| Objective:Chronic otitis media is one of the most common disease of otolaryngology head and neck surgery in Xinjiang, which havs brought serious social and economic burden for all ethnic patients of xinjiang. In order to understand the change trend of pathogenic bacteria in chronic otitis media and to guide rational clinical drug use,We analysis distribution of bacteriology of secretion in patients with chronic otitis media of xinjiang region and commonly used antimicrobial drug sensitivity for dynamic detection. Middle ear mucosa of patients with chronic otitis media and cholesteatoma epithelial tissue performed electron microscope scanning to understand the bacterial biofilm formation in the different types of chronic otitis media. At the same time of the middle ear secretion in patients with bacterial biofilm formation proceed bacterial culture,to understand the relation between the electron microscope scanning results and the bacterial culture results.we want to known the main pathogenic bacteria distribution in the middle ear secretion of electron microscope scanning results’patients,to guide diagnosis and treatment of chronic otitis media in this area.Methods:Retrospective analysis in January2008to June2013bacterial culture and drug sensitive test results of chronic otitis media patients in our hospital who were in patient with chronic otitis media, to obtain the sorting of bacteria. We analysis the change of the main pathogenic bacteria distribution and drug sensitivity of main pathogenic bacteria in two periods in2008-2011and2012-2008.we prospectively reserch samples from in the operation with scanning electron microscopy (SEM) examination,according to the analysis of different types of chronic otitis media group.Analysis the relationship between bacterial biofilm formation and the bacterial culture results in chronic otitis media,and the distribution of pathogens in patients with bacterial biofilm formation.Results:1, Total of361cases pathogenic bacteria detected in specimens of409cases and detection rate is88.26%.254 cases of pathogenic bacteria were detected in288cases of chronic suppurative otitis media (activity), and107cases of pathogenic bacteria were detected in121middle ear cholesteatoma cases. Compared between the two groups, the detection rate has no statistical significance.43pathogenic bacteria were detected. The front row of pathogenic bacteria is Staphylococcus aureus104(28.8%), Pseudomonas aeruginosa,63(17.5%), and staphylococcus epidermidis32,(8.86%),variation type rod bacteria22(6.09%) in turn.2, The main pathogenic bacteria in chronic suppurative otitis media (activity) and middle ear cholesteatoma is different overall (χ2=29.465, P=0.001). The detection rate of other positive coccus and the gram positive bacillus in chronic suppurative otitis media is relatively high than middle ear cholesteatoma(x2=7.074, P=0.008). Other negative bacilli detection rate in middle ear cholesteatoma is high than chronic suppurative otitis media(χ2=18.18, P=0.000).3,All kinds of pathogenic bacteria in different period is overall no statistical significance (χ2=9.209, P=0.418). the detection rate of Staphylococcus aureus and coagulase negative staphylococcus aureus bacteria in the2008-2011is improving than in the2012-2013.there was statistically significant, Staphylococcus aureus(χ2=21.393,P=0.000) and Coagulase negative staphylococcus (χ2=12.876,P=0.000)4, The sensitivity of staphylococcus aureus to Synercid,Teicoplanin, vancomycin in the two periods are100%.The sensitive rate is low to the Penicillin G, erythromycin and ampicillin, at17.3%,19.7%and40.3%. The sensitivity of those antibiotic in2008-2011and2012-2013is not significantly change.the sensitivity of cefazolin to the staphylococcus in two periods are respectively96.4%,75.0%(χ2=4.989,P=0.027).The sensitivity of Moxifloxacin and levofloxacin, ciprofloxacin is higher,and the minimum sensitivity rate is77.8%. gentamicin, rifampicin and SMZco have higher sensitivity to staphylococcus aureus. In the coagulase negative staphylococcus, Synercid, Teicoplanin, Vancomycin in the two periods remains100%sensitivity.Quinolone,or Penicillin to the coagulase negative staphylococcus resistance are imProving. Especially,the resistance to Penicillin is almost close to100%. In the study of Pseudomonas aeruginosa, the sensitivity of main common antibiotics is moxifloxacin90.5%, Teicoplanin72.7%, Imipenem73.7%. The sensitivity to Teicoplanin, Imipenem is increased in the2012-2013.5, The bacterial biofilm formation rate of chronic suppurative otitis media (activity) and middle ear cholesteatoma was85.5%(14/16),81.3%(13/16),chi-square (Fisher’s Exast Test) P=1.00). Experimental group two groups and control group in chronic suppurative otitis media (stationary) bacterial biofilm formation of16.7%(2/12), chi-square (Fisher’s Exast Test)(P<0.01), have statistical significance.6, Scanning electron microscopy (SEM) bacterial biofilm results of chronic otitis media compared with the results of bacterial culture. The sensitivity is70.37%and specificity is60.00%. the misdiagnosis rate was40.00%, the missed diagnosis was29.63%, positive predictive value was90.46%, negative predictive value was27.27%, the accuracy rate was68.75%, YI (Youden index) was30.37%,and Pearson correlation coefficient was0.232(P=0.201).7, The bacterial culture of chronic otitis media Patients with bacterial biofilm positive is G+bacillus5cases,which did not identify the specific pathogen. Pseudomonas aeruginosa was5cases (23.8%), Proteus was2cases (9.5%), Escherichia coli was2(9.5%) cases, mohs root bacteria in1case (4.8%); staphylococcus aureus,was1case (4.8%), coagulase negative staphylococcus was3cases(14.3%), ncluding staphylococcus aureus, measles twin aureus and epidermis staphylococcus each one;fungal was1case(4.8%),which is aspergillus fumigatus.Conclusion:The Staphylococcus aureus, Pseudomonas aeruginosa, Epidermis staphylococcus aureus, Proteus are the main front row of bacteria in chronic otitis media. The detection rate of Gram positive coccus and gram positive bacillus in chronic suppurative otitis media is relatively high than middle ear cholesteatoma, and the detection rate of gram-negative bacillus is higher in the middle ear cholesteatoma. The main pathogenic bacteria constitute of chronic otitis media is no obvious change in different periods. Staphylococcus aureus to Penicillin, erythromycin and ampicillin maintaines the higher resistance.Cephalosporins drug resistance has increased obviously.Fluoroquinolone antibiotics and SMZco keep a certain sensitivity. Coagulase negative staphylococcus to amino glycosides antibiotics has higher sensitivity and to fluoroquinolone, Penicillin has lower sensitivity, both Staphylococcus aureus and Coagulase negative staphylococcus for Synercid, Teicoplanin for Injection and Vancomycin kept high sensitivity. Ceftazidime, moxifloxacin, Imipenem-Cilastatin has higher sensitivity to Pseudomonas aeruginosa, but there has been a downward trend. Chronic suppurative otitis media (stationary phase) is associated with low proportion of bacterial biofilm formation.Active chronic suppurative otitis media and meddle ear cholesteatoma have clear relevance with the formation of bacterial biofilm.There are the similar situation in bacterial biofilm formation between chronic suppurative otitis media activity and middle ear cholesteatoma.It is the first report that cholesteatoma epithelium of middle ear cholesteatoma has fungi biofiln structure.Germiculture negative in chronic suppurative otitis media (activity) and middle ear cholesteatoma patients’ results cannot represent no bacterial biofilm formation in chronic otitis media.Bacteria culture results of patients with bacterial biofilm are consistent with the region bacteria detection,which are common bacteria in this region. Pseudomonas aeruginosa and coagulase negative staphylococcus are main pathogen of bacterial biofilm formation in chronic otitis media. |
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