慢性化脓性中耳炎患者细菌感染及药物敏感性分析

刁桐湘; 张丽媛; 刘雅芬; 夏瑞明; 余力生; 郑宏伟; 马鑫; 韩琳

doi:10.13201/j.issn.2096-7993.2021.10.002

慢性化脓性中耳炎患者细菌感染及药物敏感性分析

- 1.
  北京大学人民医院耳鼻咽喉科(北京，100044)
- 2.
  北京大学人民医院感染科
基金项目:
北京大学人民医院研究与发展基金资助(No: RDY2019-04)

详细信息

通讯作者: 韩琳, E-mail: hanlinpku@163.com

中图分类号: R764.21

收稿日期: 2021-06-28

刊出日期: 2021-10-05

Analysis of bacterial infection and drug sensitivity in patients with chronic suppurative otitis media

- 1.
  Department of Otolaryngology, People's Hospital, Peking University, Beijing, 100044, China
- 2.
  Department of Infection, People's Hospital, Peking University

More Information

Corresponding author: HAN Lin, E-mail: hanlinpku@163.com

Received Date: 28 June 2021

Publish Date: 05 October 2021

摘要

摘要: 目的探究慢性化脓性中耳炎的病原菌分布及药物敏感性情况。方法以2019年1月1日—2021年5月1日于北京大学人民医院耳鼻喉科住院待手术的慢性化脓性中耳炎患者为研究对象, 对其进行外耳道深部分泌物培养, 并对病原菌进行分离, 统计分析病原菌分布及其药物敏感性情况。结果共纳入126例患者, 其中培养阳性者53例, 共分离出细菌57株, 包括革兰阳性球菌47株、革兰阴性杆菌10株。革兰阳性球菌中甲氧西林敏感金黄色葡萄球菌(MSSA)24株, 耐甲氧西林金黄色葡萄球菌(MRSA)7株, 凝固酶阴性葡萄球菌14株, 屎肠球菌1株, 耳炎苏黎世菌1株; 革兰阴性杆菌中铜绿假单胞菌4株(4/10)。其中MSSA对左氧氟沙星、莫西沙星、克林霉素、庆大霉素有较高的耐药率, 对苯唑西林、万古霉素、利奈唑胺、利福平的敏感性高; MRSA对除万古霉素、利福平、利奈唑胺外的常用抗生素均有较高的耐药性; 而革兰阴性杆菌对左氧氟沙星、氨曲南、环丙沙星、头孢他啶以及哌拉西林/他唑巴坦有较高的耐药率, 对美罗培南、亚胺培南、阿米卡星、头孢匹肟、头孢哌酮/舒巴坦及妥布霉素较敏感。单因素及多因素分析结果表明, 年龄以及合并细菌感染为是否干耳的独立相关因素, 病史长短为其非独立相关因素。结论慢性化脓性中耳炎患者合并的病原菌感染以MSSA、MRSA及铜绿假单胞菌为主。年龄及合并细菌感染为慢性化脓性中耳炎是否干耳的独立相关因素, 因此应结合药敏结果尽早进行特异性抗生素治疗或手术干预, 避免病程迁延或严重的感染性并发症发生。
- 中耳炎, 化脓性 /
- 病原菌 /
- 抗生素类
Abstract: Objective To explore the distribution of pathogenic bacteria and drug sensitivity among patients with chronic suppurative otitis media.Methods Patients with chronic suppurative otitis media who were hospitalized in the Department of Otolaryngology, People's Hospital, Peking University for surgery from January 1, 2019 to May 1, 2021 were enrolled as the subjects, then take the deep secretions of the external auditory canal for bacterial culture. Finally, the distribution and drug sensitivity of the pathogenic bacteria are analyzed.Results A total of 126 patients were enrolled, of which 53 were culture-positive, and 57 strains of bacteria were isolated, including 47 strains of Gram-positive cocci, 10 strains of Gram-negative bacilli. Among Gram-positive cocci, 24 methicillin-sensitive staphylococcus aureus(MSSA) strains, 7 methicillin-resistant staphylococcus aureus(MRSA) strains, 14 coagulase-negative staphylococcus strains, 1 strain enterococcus faecium, and 1 strain otitis Zurich. 4 strains(4/10) of pseudomonas aeruginosa among Gram-negative bacilli. Among them, MSSA has a high resistance rate to levofloxacin, moxifloxacin, clindamycin, and gentamicin, and high sensitivity to oxacillin, vancomycin, linezolid, and rifampin. MRSA is highly resistant to common antibiotics except vancomycin, rifampicin, and linezolid. The Gram-negative bacilli have higher resistance rates to levofloxacin, aztreonam, ciprofloxacin, ceftazidime, and piperacillin/tazobactam, and to meropenem, imipenem, amika star, cefepoxime, cefoperazone/sulbactam, and tobramycin are more sensitive. The results of univariable and multivariable analysis showed that age and bacterial infection were independent factors related to dry ears, and the duration of the disease history was a non-independent factor.Conclusion The main pathogenic bacteria infections in patients with chronic suppurative otitis media are MSSA, MRSA, and pseudomonas aeruginosa. Whether it is combined with bacterial infection and age are independent factors related to whether patients with chronic suppurative otitis media could have dry ears. Therefore, patients with chronic suppurative otitis media should be treated with specific antibiotics or surgical interventions as soon as possible in combination with drug sensitivity results to avoid prolonging disease course or causing serious infectious complications.
- otitis media, suppurative /
- pathogenic bacteria /
- antibiotics

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表 1 57株病原菌分布及构成比

病原菌	株数	构成比/%
革兰阳性球菌	47	82.46
金黄色葡萄球菌	31	54.39
MSSA	24	42.11
MRSA	7	12.28
凝固酶阴性葡萄球菌	14	24.56
屎肠球菌	1	1.75
耳炎苏黎世菌	1	1.75
革兰阴性杆菌	10	17.54
铜绿假单胞菌	4	7.02
阴沟肠杆菌	2	3.51
变栖克雷伯菌	1	1.75
弗氏柠檬酸杆菌	1	1.75
施氏假单胞菌	1	1.75
支气管炎伯德特菌	1	1.75

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表 2 MSSA及MRSA的耐药率分析株(%)

药物名称	MSSA(n=24)	MRSA(n=7)
左氧氟沙星	9(37.50)	4(57.14)
莫西沙星	10(41.67)	3(42.86)
苯唑西林	1(4.17)	6(85.71)
万古霉素	0(0)	0(0)
利奈唑胺	0(0)	1(14.29)
克林霉素	17(70.83)	6(85.71)
庆大霉素	5(20.83)	3(42.86)
利福平	0(0)	0(0)

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表 3 革兰阴性杆菌的耐药率分析(n=10)

药物名称	耐药株数(%)
左氧氟沙星	7(70.00)
美罗培南	2(20.00)
亚胺培南	2(20.00)
氨曲南	6(60.00)
阿米卡星	1(10.00)
环丙沙星	5(50.00)
头孢匹肟	2(20.00)
头孢哌酮/舒巴坦	2(20.00)
头孢他啶	3(30.00)
妥布霉素	2(20.00)
哌拉西林/他唑巴坦	4(40.00)

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表 4 是否干耳相关因素的单因素分析

	不干耳(n=47)	干耳(n=79)	P
年龄	57.36±13.73	51.49±15.14	0.031
病史	14.77±19.11	21.12±18.50	0.068
性别(女)	32(68.09)	43(54.43)	0.139
侧别(左)	22(46.81)	38(48.10)	0.939
MSSA	12(25.53)	12(15.19)	0.166
MRSA	4(8.51)	3(3.80)	1.000
合并铜绿假单胞菌感染	4(8.51)	0(0)	0.018
合并细菌感染	27(57.45)	26(32.91)	0.009

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表 5 是否干耳相关因素的多因素分析

	OR(95%CI)	P
年龄/岁	1.032(1.004~1.061)	0.024
病史/年	0.981(0.961~1.002)	0.073
合并细菌感染	2.534(1.169~5.491)	0.018

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参考文献(13)

[1]	谢晓兴, 熊高云, 沈强, 等. 慢性化脓性中耳炎患者耳道分泌物的病原菌检测及药物敏感性分析[J]. 中国微生态学杂志, 2018, 30(1): 66-69. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWS201801017.htm
[2]	汪洋, 吉建, 王朱健, 等. 成人慢性化脓性中耳炎耳道分泌物病原菌分布及耐药性分析[J]. 中国眼耳鼻喉科杂志, 2019, 19(6): 383-387. https://www.cnki.com.cn/Article/CJFDTOTAL-YRBH201906006.htm
[3]	吕芸, 何健, 卫旭东, 等. 高原地区慢性化脓性中耳炎及中耳胆脂瘤的病原菌及药敏分析[J]. 中国耳鼻咽喉头颈外科, 2019, 26(1): 21-24. https://www.cnki.com.cn/Article/CJFDTOTAL-EBYT201901007.htm
[4]	中华医学会耳鼻咽喉头颈外科学分会耳科学组, 中华耳鼻咽喉头颈外科杂志编辑委员会耳科组. 中耳炎临床分类和手术分型指南(2012)[J]. 中华耳鼻咽喉头颈外科杂志, 2013, 48(1): 5-5.
[5]	朱德妹. 2008年CLSI药敏试验标准的主要改变[J]. 中国感染与化疗杂志, 2008, 8(6): 479-480. https://www.cnki.com.cn/Article/CJFDTOTAL-KGHL200806022.htm
[6]	Homøe P, Kværner K, Casey JR, et al. Panel 1: Epidemiology and Diagnosis[J]. Otolaryngol Head Neck Surg, 2017, 156(4_suppl): S1-S21. doi: 10.1177/0194599816643510
[7]	Mittal R, Lisi CV, Gerring R, et al. Current concepts in the pathogenesis and treatment of chronic suppurative otitis media[J]. J Med Microbiol, 2015, 64(10): 1103-1116. doi: 10.1099/jmm.0.000155
[8]	吴学文, 王风君, 高可雷, 等. 我国慢性化脓性中耳炎患者的病原学及其动态变化分析[J]. 中国耳鼻咽喉颅底外科杂志, 2016, 22(3): 193-197, 202. https://www.cnki.com.cn/Article/CJFDTOTAL-ZEBY201603007.htm
[9]	肖永红, 王进, 赵彩云, 等. 2006-2007年Mohnarin细菌耐药监测[J]. 中华医院感染学杂志, 2008, 33(8): 1051-1056. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY200808002.htm
[10]	Xu F, Kong W, Peng J, et al. Analysis of main pathogenic bacteria and drug sensitivity in patients with chronic suppurative otitis media and middle ear cholesteatoma in China[J]. Biotechnol Lett, 2020, 42(8): 1559-1566. doi: 10.1007/s10529-020-02880-7
[11]	Sanford JP. 桑福德抗微生物治疗指南[M]. 37版. 北京: 中国医药科技出版社, 2008: 30-31.
[12]	宋涛, 史莉, 徐雪梅, 等. 泛耐药铜绿假单胞菌湖北襄阳分离株获得性耐药元件研究[J]. 中华医院感染学杂志, 2017, 27(19): 4348-4351, 4355. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY201719008.htm
[13]	Bhutta MF, Thornton RB, Kirkham LS, et al. Understanding the aetiology and resolution of chronic otitis media from animal and human studies[J]. Dis Model Mech, 2017, 10(11): 1289-1300. doi: 10.1242/dmm.029983