Analysis of main pathogenic bacteria and drug sensitivity in patients with chronic suppurative otitis media and middle ear cholesteatoma in China
Analysis of main pathogenic bacteria and drug sensitivity in patients with chronic suppurative otitis media and middle ear cholesteatoma in China
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DOI：
10.1007/s10529-020-02880-7
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发表时间：
2020-04-08
影响因子：
2.7
通讯作者：
Zheng, Hong
中科院分区：
文献类型：
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作者：
Xu, Feng;Kong, Weili;Zheng, Hong
研究背景慢性化脓性中耳炎（CSOM）和中耳乳突瘤（MEC）是近年来被划分为不同的疾病。由于发病机制的不同，这两种疾病的病原菌可能不同。然而，很少有研究比较这两种类型的致病菌。目的分析西南地区慢性分泌性中耳炎（CSOM）和中耳炎（MEC）患者的主要致病菌及药敏情况，比较经验用药与敏感用药耳干率的差异。方法根据耳分泌物培养及术后病理检查资料，将患者分为CSOM组和MEC组。对2015年1月至2019年6月在华西医院耳鼻咽喉头颈外科住院的1087例CSOM和MEC患者进行了队列研究。结果726例CSOM中检出病原菌467例，检出率为64.46%; 361例MEC中检出病原菌190例，检出率为52.63%。CSOM组革兰阳性菌占53.96%，革兰阴性菌占46.04%，MEC组革兰阳性菌占41.05%，革兰阴性菌占58.95%（P < 0.05）。CSOM组前4位病原菌分别为金黄色葡萄球菌（33.62%）、铜绿假单胞菌（23.98%）、变形杆菌（16.92%）和凝固酶阴性葡萄球菌（10.28%）。MEC组前4位的病原菌依次为变形杆菌（22.11%）、沙门氏菌（22.11%）、沙门氏菌（22.11%）、沙门氏菌（22.11%）、沙门氏菌（22.11%）。金黄色葡萄球菌（21.05%）、铜绿假单胞菌（15.26%）和凝固酶阴性葡萄球菌（8.42%）。S. MEC组金黄色葡萄球菌对环丙沙星和诺氟沙星的敏感性高于CSOM组（分别为14.286和8.244，P <0.001和0.001）。MEC组铜绿假单胞菌对新霉素和妥布霉素的敏感性高于CSOM组（= 21.285，P < 0.001; = 4.060，P < 0.05）。MEC组凝固酶阴性葡萄球菌对新霉素的敏感率高于CSOM组（= 5.126，P < 0.05）。CSOM组变形杆菌对哌拉西林/他唑巴坦的敏感性高于MEC组（= 8.881，P < 0.05）。药物敏感组干耳率明显高于经验组（= 19.431，P < 0.001）。结论CSOM组G+菌检出率高于MEC组。CSOM组G-菌检出率低于MEC组。两组的主要病原菌均为沙门氏菌。金黄色葡萄球菌、铜绿假单胞菌、变形杆菌和凝固酶阴性葡萄球菌。使用敏感药物的患者干耳率明显高于使用经验性药物的患者。尽可能减少抗生素经验性使用率，合理选用抗生素，有利于术后干耳率的提高。
Background Chronic suppurative otitis media (CSOM) and middle ear cholesteatoma (MEC) were classified as different diseases recently. Owing to the difference in pathogeneses, the pathogenic bacteria of the two diseases can be different. However, few studies have compared the two types of pathogenic bacteria. Objective To analyze the main pathogenic bacteria and drug sensitivities in patients of Southwest China with CSOM and MEC and compare the difference of ear dryness rate between empirical and sensitive medication. Methods According to the data of culture of ear discharge and postoperative pathological examination, the patients were divided into CSOM and MEC groups. A cohort study was carried out in 1087 hospitalized patients with CSOM and MEC in the Department of Otolaryngology head and neck surgery, West China Hospital from January 2015 to June 2019. Results Pathogenic bacteria were detected in 467 of 726 cases of CSOM (64.46%) and in 190 of 361 cases of MEC (52.63%). Of the positive cases, 53.96% involved gram-positive (G+) bacteria and 46.04% involved gram-negative (G-) bacteria in the CSOM group; 41.05% involved G+ bacteria and 58.95% involved G- bacteria in the MEC group (P < 0.05). In the CSOM group, the top four pathogens were Staphylococcus aureus (33.62%), Pseudomonas aeruginosa (23.98%), Proteus (16.92%), and Coagulase-negative Staphylococci (10.28%). The top four pathogens in the MEC group were Proteus (22.11%), S. aureus (21.05%), P. aeruginosa (15.26%), and coagulase-negative staphylococci (8.42%). S. aureus was more sensitive to ciprofloxacin and moxifloxacin in the MEC group than in the CSOM group (= 14.286, P < 0.001; = 8.244, P < 0.01). P. aeruginosa was more sensitive to neomycin and tobramycin in the MEC group than in the CSOM group (= 21.285, P < 0.001; = 4.060, P < 0.05). The sensitivity rate of coagulase-negative staphylococci to neomycin in the MEC group was higher than that in the CSOM group (= 5.126, P < 0.05). The sensitivity of Proteus to piperacillin tazobactam in the CSOM group was higher than that in the MEC group (= 8.881, P < 0.05). The dry ear rate of patients with sensitive drug was significantly higher than the patients with empirical drug (= 19.431, P < 0.001). Conclusion The detection rate of G+ bacteria in the CSOM group was higher than that in the MEC group. The detection rate of G- bacteria in the CSOM group was lower than that in the MEC group. The main pathogens in the two groups included S. aureus, P. aeruginosa, Proteus and coagulase negative Staphylococcus. The dry ear rate of patients who used sensitive drugs was significantly higher than the patients who used empirical drugs. Reducing the rate of empirical use of antibiotics as much as possible and selecting antibiotics reasonably were beneficial to the improvement of dry ear rate after surgery.