摘要
目的分析鼻窦炎的病原微生物分布及与鼻窦炎感染类型的关系。方法收集2013—2017年诊治的1 050例鼻窦炎患者经鼻内窥镜手术所取的窦腔内容物标本,行直接涂片镜检、普通细菌培养、真菌培养、厌氧菌培养和质谱仪菌种鉴定。统计分析急性和慢性鼻窦炎病原菌分布差异。结果 1 050例鼻窦炎患者分为急性鼻窦炎164例、慢性鼻窦炎384例和真菌性鼻窦炎502例。细菌直接涂片和培养结果一致。经培养鉴定共检出1 283株病原菌,细菌分布为金黄色葡萄球菌177株(13.8%)、铜绿假单胞菌101株(7.9%)、流感嗜血杆菌78株(6.1%)、链球菌属90株(7.0%)、克雷伯菌属54株(4.2%);厌氧菌主要为普雷沃菌14株(1.0%)和具核梭杆菌5株(0.1%);真菌以曲霉200株(15.6%)为主,多伴有细菌的混合感染。急性鼻窦炎多为一种病原菌,慢性鼻窦炎多混合2种以上病原菌。急性和慢性鼻窦炎病原菌中链球菌(χ2=13.819,P<0.01)、肠杆菌科细菌(χ2=9.849,P<0.01)和凝固酶阴性葡萄球菌(χ2=75.407,P<0.01)的分离率差异有统计学意义,其余细菌分离率差异无统计学意义。2013—2016年真菌涂片镜检和培养阳性率分别为66.5%和49.9%;2017年改进真菌培养前处理方法后培养阳性率为87.1%,涂片镜检阳性率为68.8%。结论急性和慢性鼻窦炎致病细菌以金黄色葡萄球菌、铜绿假单胞菌和流感嗜血杆菌为主,厌氧菌多为普雷沃菌和具核梭杆菌;真菌性鼻窦炎以曲霉属为主,同时伴有细菌的混合感染。临床应根据细菌和真菌培养结果合理用药。
Objective To analyze the relationship between the spectrum of pathogenic microorganism in sinusitis and the infection types.Methods The specimens of cavity contents of 1 050 sinusitis patients were collected by endoscopic sinus surgery from 2013 to2017 for direct smear microscopy,culture for aerobes,anaerobes and fungi and identified by matrix-assisted laser desorption ionizationtime of flight mass spectrometry. The difference of pathogenic bacteria between acute and chronic sinusitis was analyzed by Chi square test.Results Among the 1 050 sinusitis cases,164 cases were acute bacterial rhinosinusitis,384 cases were chronic rhinosinusitis and502 cases were fungal rhinosinusitis. The results of direct smear were consistent with those of culture of bacteria. A total of 1 283 strains of pathogens were cultured and identified. The top three of bacteria were Staphylococcus aureus（ 177,13.8%）,Pseudomonas aeruginosa（ 101,7.9%） and Haemophilus influenza（ 78,6. 1%）,followed by Streptococcus（ 90,7. 0%） and Klebsiella（ 54,4. 2%）. The main anaerobic bacteria were Prevotella sp.（ 14,1.0%） and Fusobacterium nucleatum（ 5,0. 1%）. Aspergillus was the most common fungus（ 200,15.6%） accompanied by mixed infection with bacteria.In acute sinusitis only one pathogen was mostly found,but chronic sinusitis was usually caused by mixed infections of more than 2 kinds of pathogens. In both acute and chronic sinusitis,the isolated rates of Streptococcus（ χ2= 13.819,P〈0.01）,Enterobacteriaceae bacteria（ χ2= 9.849,P〈0.01） and coagulase negative Staphylococcus（ χ2= 75.407,P〈0.01） showed statistically significant differences,and no significant difference was found in the other bacteria. From2013 to 2016,the total positive rate of fungal smear microscopy was 66.5% and the positive rate of culture was 49.9%. In 2017,following the application of modified pretreatment before culture the positive rate of fungal elevated to 87.1%,and the positive rate of smear microscopy for fungal was 68.8%.Conclusion The pathogenic bacteria of both acute and chronic sinusitis were mainly Staphylococcus aureus,Pseudomonas aeruginosa and Haemophilus influenzae. Anaerobic bacteria mostly were Prevotella sp. and Fusobacterium nucleatum. Fungal rhinosinusitis was predominantly the mixed infection of Aspergillus accompanied by bacteria. The rational use of antibiotics should be based on the results of bacterial and fungal cultures.
作者
黄艳飞
王丽赟
王玫
岳燕
隋文君
袁梁
王向东
鲁辛辛
HUANG Yanfei;WANG Liyun;WANG Mei;YUE Yan;SUI Wenjun;YUAN Liang;WANG Xiangdong;LU Xinxin(Department of Laboratory Medicine;Department of Clinical Head attd Neck Surgery, Bering Tongren Hospital, Capital Medical University, Beijing 100730, China)
出处
《临床检验杂志》
CAS
CSCD
2018年第7期545-548,共4页
Chinese Journal of Clinical Laboratory Science
基金
国家科技重大专项(2017ZX10103004)
关键词
鼻窦炎
细菌
金黄色葡萄球菌
铜绿假单胞菌
曲霉属
sinusitis
bacteria
Staphylococcus aureus
Pseudomonas aeruginosa
Aspergillus
