224例慢性化脓性中耳炎患者耳分泌物培养结果及多重耐药菌感染分析

doi:10.16150/j.1671-2870.2021.01.014

摘要/Abstract

摘要：

目的:调查慢性化脓性中耳炎（chronic suppurative otitis media, CSOM）患者中多重耐药菌及其他病原菌的感染分布,并分析其耐药情况,为临床治疗提供依据。方法:收集2016年1月至2020年3月期间224例CSOM患者的临床资料,对其耳分泌物微生物培养及药敏试验结果进行分析。结果:177例患者的标本培养结果呈阳性（78.57%）,共检出215株菌株,其中革兰阳性球菌有72株（72/215, 33.49%）,革兰阴性杆菌19株（19/215, 8.84%）,真菌124株（124/215, 57.67%）;检出多重耐药菌共36株（36/215,16.74%）,其中金黄色葡萄球菌20株（20/36, 55.56%）,凝固酶阴性葡萄球菌（coagulase negative Staphylococcus, CoNS）12株（12/36, 33.33%）,铜绿假单胞菌2株（2/36, 5.56%）等。金黄色葡萄球菌及CoNS对青霉素耐药率最高（分别为95.10%及64.29%）,铜绿假单胞菌对左氧氟沙星耐药率最高（62.50%）。Logistic回归分析提示经验性抗生素治疗是多重耐药菌感染的独立危险因素（P<0.05）,真菌感染与经验性抗生素治疗及患者的性别、年龄间均无相关性。结论:本地区CSOM患者以真菌感染为主,提示抗感染治疗前应进行细菌和真菌培养及药敏试验;临床医师应避免经验性使用抗生素,以减少多重耐药菌的产生。

关键词: 慢性化脓性中耳炎, 多重耐药菌, 经验性治疗

Abstract:

Objective To investigate the distribution of multidrug-resistant organisms (MDRO) and other pathogens in the patients with chronic suppurative otitis media(CSOM) to provide evidence for prevention and treatment of CSOM. Methods: A total of 224 patients with CSOM were enrolled from January 2016 to March 2020. The samples of ear secretion were obtained for bacterial culture and isolating pathogen, and the test of drug sensitivity was conducted. Results: The samples from 177 patients (78.57%) were positive in bacterial culture and a total of 215 strains were detected, inclu-ding 72 strains of gram-positive bacteria(72/215, 33.49%), 19 strains of gram-negative bacteria (19/215, 8.84%), 124 strains of fungi(124/215, 57.67%). Among 215 strains, 36 strains of MDRO(36/215, 16.74%) were isolated, including 20 strains of Staphylococcus aureus(20/36, 55.56%), 12 strains of coagulase negative Staphylococcus(CoNS)(12/36, 33.33%) and 2 strains of Pseudomonasaeruginosa (2/36, 5.56%). Staphylococcus aureus and CoNS had highest resistant rate to penicillin (95.10% and 64.29%), while Pseudomonas aeruginosa had highest resistant rate to levofloxacin(62.50%). The statistical analysis revealed that empirical antibiotic treatment was an independent risk factor of MDRO infection (P<0.05), and the fungal infectionin patients had no relationship with empirical antibiotic treatment, gender or age. Conclusions: Fungal infection is the main cause for local CSOM. The bacterial culture combined with the test of drug sensitivity are essential for treatment of CSOM, and empirical antibiotic treatment should be avoided to use to reduce MDRO infection.

Key words: Chronic suppurative otitis media, Multi drug resistant organisms, Empirical treatment

中图分类号:

R764.21

王安琪, 王士礼, 郎军添, 向明亮. 224例慢性化脓性中耳炎患者耳分泌物培养结果及多重耐药菌感染分析[J]. 诊断学理论与实践, 2021, 20(01): 88-92.

WANG Anqi, WANG Shili, LANG Juntian, XIANG Mingliang. Analysis of antibiotic resistant bacteria and multidrug-resistant organisms isolated from patients with chronic suppurative otitis media[J]. Journal of Diagnostics Concepts & Practice, 2021, 20(01): 88-92.

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病原菌	株数（n）	百分比（%）
革兰阳性菌
金黄色葡萄球菌	41	19.07
山羊葡萄球菌	8	3.72
头状葡萄球菌	12	5.58
表皮葡萄球菌	5	2.33
其他革兰阳性菌	6	2.79
革兰阴性菌
铜绿假单胞菌	8	3.72
肺炎克雷伯菌	2	0.93
大肠埃希菌	1	0.47
嗜麦芽寡养单胞菌	1	0.47
其他革兰阴性菌	7	3.26
真菌
丝状真菌	107	49.77
近平滑念珠菌	5	2.33
白念珠菌	4	1.86
光滑念珠菌	3	1.40
西弗射盾子囊霉	1	0.47
其他	4	1.86
合计	215	100

病原菌	株数	（%）
革兰阳性菌
金黄色葡萄球菌
MRSA	13	36.11
MSSA	7	19.44
CoNS
表皮葡萄球菌	5	13.89
山羊葡萄球菌	3	8.33
头状葡萄球菌	2	5.56
其他CoNS	2	5.56
革兰阴性菌
铜绿假单胞菌	2	5.56
产ESBL大肠埃希菌	1	2.78
其他革兰阴性菌	1	2.78
合计	36	100

抗菌药物	金黄色葡萄球菌 (n=41)耐药率(%)	CoNS(n=28) 耐药率(%)
环丙沙星	14(34.10)	9(32.14)
克林霉素	18(43.90)	7(25.00)
红霉素	20(48.80)	12(42.86)
庆大霉素	1(2.40)	1(3.57)
左氧氟沙星	13(31.70)	10(35.71)
利奈唑烷	0(0)	0(0)
莫西沙星	6(14.60)	8(28.57)
苯唑西林	13(31.70)	11(39.29)
青霉素G	39(95.10)	18(64.29)
喹努普汀/达福普汀	0(0)	0(0)
四环素	5(12.20)	0(0)
替加环素	0(0)	0(0)
万古霉素	0(0)	0(0)
利福平	0(0)	0(0)
复方新诺明	3(7.30)	3(10.71)

抗菌药物	耐药率
头孢哌酮舒巴坦钠	0(0)
磷霉素	3/8
环丙沙星	5/8
丁胺卡那霉素	0(0)
庆大霉素	1/8
亚胺培南	1/8
左氧氟沙星	5/8
美罗培南	1/8
头孢他啶	3/8
妥布霉素	1/8
哌拉西林/他唑巴坦	0(0)
头孢吡肟	0(0)
哌拉西林	0(0)

危险因素	B	OR	95%CI	P值
经验性抗生素治疗	2.662	14.323	4.853~42.271	<0.001
性别	-0.119	0.888	0.407~1.937	0.765
年龄	-0.009	0.991	0.966~1.016	0.468