慢性鼻—鼻窦炎细菌培养及药物敏感试验分析

发布时间：2018-04-05 22:35

本文选题：慢性鼻-鼻窦炎　切入点：需氧菌　出处：《皖南医学院》2016年硕士论文

【摘要】：目的:通过对慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)患者的鼻腔细菌培养及药敏检测,了解本地区慢性鼻-鼻窦炎患者鼻腔需氧菌分布及药物敏感性特点,为本地区临床抗菌药物合理选择提供依据。方法:在2010年1月1日至2015年12月31日期间,本地区慢性鼻-鼻窦炎患者中随机选取181位患者行鼻腔需氧菌培养及药物敏感试验。标本在抗菌药物使用前采集,常规消毒鼻前庭及鼻周皮肤,无菌前鼻镜或鼻内镜辅助下,将无菌采样拭子置入中鼻道,充分与中鼻道肿胀处黏膜及息肉组织接触擦拭,旋转拭子,留取黏脓性分泌物,在1小时内送临床检验中心,行需氧菌分离培养以及药物敏感试验,根据药敏报告指导临床合理使用抗菌药物。根据年龄特征将患者分为老年CRS患者组、中青年CRS患者组以及未成年CRS患者组。通过卡方检验比较老年CRS组与中青年CRS组需氧菌培养报告阳性率差异。结果:181例标本中1例标本培养2日未见细菌生长,其余180例(99.4%,180/181)标本可见草绿色链球菌、奈瑟菌以及革兰阳性杆菌生长(根据临床上呼吸道微生物检验阳性报告标准,这类细菌考虑为正常菌群)。临床检验中心共报告需氧菌18株,11个种类,阳性率为9.9%(18/181)。革兰阳性需氧菌(Gram positive aerobes)10株(5.5%,10/181),其中最常见的菌株为金黄色葡萄球菌(3.3%,6/181);革兰阴性需氧菌(Gram negative aerobes)8株(4.4%,8/181),最常见的菌株为产气肠杆菌(1.7%,3/181),其余菌株均匀分布。老年CRS患者组30例标本,报告阳性率为16.7%(5/30),5株菌株均为革兰阳性菌,其中3株金黄色葡萄球菌比例最高(60%,3/5),余为肺炎链球菌及β-溶血A群链球菌各1株;中青年CRS患者组139例标本,报告阳性率为9.4%(13/139),革兰阳性菌5株,革兰阴性菌8株,最常见的菌株为金黄色葡萄球菌以及产气肠杆菌。未成年CRS组标本均见上呼吸道正常微生物,无临床检验中心阳性报告。经卡方检验,中青年CRS患者组与老年CRS患者组报告阳性率差异无统计学意义(?2=1.387,P=0.239,P0.05)。药物敏感试验结果示中青年CRS患者组存在1株甲氧西林耐药的表皮葡萄球菌(Methicillin resistant Staphylococcus epidermidis,MRSE)以及1株对第三代头孢类抗菌素耐药的革兰阴性杆菌。2株甲氧西林耐药的金黄色葡萄球菌(Methicillin resistant Staphylococcus aureus,MRSA)在中青年CRS患者组及老年CRS患者组各分布1株。MRSA在金黄色葡萄球菌中的比例为33.3%(2/6)。3株甲氧西林耐药的葡萄球菌(Methicillin resistant Staphylococcus,MRS)对左氧氟沙星、达福普汀、利奈唑胺以及万古霉素均敏感。总体上氨苄西林、青霉素以及阿莫西林克拉维酸耐药广范。未见万古霉素、第四代头孢菌素耐药情况。结论:慢性鼻-鼻窦炎患者鼻腔需氧菌群以上呼吸道正常菌群为主,菌种广泛,金黄色葡萄球菌、产气肠杆菌最常见,其余菌种均匀分布。药敏结果示氨苄西林、青霉素以及阿莫西林克拉维酸耐药率高,左氧氟沙星抗菌活性好。本地区少数慢性鼻-鼻窦炎患者鼻腔存在MRS以及对第三代头孢菌素耐药的革兰阴性杆菌,需加强院感监测及防控。
[Abstract]:Objective: through for chronic rhinosinusitis (chronic rhinosinusitis, CRS) bacterial culture and drug sensitivity test in patients with nasal cavity, understand chronic nasal - local sinusitis distribution of aerobic bacteria and drug sensitivity characteristics of nasal cavity, selection of drugs provides a basis for the local antibiotic. Methods: in the period from January 1, 2010 to December 31, 2015, 181 patients the nasal cavity bacteria culture and drug sensitivity test were randomly selected for chronic nasal - local sinusitis patients. Specimens before acquisition of antimicrobial drugs, regular disinfection of nasal vestibule and nasal skin, aseptic before the nose or nasal endoscope, the sterile swab into the middle meatus, full and middle meatus mucosa swelling polyps and contact wipe, rotating swab specimens from sticky purulent secretions, send the clinical inspection center in 1 hours, for aerobic bacteria culture and drug sensitivity test, according to drug sensitivity Report to guide clinical rational use of antibiotics. According to the age characteristics of the patients were divided into elderly CRS patients, CRS patients and young adult patients with CRS group. By chi square test to compare the group of patients with CRS culture positive rate between the report and the young group CRS of aerobic bacteria. Results: 181 cases of the 1 specimens in culture 2, no bacterial growth, the remaining 180 cases (99.4%, 180/181) sample showed that Streptococcus viridans, Neisseria and gram positive bacillus growth (according to the clinical respiratory tract microbial test positive report standard, this type of bacteria is considered as normal flora). The clinical inspection center reported a total of 18 strains of aerobes and 11 species. The positive rate was 9.9% (18/181). Gram positive bacteria (Gram positive aerobes) 10 strains (5.5%, 10/181), one of the most common strains of Staphylococcus aureus (3.3%, 6/181); gram negative aerobic bacteria (Gram negative aerobes) 8 strains (4.4%, 8/181 ), the most common strains of Enterobacter aerogenes (1.7%, 3/181), others were evenly distributed. The elderly patients with CRS group of 30 specimens, the positive rate was 16.7% (5/30) report, 5 strains were gram positive bacteria, 3 strains of Staphylococcus aureus was the highest (60%, 3/5). More than for Streptococcus pneumoniae and beta hemolytic streptococcus A group 1 strain; young CRS patients 139 cases, the positive rate was 9.4% (13/139) report, 5 strains of gram positive bacteria, 8 strains of gram negative bacteria, the most common strains of Staphylococcus aureus and Enterobacter aerogenes minor. CRS groups see the upper respiratory tract of normal bacteria, no positive report of clinical inspection center. The chi square test, no statistically significant difference between the positive rate of CRS in young patients and elderly patients with CRS (2=1.387, P=0.239, report? P0.05). Drug sensitivity test results showed that CRS patients in the young group in 1 strains of methicillin the methicillin-resistant Staphylococcus epidermidis Bacteria (Methicillin resistant Staphylococcus epidermidis, MRSE) and 1 strains of the third generation cephalosporin antibiotic resistant gram negative bacillus.2 strains of methicillin resistant Staphylococcus aureus (Methicillin resistant Staphylococcus aureus, MRSA CRS) in young patients and elderly patients with CRS group distribution of 1 strains of.MRSA in Staphylococcus aureus was 33.3% in the (2/6).3 strains of methicillin resistant Staphylococcus aureus (Methicillin resistant, Staphylococcus, MRS) of levofloxacin, Dafoe, leptin, linezolid and vancomycin were sensitive to ampicillin. On the whole, penicillin and amoxicillin clavulanate. No vancomycin resistant wide, fourth generation cephalosporins. Conclusion: the nasal flora of upper respiratory tract normal flora, bacteria, Staphylococcus aureus, Enterobacter aerogenes The most common, other strains of uniform distribution. The results of drug sensitivity showed ampicillin, penicillin and amoxicillin clavulanic acid resistance rate is high, the antibacterial activity of levofloxacin nasal region. Few patients with chronic rhinosinusitis and MRS to the third generation cephalosporin resistant gram negative bacilli, the need to strengthen the hospital infection monitoring and control.

【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R765.21;R765.41

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