| Background: Chronic suppurative otitis media and middle ear cholesteatoma are common diseases in Department of ENT,and the incidence rate is still high at home and abroad.Bacterial infection is an important pathogenic factor that causes repeated attacks.Affected by different factors in different regions,the distribution and main pathogenic bacteria of the two groups may be different.With the emergence of drug-resistant bacteria in recent years,it is particularly important to determine which pathogens are infected and to take reasonable anti infection treatment.Objective: To analyze and discuss the distribution of pathogenic bacteria in the external and middle ear of chronic suppurative otitis media and cholesteatoma of the middle ear and the resistance of main pathogenic bacteria,so as to provide guidance for reducing the production of resistant strains and selecting clinical antibiotics,and improve the clinical efficacy.Methods: 176 cases of chronic otitis media(including 70 cases of cholesteatoma in the middle ear and 106 cases of chronic suppurative otitis media)hospitalized in department of ENT from December 2018 to January 2020 in Shenzhen Second People's hospital were retrospectively collected.Bacteria culture and drug sensitivity test were carried out in the external auditory canal and the secretion of middle ear.According to the inclusion and exclusion criteria,it was divided into chronic suppurative otitis media group,cholesteatoma media group,external auditory meatus group and middle ear group.The distribution and composition ratio of pathogenic bacteria were recorded between each group.Through the chi square test,the differences in the detection of pathogenic bacteria between each group were analyzed,and the drug resistance of the main pathogens was analyzed.Results: 1.There were 106 cases of chronic suppurative otitis media.The positive rates of the bacteria culture in the external auditory canal and the middle ear were 83.02% and 51.89% respectively.90 strains of pathogenic bacteria were isolated and cultured from the external auditory canal.The main pathogenic bacteria were 32 coagulase negative staphylococci(35.57%),26 Staphylococcus aureus(28.89%)and 6 Candida sieversii(6.67%).56 strains of pathogenic bacteria were isolated and cultured in middle ear.And the main pathogens were Staphylococcus aureus 15(26.78%),coagulase negative Staphylococcus 10(17.86%)and Pseudomonas aeruginosa 10(17.86%).There was a notable difference in the number of coagulase negative staphylococci between the external auditory tract group and the middle ear group,and the latter is lower than the former(p=0.022).High number of Pseudomonas aeruginosa and Klebsiella pneumoniae in middle ear group,compared with the external auditory canal group(p=0.007?0.028).2.There were 70 cases of cholesteatoma in the middle ear.The positive rates of bacteria culture in the external auditory canal and the middle ear were 57.14% and 31.43% respectively.44 strains of pathogenic bacteria were isolated and cultured from the external auditory canal.The main pathogenic bacteria were 8 strains of Pseudomonas aeruginosa(18.18%),7 strains of Staphylococcus aureus(15.90%),6 strains of Klebsiella pneumoniae(13.64%).23 strains of pathogenic bacteria were isolated and cultured in middle ear.And the main pathogens were Pseudomonas aeruginosa 6(26.08%),Staphylococcus aureus 4(17.39%),Klebsiella pneumoniae 3(13.04%).The number of Gram-positive bacteria,Gram-negative bacteria and fungi in the external auditory canal group and the middle ear group were different,but the difference was not statistically significant(p>0.05).3.In the isolation and identification of pathogens in the external auditory canal,the number of G+bacteria and G-bacteria in chronic suppurative otitis media and cholesteatoma media group was greatly different(p<0.05).The comparison between the two groups is marked: the number of coagulase negative Staphylococcus was high in chronic suppurative otitis media(p=0.008),however,the number of Pseudomonas aeruginosa and Klebsiella pneumoniae in cholesteatoma group was high(p=0.009?0.028).The number of fungi detected in the two groups was different,but not statistically significant(P > 0.05).The number of Gram-positive bacteria,Gram-negative bacteria and fungi in the middle ear of chronic suppurative otitis media and cholesteatoma media group was different,but the difference was not statistically significant(p>0.05).4.The positive rate of pathogenic bacteria in the external auditory canal group of chronic suppurative otitis media and cholesteatoma media was higher than that in the middle ear group(p<0.05).In chronic suppurative otitis media group,the positive rate of pathogenic bacteria culture in external auditory canal and middle ear was longer than that in cholesteatoma media group.And the above constrasts are statistically notable(p<0.05).5.52 strains of Staphylococcus aureus were resistant to erythromycin,clindamycin and oxacillin in varying degrees,and the resistance rate to penicillin G was 65.38%;And the sensitivity rate to linezolid,quinupine / daputin,tegacyclin,vancomycin,doxycycline and furantoin was 100%.The drug resistance rate of 28 strains of Pseudomonas aeruginosa to cefazolin,cefotetan,ceftriaxone,ampicillin / sulbactam,compound minophen and furantoin was 100%;And the sensitivity rate to amikacin and cefepime was 100%.Conclusion: 1.Coagulase negative staphylococcus,Staphylococcus aureus and Pseudomonas aeruginosa were the main infections of chronic otitis media in this area;And the detection rate of fungi was high.2.The main pathogenic bacteria of chronic suppurative otitis media and cholesteatoma of the middle ear were not the same.Coagulase negative Staphylococcus and Staphylococcus aureus were the main pathogens in the external auditory canal and middle ear or mastoid of chronic suppurative otitis media,and pseudomonas aeruginosa was the main pathogenic bacteria in the external auditory canal and middle ear or mastoid of cholesteatoma.3.The resistant rate of Staphylococcus aureus to penicillin G was 65.38%,and the sensitive rate to linezolid,quinupine / daputin,tegacyclin,vancomycin,doxycycline and furantoin was 100%.The drug resistance rate of Pseudomonas aeruginosa to cefazolin,cefotetan,ceftriaxone,ampicillin / sulbactam,compound minophen and furantoin was 100%,and the sensitivity rate to amikacin and cefepime was 100%.4.It is of great significance for the selection of clinical antibiotics,the reduction of the production of drug-resistant bacteria and the improvement of clinical efficacy to actively improve the identification of pathogenic bacteria in the external auditory canal and the secretion of the middle ear of chronic suppurative otitis media and cholesteatoma. |
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