儿童慢性化脓性中耳炎病原菌分布及耐药性分析

Distribution and Drug Resistance of Pathogenic Bacteria in Children with Chronic Suppurative Otitis Media

方盼盼;王颍源;杨俊文;杨俊梅;高凯杰;孙红启;益欢欢;

1:郑州大学附属儿童医院/郑州儿童医院郑州市儿童感染与免疫重点实验室

2:郑州大学附属儿童医院/郑州儿童医院新生儿重症监护室

3:郑州大学附属儿童医院/郑州儿童医院耳鼻喉科

摘要
目的探讨儿童慢性化脓性中耳炎病原菌分布及耐药性,为临床合理用药提供参考。方法以2015年1月至2019年12月郑州大学附属儿童医院耳鼻喉科收治的儿童慢性化脓性中耳炎患者401例(418耳)为研究对象,男163例,女238例,年龄2月21天~15岁,平均2.41±2.31岁。取中耳分泌物行细菌培养及药敏试验,采用WHONET 5.6软件进行药物敏感性分析。结果 418耳慢性化脓性中耳炎中共391耳检出病原菌,排除取材时污染的7耳,共384耳,病原菌检出率为91.87%(384/418),其中细菌感染372耳,真菌感染12耳,革兰阳性菌检出率较高,为329株(85.68%);主要检出菌株依次为金黄色葡萄球菌168(43.75%)、肺炎链球菌106(27.60%)、表皮葡萄球菌26(6.77%)、铜绿假单胞菌19(4.95%)、嗜血杆菌13(3.39%)、真菌12(3.13%)株。常见致病菌对抗菌药物的敏感性因菌种而异,金黄色葡萄球菌对青霉素G、红霉素耐药率均>85%,肺炎链球菌对克林霉素、红霉素耐药率达100%,铜绿假单胞菌耐药率较高的依次为氨曲南和头孢吡肟。结论本组慢性化脓性中耳炎患儿的主要致病菌为金黄色葡萄球菌、肺炎链球菌、铜绿假单胞菌,临床上应根据致病菌的药敏试验结果合理选择抗菌药物,以确保患儿用药合理、安全、有效。
关键词
慢性化脓性中耳炎;病原菌;药敏试验
基金项目(Foundation):
2018年河南省医学科技攻关计划(联合共建项目)(2018020677)
作者
方盼盼;王颍源;杨俊文;杨俊梅;高凯杰;孙红启;益欢欢;
参考文献

1 Acuin J.Chronic suppurative otitis media :burden of illness and management options.Geneve:World Health Organization,2004.https://apps.who.int/iris/handle/10665/42941

2 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.

3 Neeff M,Biswas K,Hoggard M,et al.Molecular microbiological profile of chronic suppurative otitis media[J].Journal of Clinical Microbiology,2016,54(10):JCM01068-16.

4 Schilder AG,Chonmaitree T,Cripps AW,et al.Otitis media[J].Nat Rev Dis Primers,2016,8(2):16064-218.

5 熊素芳,王美荣,马维瑾,等.慢性化脓性中耳炎分泌物的细菌培养及药敏试验分析[J].听力学及言语疾病杂志,2019,27(2):216-218.

6 Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing[S].https://webstore.ansi.org/Standards/CLSI/CLSIM100Ed29

7 Aarhus L,Hom?e P,Engdahl B.Otitis media in childhood and disease in adulthood:a 40-year follow-up study[J].Ear and Hearing,2020,41(1):67-71.

8 Uddén F,Filipe M,Reimer ?,et al.Aerobic bacteria associated with chronic suppurative otitis media in Angola[J].Infectious Diseases of Poverty,2018,7(1):42-49.

9 Brennan-Jones CG,Head K,Chong LY,et al Topical antibiotics for chronic suppurative otitis media[J].Cochrane Database Syst Rev,2020.Issue 1.DOI:10.1002/14651858.CD013051.pub2

10 World Health Organisation.Prevention of hearing impairment from chronicotitis media.Geneva:World Health Organisation,2000.https://apps.who.int/iris/handle/10665/63870

11 Coleman A,Wood A,Bialasiewicz S,et al.The unsolved problem of otitis media in indigenous populations:a systematic review of upper respiratory and middle ear microbiology in indigenous children with otitis media[J].Microbiome,DOI:10.1186/S40168-018-0577-2.

12 Ding YL,Fu JJ,Chen J,et al.Molecular characterization and antimicrobial susceptibility of Staphylococcus aureus isolated from children with acute otitis media in Liuzhou,China[J].BMC Pediatr,2018,18:388.

13 李冠兵,徐淼波.90例急性中耳炎患儿分泌物病原菌分布及耐药性分析[J].临床耳鼻咽喉头颈外科杂志,2019,33(11):1093-1094.

14 Zhou X,De Luise C,Gaffney M,et al.National impact of 13-valent pneumococcal conjugate vaccine on ambulatory care visits for otitis media in children under 5 years in the United States[J].Int J Pediatr Otorhinolaryngol,2019,119:96-102.

15 Hu FP,Guo Y,Yang Y,et al.Resistance reported from China antimicrobial surveillance network (CHINET) in 2018[J].Eur J Clin Microbiol Infect Dis,2019,38(1):2275-2281.

16 王志红,张华,苏磊,等.慢性化脓性中耳炎分泌物的细菌培养及药敏试验[J].中华医院感染学杂志,2017,27(6):1355-1358.

17 Fu J,Li L,Liang Z,et al.Etiology of acute otitis media and phenotypic-molecular characterization of Streptococcus pneumoniae isolated from children in Liuzhou,China[J].BMC Infectious Diseases,2019,19:168.

18 王金玉.慢性化脓性中耳炎伴外耳道真菌病诊治[J].中国耳鼻咽喉头颈外科,2019,26(9):509-510.

19 方秀玲,林功标,林伟,等.103例外耳道真菌病的诊疗分析[J].中华耳科学杂志,2019,17(5):727-731.