CAJ | 학술논문

目的：分析新疆地区慢性化脓性中耳炎与中耳胆脂瘤患者主要病原菌及药物敏感性，为合理选用抗生素提供依据。方法回顾性分析2008年1月到2013年12月期间诊治的新疆地区409例（耳）中耳炎患者的临床资料，其中，慢性化脓性中耳炎288耳，中耳胆脂瘤121耳，对两组中耳脓性分泌物的细菌培养及药敏结果进行对比分析。结果①409例（耳）患者中361例（耳）检出病原菌，其中细菌245例（耳），真菌16例（耳），慢性化脓性中耳炎G＋菌检出率较高，中耳胆脂瘤G -菌检出率较高（χ2＝12．216，P＝0．000）；②慢性化脓性中耳炎病原菌检出率（88．19％，254/288）由高到低依次为金黄色葡萄球菌78耳（30．71％）、绿脓杆菌46耳（18．11％）、凝固酶阴性葡萄球菌43耳（16．93％）、变形杆菌20耳（7．87％）；中耳胆脂瘤病原菌检出率（88．43％，107/121）由高到低依次为金黄色葡萄球菌26耳（24．30％）、绿脓杆菌17耳（15．89％）、凝固酶阴性葡萄球菌16耳（14．95％）、变形杆菌14耳（13．08％）；③金黄色葡萄球菌、凝固酶阴性葡萄球菌对喹努普汀达福普汀、替考拉宁、万古霉素、莫西沙星均有较高的敏感度，中耳胆脂瘤中的凝固酶阴性葡萄球菌对庆大霉素、复方新诺明、红霉素的敏感度较高；中耳胆脂瘤中的绿脓杆菌对头孢他定、亚胺培南的敏感度较低，中耳胆脂瘤中绿脓杆菌、变形杆菌对复方新诺明、头孢唑啉的药物敏感度较高。结论本组病例中慢性化脓性中耳炎（活动期）与中耳胆脂瘤的G＋、G-的检出率有差别，主要致病菌依次是金黄色葡萄球菌、绿脓杆菌、凝固酶阴性葡萄球菌、变形杆菌；部分常用抗菌药物在两种中耳炎中的敏感度有差别，以绿脓杆菌和变形杆菌较明显。
목적：분석신강지구만성화농성중이염여중이담지류환자주요병원균급약물민감성，위합리선용항생소제공의거。방법회고성분석2008년1월도2013년12월기간진치적신강지구409례（이）중이염환자적림상자료，기중，만성화농성중이염288이，중이담지류121이，대량조중이농성분비물적세균배양급약민결과진행대비분석。결과①409례（이）환자중361례（이）검출병원균，기중세균245례（이），진균16례（이），만성화농성중이염G＋균검출솔교고，중이담지류G -균검출솔교고（χ2＝12．216，P＝0．000）；②만성화농성중이염병원균검출솔（88．19％，254/288）유고도저의차위금황색포도구균78이（30．71％）、록농간균46이（18．11％）、응고매음성포도구균43이（16．93％）、변형간균20이（7．87％）；중이담지류병원균검출솔（88．43％，107/121）유고도저의차위금황색포도구균26이（24．30％）、록농간균17이（15．89％）、응고매음성포도구균16이（14．95％）、변형간균14이（13．08％）；③금황색포도구균、응고매음성포도구균대규노보정체복보정、체고랍저、만고매소、막서사성균유교고적민감도，중이담지류중적응고매음성포도구균대경대매소、복방신낙명、홍매소적민감도교고；중이담지류중적록농간균대두포타정、아알배남적민감도교저，중이담지류중록농간균、변형간균대복방신낙명、두포서람적약물민감도교고。결론본조병례중만성화농성중이염（활동기）여중이담지류적G＋、G-적검출솔유차별，주요치병균의차시금황색포도구균、록농간균、응고매음성포도구균、변형간균；부분상용항균약물재량충중이염중적민감도유차별，이록농간균화변형간균교명현。
Objective To study the main pathogenic bacteria and drug sensitivity in patients with chronic sup-purative otitis media and patients with middle ear cholesteatoma in Xinjiang ,and to provide evidence for reasonable u-sing antibiotics for the two diseases .Methods We performed a retrospective analysis of the middle ear secretion bac-terial culture results of 409 patients with chronic suppurative otitis media and middle ear cholesteatoma at our hospi-tal from January 2008 to December 2013 .Results ①There were 361 strains of microbes isolated from 409 patients , and 16 of them were fungi ,and 245 were bacteria .There was a statistical significance of the pathogen detection rate about G+ and G- bacteria between chronic suppurative otitis media and middle ear cholesteatoma (χ2 =12 .216 ,P=0 .000) .②Staphylococcus aureus(in 78 of 254 ears ,30 .7% ) ,pseudomonas aeruginosa(in 46 of 254 ears ,18 .1% ) , coagulase-negative staphylococcus(in 42 of 254 ears ,16 .5% ) ,and proteus mirabilis(in 20 of 254 ears ,7 .87% ) were the most frequently insolated pathogens in chronic suppurative otitis media ,while staphylococcus aureus(in 26 of 107 ears ,24 .30% ) ,pseudomonas aeruginosa(in 17 of 107 ears ,15 .9% ) ,coagulase-negative staphylococcus (in 16 of 107 ears ,15 .0% ) ,and proteus mirabilis(in 14 of 107 ears ,13 .1% ) were the most frequently insolated patho-gens in middle ear cholesteatoma .③Staphylococcus aureus and coagulase -negative staphylococcus were all sensi-tive to quinoline nupu ting /dalfopristin ,teicoplanin ,vancomycin ,and moxifloxacin .The sensitivity of coagulase -negative staphylococcus to gentamicin ,trimethoprim -sulfamethoxazole ,and erythromycin in the middle ear chol-esteatoma were higher than those of in chronic suppurative otitis media .The sensitivity of pseudomonas aeruginosa to ceftazidime ,and imipenem were lower in the middle ear cholesteatoma .The drug sensitivity of pseudomonas aeruginosa ,proteus to trimethoprim/sulfamethoxazole and cefazolin was higher in middle ear cholesteatoma .Conclu-sion There are differences between chronic suppurative otitis media (active) and middle ear cholesteatoma about G+ ,G- bacteria detection rate .Staphylococcus aureus ,coagulase-negative staphylococcus ,pseudomonas aerugi-nosa ,and proteus mirabilis are the main pathogenic bacteria in these two chronic otitis media .There is a difference of some commonly used antimicrobial sensitivity in these two kinds of otitis media ,which is more obvious in pseudo-monas aeruginosa and proteus mirabilis .