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目的:对浙江三门县地区化脓性中耳炎的病原学特征进行分析,为临床抗菌药物治疗提供参考依据。方法:选取2014年9月-2016年9月于三门县人民医院进行就诊的浙江三门县地区化脓性中耳炎患者546例,收集患者的耳分泌物标本进行病原菌的分离与鉴定,并对其进行药敏试验,采用WHONET 5.6软件对药敏结果进行分析。结果:546例化脓性中耳炎患者中,其中耳分泌物培养出病原菌的有478例,阳性率为87.5%。478例患者耳分泌物共分离出病原菌518株,其中分离出最多的为革兰阳性菌,占75.5%,主要菌种包括金黄色葡萄球菌、凝固酶阴性葡萄球菌及肺炎链球菌等,其次为革兰阴性菌与真菌,分别占18.7%、5.8%,其中革兰阴性菌以铜绿假单胞菌最多,其次为肺炎克雷伯菌,真菌主要为近平滑念珠菌。对主要病原菌进行药敏试验结果发现,金黄色葡萄球菌与凝固酶阴性葡萄球菌对万古霉素、庆大霉素、替考拉宁、左氧氟沙星、环丙沙星等具有较低的耐药性;铜绿假单胞杆菌与肺炎克雷伯菌对庆大霉素、美罗培南、亚安培南等具有较低的耐药性。结论:由于浙江三门县地区引发患者发生化脓性中耳炎的病原菌不同,临床上应对患者耳分泌物的细菌培养与药敏试验给予重视,根据药敏试验结果进行合理药物的选择。
Objective: To analyze the etiological characteristics of suppurative otitis media in Sanmen County of Zhejiang Province, and provide a reference for the clinical treatment of antimicrobial agents. Methods: From September 2014 to September 2016, 546 patients with suppurative otitis media from Sanmen County, Zhejiang Province were enrolled in Sanmen County People’s Hospital. The specimens of the patients’ ear secretions were collected for the isolation and identification of pathogenic bacteria. Susceptibility testing, using WHONET 5.6 software for drug susceptibility results were analyzed. Results: Of the 546 cases of suppurative otitis media, 478 cases of pathogenic bacteria were secreted by the middle ear, and the positive rate was 87.5%. A total of 518 strains of pathogens were isolated from 478 patients with ear secretions, of which, Gram-positive bacteria were the most common, accounting for 75.5%. Staphylococcus aureus, coagulase-negative Staphylococcus aureus and Streptococcus pneumoniae were the main species, followed by Gram-negative bacteria and fungi, accounting for 18.7%, 5.8%, respectively, of which Gram-negative bacteria to Pseudomonas aeruginosa most, followed by Klebsiella pneumoniae, fungi mainly for Candida parapsilosis. Susceptibility test of major pathogens showed that Staphylococcus aureus and coagulase-negative staphylococci had low resistance to vancomycin, gentamicin, teicoplanin, levofloxacin and ciprofloxacin. Pseudomonas aeruginosa and Klebsiella pneumoniae have lower resistance to gentamicin, meropenem, and amikacillin. CONCLUSIONS: Due to the different pathogenic bacteria causing suppurative otitis media in Sanmen County of Zhejiang Province, bacterial culture and drug susceptibility testing of ear secretions should be paid more attention in clinic. According to the result of drug susceptibility test, rational drug selection should be made.