Tantilipikorn Pongsakorn, Fritz Michael, Tanabodee Jirayu, Lanza Donald C, Kennedy David W
Department of Otolaryngology, Chiangmai University, Thailand.
Am J Rhinol. 2002 Sep-Oct;16(5):255-60.
Recent evidence suggests that endoscopically obtained cultures from the middle meatus give comparable results to antral puncture for acute sinusitis. The best method for obtaining middle meatal cultures remains somewhat controversial because it has been theorized that specimens obtained with a swab are contaminated easily. This study compares endoscopic culture results from two different methods: swab and aspiration. Specifically, this study sought to determine whether or not the culture contamination rate is higher using the swab versus an aspiration technique.
One hundred consecutive culture specimensfrom 81 chronic rhinosinusitis patients were compared. Fifty cultures were obtained using a swab technique (group I) and another 50 cultures were obtained by aspirating pathological material into a sterile suction trap (group II). The patient populations in each group were similar; there were no differences in terms of age, gender, comorbid medical conditions, or prior medical therapy. Cultures were considered contaminated if they yielded normal nasal flora or if rare or few Staphylococcus coagulase-negative colonies grew after no bacteria was identified in gram stain. Staphylococcus aureus, Staphylococcus coagulase-negative, and Pseudomonas aeruginosa were the three most common organisms in both groups.
Gram-negative bacteria were noted in 21/60 (35%) positive cultures. Although the contamination rate of the suction aspiration group (14%) was less than the endoscopic swab group (10%), this did not approach statistical significance (p = 0.75).
Data from this study suggest that endoscopically guided aspiration of pathological material is no better than properly obtained swabs in directing antimicrobial therapy for chronic rhinosinusitis.
最近的证据表明，从中鼻道通过内镜获取的培养物对于急性鼻窦炎的诊断结果与上颌窦穿刺相当。获取中鼻道培养物的最佳方法仍存在一定争议，因为从理论上讲，用拭子获取的标本容易受到污染。本研究比较了两种不同方法（拭子法和抽吸法）的内镜培养结果。具体而言，本研究旨在确定使用拭子法与抽吸技术相比，培养污染率是否更高。
比较了81例慢性鼻-鼻窦炎患者的100份连续培养标本。50份培养物通过拭子技术获取（第一组），另外50份培养物通过将病理材料抽吸到无菌吸引器中获取（第二组）。每组的患者群体相似；在年龄、性别、合并症或既往治疗方面没有差异。如果培养物产生正常鼻菌群，或者在革兰氏染色未发现细菌后生长出罕见或少量凝固酶阴性葡萄球菌菌落，则认为培养物受到污染。金黄色葡萄球菌、凝固酶阴性葡萄球菌和铜绿假单胞菌是两组中最常见的三种微生物。
在60份阳性培养物中，有21份（35%）发现革兰氏阴性菌。虽然抽吸组的污染率（14%）低于内镜拭子组（10%），但差异无统计学意义（p = 0.75）。
本研究数据表明，在内镜引导下抽吸病理材料在指导慢性鼻-鼻窦炎的抗菌治疗方面并不比正确获取的拭子更好。
