新疆塔克拉玛干沙漠地区慢性化脓性中耳炎病原菌及药物敏感性分析

Analysis of pathogens and drug sensitivity of chronic suppurative otitis media in the Taklamakan Desert region of Xinjiang

摘要:

目的 前瞻性研究新疆塔克拉玛干沙漠地区慢性化脓性中耳炎的病原菌分布及药物敏感性情况，为该地区慢性化脓性中耳炎(CSOM)的治疗方案提供依据。方法 选取2024年1月30日—2024年11月30日在广东医科大学附属第三师图木舒克市总医院耳鼻咽喉科就诊的CSOM患者作为研究对象，从患耳收集脓性分泌物，进行病原菌的培养和药敏试验，统计分析致病菌分布及药物敏感性情况。结果 研究纳入176例患者，其中121例检测出病原菌，检出率为68.8%。共检出病原菌122株，其中革兰氏阳性菌73株(59.8%),以金黄色葡萄球菌为主，共检出66株(54.1%)，甲氧西林敏感金黄色葡萄球菌(MSSA)54株(44.3%)，耐甲氧西林金黄色葡萄球菌(MRSA)12株(9.8%)；革兰氏阴性菌32株(26.2%)，以铜绿假单胞菌为主(17株，13.9%)；真菌17株(13.9%)，以丝状真菌为主(13株，10.7%)。药敏试验显示MSSA对青霉素、红霉素和克林霉素的耐药性较高，但对苯唑西林、左氧氟沙星、利奈唑胺、利福平、替加环素及万古霉素等药物表现出较高的敏感性；而MRSA对苯唑西林、红霉素、克林霉素、喹诺酮类等常用抗生素的耐药性较高，但对庆大霉素、复方新诺明、利奈唑胺、利福平、替加环素及万古霉素显示出较高的敏感性。革兰氏阴性菌中部分对头孢呋辛耐药，对头孢他啶、头孢吡肟、庆大霉素、亚胺培南、美罗培南等药物敏感性高。结论 新疆塔克拉玛干沙漠地区慢性中耳炎的主要致病菌为金黄色葡萄球菌、铜绿假单胞菌及丝状真菌，MRSA及真菌的构成比相对较高。尽早完善细菌学和真菌学分析有助于实现更有针对性的治疗，缩短病程，提高疗效。

Abstract:

Objective To study the pathogens and the drug susceptibility in patients with chronic suppurative otitis media (CSOM) in the Taklamakan Desert region of Xinjiang, so as to provide a basis for the treatment of CSOM in this area.Methods Patients with CSOM treated in the Department of Otorhinolaryngology, General Hospital of the Third Division of Xinjiang Production and Construction Corps Affiliated to Guangdong Medical University from January 30, 2024 to November 30, 2024 were selected as the study subjects. The purulent secretions from the affected ears were collected for pathogen culture and drug sensitivity tests. The distribution of pathogens and drug sensitivity were statistically analyzed.Results A total of 176 patients were included in this study, and 121 cases were found to have pathogens, with a detection rate of 68.8%. A total of 122 strains of pathogens were identified, among which 73 strains (59.8%) were Gram-positive bacteria, with Staphylococcus aureus being the predominant, accounting for 66 strains (54.1%), including 54 strains (44.3%) of methicillin-sensitive Staphylococcus aureus (MSSA) and 12 strains (9.8%) of methicillin-resistant Staphylococcus aureus (MRSA). There were 32 strains (26.2%) of Gram-negative bacteria, Pseudomonas aeruginosa was the main type (17 strains, 13.9%). Seventeen strains of fungi were detected (13.9%), with filamentous fungi being the predominant type (13 strains, 10.7%). The drug sensitivity tests showed that MSSA had a relatively high resistance to penicillin, erythromycin and clindamycin, but demonstrated high sensitivity to drugs such as oxacillin, levofloxacin, linezolid, rifampicin, tigecycline and vancomycin. However, MRSA had a relatively high resistance to commonly used antibiotics such as oxacillin, erythromycin, clindamycin, and quinolones, but showed a high sensitivity to gentamicin, compound sulfamethoxazole, linezolid, rifampicin, tigecycline, and vancomycin. The resistance rate of Gram-negative bacteria to cefuroxime was high, while they were highly sensitive to ceftazidime, cefepime, gentamicin, imipenem and meropenemetc,etc.Conclusions The main pathogens causing CSOM in the Taklamakan Desert region of Xinjiang are Staphylococcus aureus, Pseudomonas aeruginosa, and Filamentous fungi, with relatively high proportions of MRSA and fungi. Early completion of bacteriological and mycological analysis is conducive to achieving more targeted treatment, shortening the course of the disease and improving the therapeutic effect.