耳鼻喉急性感染患者临床特征分析
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摘要
目的调查耳鼻喉急性感染患者临床特征,以指导临床抗感染治疗。方法收集814例耳鼻喉患者临床资料,对患者急性感染病原菌类型、感染临床特征进行分析,采用MIC法检测分离菌株对常用抗生素耐药情况。结果 814例患者中感染231例,感染率28.38%。男性459例,142例感染,感染率30.94%;女性355例,89例感染,感染率25.07%。231例患者标本培养出172株病原菌,阳性率74.46%。鼻分泌物标本分离69株,耳分泌物分离61株。革兰阴性菌121株,革兰阳性菌45株,真菌6株,构成比分别为70.35%、26.16%和3.49%。肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、鲍曼不动杆菌、金黄色葡萄球菌、表皮葡萄球菌、肺炎链球菌分别为78、24、9、3、29、8和3株。革兰阴性菌分离株对头孢他啶、头孢克肟、哌拉西林、哌拉西林他唑巴坦、四环素、复方新诺明、诺氟沙星、罗米沙星、庆大霉素、妥布霉素、亚胺培南耐药率分别为27.27%、22.31%、47.93%、5.79%、44.63%、42.15%、43.80%、32.23%、47.11%、28.93%和0.83%。革兰阳性菌分离株对青霉素G、头孢呋辛、头孢克肟、四环素、红霉素、阿奇霉素、诺氟沙星、罗米沙星、庆大霉素、利福平和替加环素耐药率分别为42.22%、28.89%、26.67%、42.22%、40.00%、28.89%、37.78%、33.33%、37.78%、4.44%和0.00%。结论呼吸系统是耳鼻喉急性感染患者的主要感染部位,鼻分泌物标本检出菌株数最多。
Objectives To investigate the clinical characteristics of patients with an acute ear, nose, and throat infection in order to guide the clinical treatment of those infections. Methods Clinical data on 814 patients seen by Otorhinolaryngology were collected, and the type of pathogen and clinical features were studied in patients with an acute ear, nose, and throat infection. The sensitivity of clinical isolates to commonly used antibiotics was determined based on the MIC. Results Of 814 patients, 231 had an infection, for a rate of infection of 28.38%. Of 459 male patients, 142 had an acute infection, for a rate of infection of 30.94%. Of 355 female patients, 89 had an acute infection, for a rate of infection of 25.07%. One hundred and seventy-two pathogens were cultured from 231 specimens, so 74.46% of those specimens tested positive for a pathogen. Sixty-nine strains were isolated from nasal secretions, and 61 strains were isolated from aural secretions. Pathogens consisted of 121 strains of Gram-negative bacteria(70.35%), 45 strains of Gram-positive bacteria(26.16%), and 6 strains of fungi(3.49%). Seventy-eight strains of Klebsiella pneumoniae were isolated, 24 strains of Pseudomonas aeruginosa were isolated, 9 strains of Escherichia coli were isolated, 3 strains of Acinetobacter baumannii were isolated, 29 strains of Staphylococcus aureus were isolated, 8 strains of S. epidermidis were isolated, and 3 strains of Streptococcus pneumoniae were isolated. The resistance of Gram-negative bacteria to ceftazidime was 27.27%, their resistance to cefixime was 22.31%, their resistance to piperacillin was 47.93%, their resistance to tazobactam was 5.79%, their resistance to tetracycline was 44.63%, their resistance to trimethoprim-sulfamethoxazole was 42.15%, their resistance to norfloxacin was 43.80%, their resistance to lomefloxacin was 32.23%, their resistance to gentamicin was 47.11%, their resistance to tobramycin was 28.93%, and their resistance to imipenem was 0.83%. The resistance of Gram-positive bacteria to penicillin G was 42.22%, their resistance to cefuroxime was 28.89%, their resistance to cefixime was 26.67%, their resistance to tetracycline was 42.22%, their resistance to erythromycin was 40.00%, their resistance to azithromycin was 28.89%, their resistance to norfloxacin was 37.78%, their resistance to lomefloxacin was 33.33%, their resistance to gentamicin was 37.78%, their resistance to rifampicin was 4.44%, and their resistance to tigecycline was 0.00%. Conclusion The respiratory system is the main site of infection in patients with an acute ear, nose, and throat infection, and pathogens were most often detected in nasal secretions.
Objectives To investigate the clinical characteristics of patients with an acute ear, nose, and throat infection in order to guide the clinical treatment of those infections. Methods Clinical data on 814 patients seen by Otorhinolaryngology were collected, and the type of pathogen and clinical features were studied in patients with an acute ear, nose, and throat infection. The sensitivity of clinical isolates to commonly used antibiotics was determined based on the MIC. Results Of 814 patients, 231 had an infection, for a rate of infection of 28.38%. Of 459 male patients, 142 had an acute infection, for a rate of infection of 30.94%. Of 355 female patients, 89 had an acute infection, for a rate of infection of 25.07%. One hundred and seventy-two pathogens were cultured from 231 specimens, so 74.46% of those specimens tested positive for a pathogen. Sixty-nine strains were isolated from nasal secretions, and 61 strains were isolated from aural secretions. Pathogens consisted of 121 strains of Gram-negative bacteria(70.35%), 45 strains of Gram-positive bacteria(26.16%), and 6 strains of fungi(3.49%). Seventy-eight strains of Klebsiella pneumoniae were isolated, 24 strains of Pseudomonas aeruginosa were isolated, 9 strains of Escherichia coli were isolated, 3 strains of Acinetobacter baumannii were isolated, 29 strains of Staphylococcus aureus were isolated, 8 strains of S. epidermidis were isolated, and 3 strains of Streptococcus pneumoniae were isolated. The resistance of Gram-negative bacteria to ceftazidime was 27.27%, their resistance to cefixime was 22.31%, their resistance to piperacillin was 47.93%, their resistance to tazobactam was 5.79%, their resistance to tetracycline was 44.63%, their resistance to trimethoprim-sulfamethoxazole was 42.15%, their resistance to norfloxacin was 43.80%, their resistance to lomefloxacin was 32.23%, their resistance to gentamicin was 47.11%, their resistance to tobramycin was 28.93%, and their resistance to imipenem was 0.83%. The resistance of Gram-positive bacteria to penicillin G was 42.22%, their resistance to cefuroxime was 28.89%, their resistance to cefixime was 26.67%, their resistance to tetracycline was 42.22%, their resistance to erythromycin was 40.00%, their resistance to azithromycin was 28.89%, their resistance to norfloxacin was 37.78%, their resistance to lomefloxacin was 33.33%, their resistance to gentamicin was 37.78%, their resistance to rifampicin was 4.44%, and their resistance to tigecycline was 0.00%. Conclusion The respiratory system is the main site of infection in patients with an acute ear, nose, and throat infection, and pathogens were most often detected in nasal secretions.
引文
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[11] 桂雄斌,何颖,张阳德,等.耳鼻喉急性感染及术后疼痛的临床治疗分析[J].中国医药指南,2013(19):424-5.
[12] 刘超峰.258例呼吸内科住院患者医院感染情况、呼吸内科住院患者医院感染情况、影响因素分析[J].中国保健营养,2012,22(4):334.
[13] 张莉,杨持.中国北方地区咽炎患者咽部菌群动态变化的研究[J].中华临床医师杂志,2009,3(1):62-71.
[14] 关艳华,赵明耀,赵国强.反复上呼吸道感染患儿危险因素分析[J].中华医院感染学杂质,2014,24(2):480-2.
[2] 侯丽达.819例耳鼻喉外科手术患者术后感染影响因素分析[J].中华医院感染学杂志,2013,23(9):2112-4.
[3] Gera C,Kumar N.Otolaryngologic manifestations of various rheumatic disease:awareness and practice among otolaryngologists[J].Indian J Otolarygol Head Neck Surg,2015,67(4):366-9.
[4] Murray R,Logvinenko T,Roberson D.Frequency and cause of readmissions following pediatric otolaryngologic surgery [J].Laryngoscope,2016,126(1):199-204.
[5] 谢民强.耳鼻咽喉头颈部感染性疾病[M].北京:人民卫生出版社,2005:21-34.
[6] Ribas A,Silvestre R,Mottecy CM,et al.Relationship between otolaryngologic complaints and systemic comorbidities observed in a group of hearing aid users[J].Int Arch Otorhinolaryngol,2015,19(3):216-21.
[7] Imran TF,Helfgott S.Respiratory and otolaryngolotic manifestations of giant cell areteritis[J].Clin Exp Rheumatol,2015,33(89):164-70.
[8] 梁江平,裴志滨,卢荣明.耳鼻喉科患者低温等离子术后医院感染分析[J].中华医院感染学杂质,2014,24(13):3309-11.
[9] Prestes L,Hamerschmidt R,Tenorio S,et al.Epidemiologic profile of an otolaryngologic emergency service[J].Int Arch Otorhinolaryngol,2014,18(4):380-2.
[10] Lally L,Lebovics RS,Huang WT,et al.Effectivemess of rituximab for the otolaryngologic manifestations of granulomatosis with polyangiitis(Wegener's)[J].Arthritis Care Res,2014,66(9):1403-9.
[11] 桂雄斌,何颖,张阳德,等.耳鼻喉急性感染及术后疼痛的临床治疗分析[J].中国医药指南,2013(19):424-5.
[12] 刘超峰.258例呼吸内科住院患者医院感染情况、呼吸内科住院患者医院感染情况、影响因素分析[J].中国保健营养,2012,22(4):334.
[13] 张莉,杨持.中国北方地区咽炎患者咽部菌群动态变化的研究[J].中华临床医师杂志,2009,3(1):62-71.
[14] 关艳华,赵明耀,赵国强.反复上呼吸道感染患儿危险因素分析[J].中华医院感染学杂质,2014,24(2):480-2.