慢性鼻窦炎患者鼻腔定植菌的筛查和耐药性分析

Screening and antibiotic resistance analysis of nasal colonized bacteria in patients with chronic rhinosinusitis

目的:总结慢性鼻窦炎(CRS)患者鼻腔定植菌的检出情况和耐药特征,探讨其与CRS发病的相关性。方法:通过在我院就诊的200例CRS患者进行鼻前庭标本采集,以微生物自动化系统接种于各类细菌培养液进行细菌培养和菌落观察,并进行质谱鉴定和相应的抗菌药物敏感性试验。结果:共检出鼻腔定植菌株275株,包括凝固酶阴性葡萄球菌、金黄色葡萄球菌、肺炎链球菌、卡他莫拉菌、流感嗜血杆菌、铜绿假单胞菌,以及大肠埃希菌、肺炎克雷伯菌等肠杆菌科细菌;部分菌株定植率在未成年和成年患者,或接受鼻内镜手术和非手术治疗患者间存在差异。结论:CRS患者鼻腔定植菌与CRS常见致病菌在构成上部分相似,并存在抗菌药物耐药性,这种耐药菌的储存库在特定条件下转化为CRS致病菌,开展鼻腔定植菌筛查有望为CRS的诊治提供新的思路。

Objective:Since bacterial infection is one of the common pathogenic factors lead to chronic rhinosinusitis(CRS),our study is designed to investigate the prevalence and antibiotic resistance of nasal colonized bacteria in patients with CRS,and to analyze the correlation between nasal colonized bacteria and pathogenesis of CRS.Method:Nasal vestibule samples collected from 200 patients with CRS were automatically inoculated on to various bacterial culture medium,cultured by WaspLab microbiology automated system,potential pathogenic bacterial colonies grew on agar plates were then examined,identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry,and analyzed their antibiotic-resistant phenotype by antibiotic susceptibility testing.Result:Two hundred and seventy-five bacterial strains of nasal colonization were isolated,including coagulase-negative Staphylococci,Staphylococcus aureus,Streptococcus pneumonia,Moraxella catarrhalis,Haemophilus influenza,Pseudomonas aeruginosa,and Enterobacteriaceae such as Escherichia coli and Klebsiella pneumoniae.All strains displayed various degrees of antimicrobial resistance among children and adult patients,or among patients with and without endoscopic sinus surgery.Conclusion:The constitution of nasal colonized commensal bacteria in patients with CRS was partially similar to that of pathogenic bacteria causing CRS.They may form a reservoir of antimicrobial resistant pathogens,which would transform into pathogenic bacteria causing CRS under certain conditions.Screening of nasal colonized bacteria may represent an alternative approach for diagnosis and treatment of CRS.