菌分布及其药物敏感性,为临床医生合理用药提供依据。通过回顾性分析2019—2021年广西壮族自治区妇幼保健院收治的外耳道炎或中耳炎患儿的基本资料,统计培养分离的细菌和真菌构成比,并分析主要致病菌的耐药情况。结果显示:共送检耳分泌物样本918份,623例(67.86%)培养结果为阳性。其中,仅检出细菌的有438例(70.30%),仅检出真菌为164例(26.32%),检出细菌合并真菌为21例(3.37%)。革兰氏阳性细菌以金黄色葡萄球菌和肺炎链球菌为主,革兰氏阴性细菌以铜绿假单胞菌和流感嗜血杆菌为主。念珠菌以近平滑念珠菌和白念珠菌为主,丝状真菌以黄曲霉和黑曲霉为主。药敏试验结果发现,金黄色葡萄球菌对万古霉素、利奈唑胺、氨基糖苷类及喹诺酮类抗生素较为敏感,而对青霉素和大环内酯类耐药率高。肺炎链球菌对青霉素、万古霉素、左氧氟沙星、阿莫西林/克拉维酸等的敏感性较高,而对大环内酯类、二代头孢的耐药率较高。阴性杆菌中,铜绿假单胞菌对青霉素类、头孢类、喹诺酮类及碳青霉烯类等均较为敏感。流感嗜血杆菌对阿莫西林/克拉维酸及氧氟沙星均敏感,对复方新诺明、氨苄西林及二代头孢部分耐药。念珠菌的药敏试验结果显示,近平滑念珠菌对三唑类抗真菌药敏感;白念珠菌对两性霉素B全敏感,对三唑类抗生素有一定的耐药性。本研究证实:南宁地区儿童耳炎感染的细菌主要为金黄色葡萄球菌、肺炎链球菌、铜绿假单胞菌;真菌感染以近平滑念珠菌和黄曲霉为主。临床医生在治疗南宁地区儿童耳炎时,细菌性耳炎可经验性使用阿莫西林/克拉维酸或β-内酰胺类抗生素,真菌性耳炎可经验性使用伏立康唑治疗。

The purpose of the current study is to analyze the pathogens of otitis in children and its drug sensitivity for references of clinical empirical medication.In this retrospective study,we analyzed ear secretion culture data of the children with otitis in the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region from January 2019 to December 2021.We calculated the constituent ratio of the positive bacteria and fungi,then analyzed the drug sensitivity of the major Gram-positive bacteria,Gram-negative bacteria and candida.The results demonstrated that,of all the 918 ear secretion samples,623 were positive culture.438(70.30%)were bacteria positive,and 164(26.32%)were fungi positive,while 21(3.37%)were both bacteria and fungi positive.Staphylococcus aureus and streptococcus pneumoniae were the major gram-positive bacteria,and Pseudomonas aeruginosa and haemophilus influenzae were the major gram-negative bacteria.The most common yeast fungi were candida parapsilosis and candida albicans,and the top two mould were aspergillus flavus and aspergillus niger.As results of drug sensitivity test of main gram-positive bacteria,staphylococcus aureus were sensitive to vancomycin,linezolid,aminoglycosides and quinolones,but showed high resistance to penicillin and macrolides.However,most streptococcus pneumoniae were sensitive to penicillin,vancomycin,levofloxacin and amoxicillin-clavulanic acid,but were highly resistant to macrolides and the second generation cephalosporins.In terms of major gram-negative bacteria,pseudomonas aeruginosa were widely sensitive to penicillins,cephalosporins,quinolones and carbapenems agents.And,all haemophilus influenzae in the study were sensitive to amoxicillin-clavulanic and ofloxacin,but a part of strains were resistant to sulfamethoxazole,ampicillin and the second generation cephalosporins.Antifungal drug sensitivity results showed that all isolated candida parapsilosis and a large part of candida albicans were sensitive to triazole drugs.It concludes that the top three pathogenic bacteria of otitis in children are staphylococcus aureus,streptococcus pneumoniae and pseudomonas aeruginosa.In terms of pathogenic fungi,the major yeast and mould are candida parapsilosis and aspergillus flavus,respectively.Clinicians could empirically administrate antibiotics or antifungal agents referring to our study results before getting culture and drug sensitivity reports.