新疆慢性中耳炎细菌学动态分析与细菌生物膜形成的研究

发布时间：2018-02-24 16:08

本文关键词： 慢性中耳炎细菌学细菌生物膜扫描电镜　出处：《新疆医科大学》2013年博士论文　论文类型：学位论文

【摘要】：目的：慢性中耳炎是新疆最常见的耳鼻咽喉头颈外科疾病之一,对新疆各族患者带来了严重的社会和经济负担。对新疆地区慢性化中耳炎患者分泌物的细菌学分布及常用抗菌药物药物敏感性进行动态检测,以了解慢性化脓性中耳炎致病菌的变化趋势和指导临床合理用药；对慢性中耳炎患者的中耳粘膜及胆脂瘤上皮组织进行电镜扫描,了解细菌生物膜在不同类型慢性中耳炎中的形成情况,同时对细菌生物膜形成患者的中耳分泌物进行细菌培养,了解电镜扫描结果与中耳分泌物细菌培养结果之间的差异,并了解电镜扫描结果阳性患者主要病原菌分布情况,指导慢性中耳炎在本地区的诊疗。方法：回顾性分析2008年1月到2013年6月期间在我院住院治疗的慢性中耳炎患者的中耳分泌物进行细菌培养和药物敏感试验,取得细菌分离率的排序；比较2008-2011,2012-2013两个时间段主要致病菌分布的变化,主要致病菌的药物敏感度及变化；前瞻性对手术中取得的样本进行扫描电镜检查,按照不同类型慢性中耳炎入组分析；分析慢性中耳炎细菌生物膜形成与细菌培养结果之间的关系,并对细菌生物膜形成患者病原菌分布进行排序。结果：1、全部共计409例标本中361例检出病原菌,检出率88.26%,其中慢性化脓性中耳炎(活动期)288例中254例检出病原菌,中耳胆脂瘤组121例中107例检出病原菌,两组间比较,检出率无统计学意义。共检出43种病原菌,位于前列的检出病原菌依次是金黄色葡萄球菌104(28.8%),铜绿假单胞菌63(17.5%),表皮葡萄球菌32(8.86%),奇异变形杆菌22(6.09%)2、慢性化脓性中耳炎(活动期)与中耳胆脂瘤主要病原菌构成比总体有差异,χ2=29.465,P=0.001,其他阳性球菌与革兰氏阳性杆菌的检出率在慢性化脓性中耳炎中的检出率较中耳胆脂瘤高,χ2=7.074,P=0.008.其他阴性杆菌的在中耳胆脂瘤中的检出率较慢性化脓性中耳炎高χ2=18.18,P=0.000。3、各种病原菌不同时间段总体构成比对比,χ2=9.209,P=0.418,没有统计学意义。金黄色葡萄球菌,凝固酶阴性葡萄球菌2012-2013年度检出率与2008-2011年度比较,检出率有所提高,金黄色葡萄球菌χ2=21.393,P=0.000：凝固酶阴性葡萄球菌χ2=12.876,P=0.000有统计学意义。4、金黄色葡萄球菌对喹努普汀达福普汀,替考拉宁,万古霉素在两个时间段的敏感性均为100%,对青霉素G、红霉素和氨苄西林敏感率较低,分别是17.3%,19.7%和40.3%,2008-2011年度与2012-2013年度比较细菌的敏感性没有明显变化,头孢唑啉的敏感性在两个时间段分别是96.4%、75.0%,χ2=4.989,P=0.027。莫西沙星,左氧氟沙星,环丙沙星为代表的喹诺酮抗生素达敏感性较高,最低为77.8%,庆大霉素,利福平、复方新诺明有较高的敏感性。在对凝固酶阴性葡萄球菌发现,喹努普汀达福普汀,替考拉宁,万古霉素在两个时间段的仍然保持了100%敏感性。喹诺酮类,还是青霉素类,凝固酶阴性葡萄球菌的耐药性均提高,特别是青霉素的耐性几乎接近100%。在对绿脓杆菌的研究中,主要常用抗生素敏感性莫西沙星90.5%,头孢他啶72.7%,亚胺培南73.7%,头孢他啶与亚安培南的敏感性在2012-2013年度有所增高。5、慢性化脓性中耳炎(活动期)与中耳胆脂瘤细菌生物膜形成率分别是85.5%(14/16),81.3%(13/16),卡方检验(Fisher's Exast Test) P=1.00。实验组两组与对照组慢性化脓性中耳炎(禁止期)细菌生物膜形成16.7%(2/12),卡方检验(Fisher's Exast Test) P均0.01,具有统计学意义。6、慢性中耳炎扫描电镜细菌生物膜结果与细菌培养结果之间的比较.灵敏度Se=70.37%,特异性SP=60.00%,误诊率40.00%,漏诊率29.63%,阳性预测值90.46%,阴性预测值27.27%,正确率68.75%YI(Youden index30.37%, Pearson相关系数为0.232(P=0.201)。7、慢性中耳炎细菌生物膜阳性患者细菌培养病原菌分布G+杆菌5例未鉴定具体的细菌种类,绿脓杆菌5例(23.8%),变形杆菌2例(9.5%),大肠埃希杆菌2(9.5%)例,摩氏根菌1例(4.8%)；,金黄色葡萄球菌1例(4.8%),凝固酶阴性球菌3例,占14.3%,其中人葡萄球菌,麻疹孪生球菌,表皮葡萄球菌各一例。真菌1例,占4.8%,为烟曲霉菌一例。结论：新疆慢性中耳炎细菌检出位于前列的依次是金黄色葡萄球菌,绿脓杆菌,表皮葡萄球菌,奇异变形杆菌。革兰氏阳性球菌与革兰氏阳性杆菌的检出率在慢性化脓性中耳炎中的检出率较中耳胆脂瘤高,而革兰氏阴性菌的检出率中耳胆脂瘤中较高。不同时间段慢性中耳炎的主要病原菌构成没有明显变化。金黄色葡萄球菌对青霉素、红霉素、氨苄西林保持了较高的耐药性,头孢菌素耐药性明显增高趋势,氟喹诺酮类抗生素及复方新诺明保持了一定的敏感性,凝固酶阴性葡萄球菌对氨基甙类抗生素敏感性较高,氟喹诺酮类,青霉素类敏感性较低,二者对喹努普汀达福普汀,替考拉宁,万古霉素保持了较高的敏感性。头孢他定、莫西沙星、亚安培南对绿脓杆菌有较高的敏感性,但已经有下降趋势。慢性化脓性中耳炎静止期与细菌生物膜形成的比例较低有关,慢性化脓性中耳炎活动期、中耳胆脂瘤与细菌生物膜的形成有明确的相关性,慢性化脓性中耳炎活动期与中耳胆脂瘤两种疾病中细菌生物膜的形成情况基本相似,首次发现中耳胆脂瘤胆脂瘤上皮中存在者真菌形成的生物膜结构。细菌培养结果阴性不能代表慢性中耳炎患者没有细菌生物膜的形成；细菌生物膜患者细菌培养结果与本地区细菌检出情况基本一致,均为本地区常见细菌,绿脓杆菌与凝固酶阴性葡萄球菌是慢性中耳炎细菌生物膜形成主要病原菌。
[Abstract]:Objective: chronic otitis media is one of the most common Xinjiang otolaryngology head and neck surgery, has brought serious social and economic burden of all ethnic groups in Xinjiang patients. The secretions of patients with chronic otitis media in Xinjiang area of pathogens and antimicrobial susceptibility of dynamic detection, to understand the changes and trends of chronic suppurative otitis media pathogens to guide the clinical rational use of drugs; scanning electron microscope on patients with chronic otitis media and cholesteatoma of the middle ear mucosa epithelial tissue, the formation of bacterial biofilm in the understanding of different types of chronic otitis media, while the formation of middle ear secretion in patients with bacterial biofilm bacterial culture, to understand the differences between results of SEM and middle ear secretions bacterial culture results and understand the results of SEM, the distribution of main pathogenic bacteria positive patients, chronic otitis media in the local guide The diagnosis and treatment. Methods: a retrospective analysis from January 2008 to June 2013 for bacterial culture and drug sensitivity test in the middle ear secretions of patients with chronic otitis media in our hospital, to obtain bacterial isolation rate of order; 2008-20112012-2013 two period main pathogen distribution, main pathogens and drug sensitivity changes; SEM examination was carried out on surgical samples obtained prospectively, according to different types of chronic otitis media in the group analysis; the relationship between the analysis of chronic otitis media with bacterial biofilm formation and bacterial culture results, and the formation of bacterial biofilm with pathogen distribution were sequenced. Results: 1 a total of 409 cases, all were 361 cases of pathogenic bacteria, the detection rate of 88.26%, including chronic suppurative otitis media (activity) in 288 cases, 254 cases of pathogens, cholesteatoma in 121 cases of group 107 Pathogens were found, compared between the two groups, there was no statistical significance. There were 43 kinds of pathogenic bacteria, at the forefront of the pathogenic bacteria were Staphylococcus aureus (28.8%) 104, 63 Pseudomonas aeruginosa (17.5%), Staphylococcus epidermidis (8.86%), 32 (6.09% of 22 Bacillus proteus 2), chronic suppurative otitis media (activity) and the main pathogenic bacteria of cholesteatoma are different than the overall, X 2=29.465, P=0.001, other positive cocci and gram positive bacilli were detected in chronic suppurative otitis media in the middle ear cholesteatoma tumor detection rate is high, X 2=7.074, P=0.008. other negative bacilli in middle ear cholesteatoma detection rate is relatively high in chronic suppurative otitis media x 2=18.18, P=0.000.3, all kinds of bacteria in different time frame than the contrast, X 2=9.209, P=0.418, not statistically significant. Staphylococcus aureus, coagulase negative Staphylococcus in 2012-2013 years Compared with the 2008-2011 annual rate of detection, the detection rate of Staphylococcus aureus increased, X 2=21.393, P=0.000 x 2=12.876: coagulase negative staphylococci, P=0.000 was statistically significant.4 of Staphylococcus aureus to try Dafoe of leptin leptin sensitivity, teicoplanin, vancomycin in two time periods were 100% of penicillin G erythromycin and ampicillin sensitive low rate were 17.3%, 19.7% and 40.3%, 2008-2011 and 2012-2013 year comparison of sensitivity of bacteria did not change significantly, the sensitivity of cefazolin in two time periods were 96.4%, 75%, X 2=4.989, P=0.027. moxifloxacin, levofloxacin, ciprofloxacin and quinolone antibiotics as the representative of higher sensitivity a minimum of 77.8%, gentamicin, rifampicin, cotrimoxazole has high sensitivity. In the discovery of coagulase negative staphylococcus, of leptin dalfopristin. Ting, teicoplanin, vancomycin in two time periods remains 100%. Sensitivity or penicillins, quinolones, drug resistance of coagulase negative staphylococci were increased, especially near 100%. in penicillin tolerance of Pseudomonas aeruginosa, mainly used antibiotics moxifloxacin 90.5%, ceftazidime imipenem 72.7%, 73.7% the sensitivity, ceftazidime and imipenem increased Yaan.5 in 2012-2013, chronic suppurative otitis media and cholesteatoma (activity) of bacterial biofilm formation rate was 85.5% (14/16), 81.3% (13/16), chi square test (Fisher's Exast Test) P=1.00. experimental group two group and control group with chronic suppurative otitis media (Prohibition) of bacterial biofilm formation in 16.7% (2/12), chi square test (Fisher's Exast Test) of P was 0.01,.6 was statistically significant, chronic otitis media SEM of bacterial biofilm The comparison between the results and the results of bacterial culture. The sensitivity Se=70.37%, specificity SP=60.00%, the misdiagnosis rate was 40%, misdiagnosis rate was 29.63%, the positive predictive value of 90.46%, negative predictive value of 27.27%, the correct rate of 68.75%YI (Youden index30.37% Pearson, the correlation coefficient was 0.232 (P=0.201).7, chronic otitis media and positive bacterial biofilms were bacteria pathogens the distribution of G+ bacilli and 5 cases without identification of bacterial species specific, 5 cases of Pseudomonas aeruginosa (23.8%), 2 (9.5%) cases of Proteus, Escherichia coli in 2 cases (9.5%), 1 cases (4.8%); 7 root fungus, 1 cases of Staphylococcus aureus (4.8%), coagulase negative Staphylococcus aureus in 3 cases among them, accounted for 14.3%, Staphylococcus aureus, measles twin, Staphylococcus epidermidis in each case. Fungi in 1 cases, accounting for 4.8%, a case of Aspergillus fumigatus. Conclusion: chronic otitis media in Xinjiang at the forefront of the bacteria are Staphylococcus aureus, Pseudomonas aeruginosa, Staphylococcus epidermidis, Qi Different proteus. Gram positive cocci and gram positive bacilli were detected in chronic suppurative otitis media cholesteatoma detection rate is high, and the high detection rate of gram negative bacteria. The main pathogens of middle ear cholesteatoma in different time periods of chronic otitis media which has no obvious change. Staphylococcus aureus to penicillin, erythromycin, ampicillin keep high drug resistance, cephalosporin resistance increased, fluoroquinolones and cotrimoxazole to maintain a certain sensitivity, coagulase negative staphylococci on amino glucoside antibiotic sensitivity, fluoroquinolones, penicillin sensitivity is low, the two of Dafoe. Teicoplanin on leptin, leptin, vancomycin keep high sensitivity. Ceftazidime, imipenem moxifloxacin, Yaan has high sensitivity to Pseudomonas aeruginosa, but there have been Decreased. Chronic suppurative otitis media in the quiescent stage and bacterial biofilm formation are low proportion of chronic suppurative otitis media with cholesteatoma formation stage, bacterial biofilm has a clear correlation between bacterial biofilm in chronic suppurative otitis media and cholesteatoma stage two disease formation in similar circumstances for the first time, found the biofilm structure of fungi form cholesteatoma of middle ear cholesteatoma. Bacterial culture results in the formation of negative patients with chronic otitis media can not represent no bacterial biofilm; bacterial biofilm in patients with bacterial culture results and the region of bacteria is basically consistent, are the common bacteria in the region, Pseudomonas aeruginosa and coagulase negative Staphylococcus aureus is a chronic otitis media the main pathogens of bacterial biofilm formation.

【学位授予单位】：新疆医科大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R764.21

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