CAJ | 학술논문

目的：探讨慢性化脓性鼻窦炎的菌种分布情况及药物敏感性。方法选择接受鼻内窥镜手术的慢性化脓性鼻窦炎患者89例，术中收集患者鼻道分泌物，并进行培养基培养，采用纸片扩散法（Kirby-Bau-er，K-B法）进行药物敏感性监测，分析菌株对头孢唑啉、头孢他啶、头孢吡肟、亚胺培南、美罗培南、万古霉素、头孢哌酮舒巴坦、环丙沙星等抗菌药物的敏感性。结果89例慢性化脓性鼻窦炎患者鼻道黏脓性分泌物标本经送检分析，80例患者检出细菌，阳性检出率为89．89％（80／89）；80例患者中共检出82株细菌，共计15种细菌，其中1例患者的鼻道黏脓性分泌物标本检出2株细菌。在检出的15种细菌中表皮葡萄球菌、金黄色葡萄球菌、大肠埃希杆菌、铜绿假单胞菌、产气肠杆菌等5种细菌占据前5位，分别占21．95％、18.29％、14.63％、13．41％、10．98％。金黄色葡萄球菌的药敏检查结果显示所有的金黄色葡萄球菌对万古霉素敏感，敏感性为100．00％；而对头孢唑啉、头孢他啶、头孢吡肟、亚胺培南、美罗培南、头孢哌酮舒巴坦、环丙沙星等抗菌药物的敏感性均为0．00％。所有的表皮葡萄球菌对亚胺培南、美罗培南、万古霉素、头孢哌酮舒巴坦均敏感，敏感性为100．00％；其次是头孢唑啉，敏感性为86．67％，而对头孢他啶、头孢吡肟、环丙沙星的敏感性较差，均在30．00％以下。大肠埃希杆菌、铜绿假单胞菌及产气肠杆菌等革兰阴性菌均对亚胺培南、美罗培南敏感，敏感性为100．00％。结论慢性化脓性鼻窦炎患者多伴有细菌感染，主要致病菌包括表皮葡萄球菌、金黄色葡萄球菌、大肠埃希杆菌、铜绿假单胞菌、产气肠杆菌等，细菌培养阳性对万古霉素、亚胺培南、美罗培南、头孢哌酮舒巴坦、头孢唑啉等抗菌药物敏感，所以在进行抗菌治疗前但应密切监测抗菌谱的改变，以便及时调整用药。目的：探討慢性化膿性鼻竇炎的菌種分佈情況及藥物敏感性。方法選擇接受鼻內窺鏡手術的慢性化膿性鼻竇炎患者89例，術中收集患者鼻道分泌物，併進行培養基培養，採用紙片擴散法（Kirby-Bau-er，K-B法）進行藥物敏感性鑑測，分析菌株對頭孢唑啉、頭孢他啶、頭孢吡肟、亞胺培南、美囉培南、萬古黴素、頭孢哌酮舒巴坦、環丙沙星等抗菌藥物的敏感性。結果89例慢性化膿性鼻竇炎患者鼻道黏膿性分泌物標本經送檢分析，80例患者檢齣細菌，暘性檢齣率為89．89％（80／89）；80例患者中共檢齣82株細菌，共計15種細菌，其中1例患者的鼻道黏膿性分泌物標本檢齣2株細菌。在檢齣的15種細菌中錶皮葡萄毬菌、金黃色葡萄毬菌、大腸埃希桿菌、銅綠假單胞菌、產氣腸桿菌等5種細菌佔據前5位，分彆佔21．95％、18.29％、14.63％、13．41％、10．98％。金黃色葡萄毬菌的藥敏檢查結果顯示所有的金黃色葡萄毬菌對萬古黴素敏感，敏感性為100．00％；而對頭孢唑啉、頭孢他啶、頭孢吡肟、亞胺培南、美囉培南、頭孢哌酮舒巴坦、環丙沙星等抗菌藥物的敏感性均為0．00％。所有的錶皮葡萄毬菌對亞胺培南、美囉培南、萬古黴素、頭孢哌酮舒巴坦均敏感，敏感性為100．00％；其次是頭孢唑啉，敏感性為86．67％，而對頭孢他啶、頭孢吡肟、環丙沙星的敏感性較差，均在30．00％以下。大腸埃希桿菌、銅綠假單胞菌及產氣腸桿菌等革蘭陰性菌均對亞胺培南、美囉培南敏感，敏感性為100．00％。結論慢性化膿性鼻竇炎患者多伴有細菌感染，主要緻病菌包括錶皮葡萄毬菌、金黃色葡萄毬菌、大腸埃希桿菌、銅綠假單胞菌、產氣腸桿菌等，細菌培養暘性對萬古黴素、亞胺培南、美囉培南、頭孢哌酮舒巴坦、頭孢唑啉等抗菌藥物敏感，所以在進行抗菌治療前但應密切鑑測抗菌譜的改變，以便及時調整用藥。
목적：탐토만성화농성비두염적균충분포정황급약물민감성。방법선택접수비내규경수술적만성화농성비두염환자89례，술중수집환자비도분비물，병진행배양기배양，채용지편확산법（Kirby-Bau-er，K-B법）진행약물민감성감측，분석균주대두포서람、두포타정、두포필우、아알배남、미라배남、만고매소、두포고동서파탄、배병사성등항균약물적민감성。결과89례만성화농성비두염환자비도점농성분비물표본경송검분석，80례환자검출세균，양성검출솔위89．89％（80／89）；80례환자중공검출82주세균，공계15충세균，기중1례환자적비도점농성분비물표본검출2주세균。재검출적15충세균중표피포도구균、금황색포도구균、대장애희간균、동록가단포균、산기장간균등5충세균점거전5위，분별점21．95％、18.29％、14.63％、13．41％、10．98％。금황색포도구균적약민검사결과현시소유적금황색포도구균대만고매소민감，민감성위100．00％；이대두포서람、두포타정、두포필우、아알배남、미라배남、두포고동서파탄、배병사성등항균약물적민감성균위0．00％。소유적표피포도구균대아알배남、미라배남、만고매소、두포고동서파탄균민감，민감성위100．00％；기차시두포서람，민감성위86．67％，이대두포타정、두포필우、배병사성적민감성교차，균재30．00％이하。대장애희간균、동록가단포균급산기장간균등혁란음성균균대아알배남、미라배남민감，민감성위100．00％。결론만성화농성비두염환자다반유세균감염，주요치병균포괄표피포도구균、금황색포도구균、대장애희간균、동록가단포균、산기장간균등，세균배양양성대만고매소、아알배남、미라배남、두포고동서파탄、두포서람등항균약물민감，소이재진행항균치료전단응밀절감측항균보적개변，이편급시조정용약。
Objective To investigate the bacterial distribution and drug sensitivity characteristics of chronic suppurative sinusitis.Methods Nasal secretions of 89 cases of chronic suppurative sinusitis patients before operation were collected in this study,and nasal secretions were culture in medium.Disk diffusion method (Kirby-Bauer,K-B)was used for drug sensitivity test.Sensitivity of bacteria strain to cefazolin,ceftazidime,cefepime,imipenem,mero-penem,vancomycin,cefoperazone -sulbactam,ciprofloxacin and other antibiotics were analyzed.Results After the submission of purulent secretion specimens of nasal meatus in 89 cases chronic suppurative sinusitis patients with sticky,we found that 80 of the patients were detected bacteria.The positive rate was 89.89% (80/89).80 patients were detected in 82 strains of bacteria,a total of 15 species,of which 1 cases of nasal meatus sticky purulent secretion specimens there were 2 strains of bacteria.In 15 kinds of staphylococcus aureus were detected bacteria,staphylococcus aureus,escherichia coli,pseudomonas,enterobacter aerogenes,5 kinds of bacteria occupy the top 5,respectively, accounted for 21.95%,18.29%,14.63%,13.41%,10.98%.Drug sensitivity test of staphylococcus aureus showed that all of the staphylococcus aureus was sensitive to vancomycin,the sensitivity was 100%;the sensitivity of cefazo-lin,ceftazidime,cefepime,imipenem,meropenem,cefoperazone sulbactam,ciprofloxacin and other antibiotics were 0.00%.All the staphylococcus epidermidis were sensitive to imipenem,meropenem,vancomycin,cefoperazone sulbac-tam,the sensitivity was 100.00%;followed by cefazolin,the sensitivity was 86.67%,and to ceftazidime,cefepime, ciprofloxacin sensitive,were all below 30.00%.Escherichia coli,pseudomonas aeruginosa and enterobacter aerogenes and other gram negative bacteria were sensitive to imipenem,meropenem,the sensitivity was 100.00%.Conclusion The bacterial infection in patients with chronic suppurative sinusitis pathogens,including staphylococcus epidermidis, staphylococcus aureus,escherichia coli,pseudomonas,enterobacter aerogenes,bacterial culture positive to vancomy-cin,imipenem,meropenem,cefoperazone Shubatan,cefazolin and antimicrobial susceptibility,and so on antimicrobial treatment but should closely monitor the antimicrobial spectrum of change,in order to adjust the medication.