76例急性化脓性中耳炎患儿耳分泌物的病原菌分布情况及药敏结果分析

Microbial distribution and antibiotic sensitivity analysis of 76 cases of purulent otitis media in children

摘要:

目的 探究急性化脓性中耳炎患儿耳分泌物的病原菌分布情况及药敏结果。方法 选取2018年1月—2023年5月武汉儿童医院接诊的76例急性化脓性中耳炎患儿，采集中耳分泌物行病原学培养及药敏试验检测，分析致病菌分布特征及药敏结果，并分析主要感染菌种的耐药性变迁结局。结果 76例患儿共检出病原菌84株，肺炎链球菌和金黄色葡萄球菌的占比较高，分别为71.43%和23.81%。1个月～1岁、> 1～3岁、> 3～8岁患儿肺炎链球菌感染率分别为40.00%、35.00%和25.00%，金黄色葡萄球菌感染率分别为25.00%、30.00%和45.00%。肺炎链球菌对左旋氧氟沙星的耐药性2018～2019年低于2022～2023年（P <0.05）。肺炎链球菌对阿奇霉素、四环素和克林霉素的耐药性较高，分别为81.67%（49/60）、90.00%（54/60）和66.67%（40/60）；对万古霉素和利奈唑胺的敏感性最高，耐药率均为0.00%；对氯霉素、厄他培南和奎奴普丁/达福普汀的耐药性较低，分别为8.33%（5/60）、13.33%（8/60）和10.00%（6/60）；对左旋氧氟沙星、美罗培南、复方新诺明、头孢噻肟、头孢曲松、头孢吡肟和青霉素均存在不同程度的耐药性，耐药率为21.67%～48.33%。金黄色葡萄球菌对左旋氧氟沙星、头孢吡肟、阿奇霉素、四环素和克林霉素的耐药性较高，分别为70.00%（14/20）、65.00%（13/20）、65.00%（13/20）、90.00%（18/20）和70.00%（14/20）；对万古霉素、利奈唑胺的敏感性最高，耐药率均为0.00%；对氯霉素和奎奴普丁/达福普汀的耐药性较低，均为5.00%（1/20）；对美罗培南、复方新诺明、头孢噻肟、头孢曲松、青霉素和厄他培南均存在不同程度的耐药性，耐药率为20.00%～50.00%。结论 急性化脓性中耳炎患儿的病原菌分布中以肺炎链球菌和金黄色葡萄球菌占比最高，药敏试验得出两者对阿奇霉素、四环素及克林霉素的耐药性偏高，而对氯霉素、万古霉素、利奈唑胺、厄他培南及奎奴普丁/达福普汀的耐药性相对较低。

Abstract:

Objective To investigate the distribution of pathogens and analyze drug sensitivity in the ear discharge of children with acute purulent otitis media.Methods A total of 76 children diagnosed with acute purulent otitis media between January 2018 and May 2023 at Wuhan Children's Hospital were included. Ear discharge samples were collected for microbiological culture and drug sensitivity testing. The study analyzed the characteristics of pathogenic bacteria distribution and drug sensitivity results, and evaluated the resistance changes of major infectious strains.Results Among the 76 cases, a total of 84 strains of pathogens were identified, with Streptococcus pneumoniae and Staphylococcus aureus being the most prevalent, accounting for 71.43% and 23.81%, respectively. The infection rates of Streptococcus pneumoniae in children aged 1 month to 1 year, > 1 year to 3 years, and > 3 years to 8 years were 40.00%, 35.00%, and 25.00%, respectively. The infection rates of Staphylococcus aureus were 25.00%, 30.00%, and 45.00%, respectively. The resistance of Streptococcus pneumoniae to levofloxacin was lower in 2018 to 2019 than in 2022 to 2023 (P < 0.05). Streptococcus pneumoniae showed high resistance to azithromycin, tetracycline, and clindamycin, with resistance rates of 81.67% (49/60), 90.00% (54/60), and 66.67% (40/60), respectively. The sensitivity was highest to vancomycin and linezolid, with resistance rates of 0.00%. Resistance rates to chloramphenicol, ertapenem, and quinupristin/dalfopristin were relatively low, ranging from 5.00% to 13.33%. Staphylococcus aureus exhibited high resistance to levofloxacin, cefepime, azithromycin, tetracycline, and clindamycin, with resistance rates of 70.00% (14/20), 65.00% (13/20), 65.00% (13/20), 90.00% (18/20), and 70.00% (14/20), respectively. The sensitivity was highest to vancomycin and linezolid, with resistance rates of 0.00%. Resistance rates to chloramphenicol, ertapenem, quinupristin/dalfopristin, ceftriaxone, cefotaxime, and penicillin varied from 5.00% to 50.00%.Conclusions The predominant pathogens in children with acute purulent otitis media are Streptococcus pneumoniae and Staphylococcus aureus. Drug sensitivity testing revealed higher resistance of both strains to azithromycin, tetracycline, and clindamycin. Resistance to chloramphenicol, vancomycin, linezolid, ertapenem, and quinupristin/dalfopristin was relatively low.