Deb Tanmoy, Ray Debabrata
Tripura Health Services, IGM Hospital, 23 Mantri Bari Road, Agartala, Tripura (West) 799001 India.
Indian J Otolaryngol Head Neck Surg. 2012 Dec;64(4):326-9. doi: 10.1007/s12070-011-0323-6. Epub 2011 Nov 5.
Chronic suppurative otitis media (CSOM) is one of the most commonly encountered diseases in otolaryngology practice. Even in this era of powerful antibiotics, CSOM still consumes considerable medical expenditure, especially in the poorer sections of the society. The present prospective study was conducted at the IGM Hospital, Agartala, in North East India towards clinico-microbiologic evaluation of chronic suppurative otitis media. The focus was mainly on aerobic bacteria, involved in active CSOM in adults as well as children. An attempt was made, despite resource and man power constraints, to have a glimpse of the current antibiotic sensitivity pattern, with special reference to ciprofloxacin. However, the main aim of this study is to see the types of aerobic bacteria involved in CSOM, in our region. Aural swabs were collected from 100 ears, from 97 patients complaining of ear discharge, continuous or intermittent, with a non- intact tympanic membrane for at least 12 weeks. Swabs were sent to the hospitals microbiology laboratory for culture and sensitivity tests. Bacteria could be isolated in 53 cases and 47 swabs were culture negative. The commonest bacteria isolated was pseudomonas (20) followed by Staphylococcus aureus (11), E. coli (11), proteus (9) and klebseilla (2). Three patients had bilateral ear discharge of which one had proteus in both ear swabs, one grew proteus in one ear and no growth in the other, and one patient showed no aerobic bacteria in any of his ear swabs. Among the culture positive cases (n = 53) gram negative bacteria were isolated in 79.24% (n = 42) and S. aureus in 11(20.75%) cases. Among 97 patients number of male and female patients was 50 and 47, respectively. Pseudomonas, E. coli, Bacilli proteus and S. aureus were the predominant bacteria involved in CSOM. Out of the 53 positive isolates ciprofloxacin could be tested against 35 i.e., 66%. Ciprofloxacin was sensitive in 26 isolates, intermediately sensitive in 4 and resistant in only five isolates. It is concluded that, gram negative bacteria especially pseudomonas is the commonest bacteria involved in CSOM in this part of north east India. Ciprofloxacin is an important tool in the management of active CSOM as it is cheap, less ototoxic and widely available as topical preparations.
慢性化脓性中耳炎（CSOM）是耳鼻喉科临床最常见的疾病之一。即使在强效抗生素时代，CSOM仍耗费大量医疗费用，在社会贫困阶层中尤为如此。本前瞻性研究在印度东北部阿加尔塔拉的IGM医院开展，旨在对慢性化脓性中耳炎进行临床微生物学评估。重点主要放在参与成人及儿童活动性CSOM的需氧菌上。尽管存在资源和人力限制，仍尝试了解当前的抗生素敏感性模式，特别提及环丙沙星。然而，本研究的主要目的是了解我们地区CSOM中涉及的需氧菌类型。从97例主诉有持续或间歇性耳漏、鼓膜穿孔至少12周的患者的100只耳朵采集耳拭子。拭子被送往医院微生物实验室进行培养和药敏试验。53例培养出细菌，47例拭子培养阴性。分离出的最常见细菌是铜绿假单胞菌（20例），其次是金黄色葡萄球菌（11例）、大肠杆菌（11例）、变形杆菌（9例）和克雷伯菌（2例）。3例患者双耳有耳漏，其中1例双耳拭子均培养出变形杆菌，1例一只耳朵培养出变形杆菌，另一只耳朵无细菌生长，1例患者双耳拭子均未培养出需氧菌。在培养阳性病例（n = 53）中，79.24%（n = 42）分离出革兰氏阴性菌，11例（20.75%）分离出金黄色葡萄球菌。97例患者中，男性50例，女性47例。铜绿假单胞菌、大肠杆菌、变形杆菌和金黄色葡萄球菌是CSOM中主要涉及的细菌。在53株阳性分离株中，35株（即66%）可进行环丙沙星药敏试验。环丙沙星在26株分离株中敏感，4株中度敏感，仅5株耐药。得出结论，革兰氏阴性菌尤其是铜绿假单胞菌是印度东北部该地区CSOM中最常见的细菌。环丙沙星是治疗活动性CSOM的重要药物，因为它价格便宜、耳毒性较小且有多种外用制剂可供使用。
