Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, 37 Guo Xue Lane, Chengdu, 610064, Sichuan, People's Republic of China.
Biotechnol Lett. 2020 Aug;42(8):1559-1566. doi: 10.1007/s10529-020-02880-7. Epub 2020 Apr 8.
Chronic suppurative otitis media (CSOM) and middle ear cholesteatoma (MEC) were classified as different diseases recently. Owing to the difference in pathogeneses, the pathogenic bacteria of the two diseases can be different. However, few studies have compared the two types of pathogenic bacteria.
To analyze the main pathogenic bacteria and drug sensitivities in patients of Southwest China with CSOM and MEC and compare the difference of ear dryness rate between empirical and sensitive medication.
According to the data of culture of ear discharge and postoperative pathological examination, the patients were divided into CSOM and MEC groups. A cohort study was carried out in 1087 hospitalized patients with CSOM and MEC in the Department of Otolaryngology head and neck surgery, West China Hospital from January 2015 to June 2019.
Pathogenic bacteria were detected in 467 of 726 cases of CSOM (64.46%) and in 190 of 361 cases of MEC (52.63%). Of the positive cases, 53.96% involved gram-positive (G+) bacteria and 46.04% involved gram-negative (G-) bacteria in the CSOM group; 41.05% involved G+ bacteria and 58.95% involved G- bacteria in the MEC group (P < 0.05). In the CSOM group, the top four pathogens were Staphylococcus aureus (33.62%), Pseudomonas aeruginosa (23.98%), Proteus (16.92%), and Coagulase-negative Staphylococci (10.28%). The top four pathogens in the MEC group were Proteus (22.11%), S. aureus (21.05%), P. aeruginosa (15.26%), and coagulase-negative staphylococci (8.42%). S. aureus was more sensitive to ciprofloxacin and moxifloxacin in the MEC group than in the CSOM group (= 14.286, P < 0.001; = 8.244, P < 0.01). P. aeruginosa was more sensitive to neomycin and tobramycin in the MEC group than in the CSOM group (= 21.285, P < 0.001; = 4.060, P < 0.05). The sensitivity rate of coagulase-negative staphylococci to neomycin in the MEC group was higher than that in the CSOM group (= 5.126, P < 0.05). The sensitivity of Proteus to piperacillin tazobactam in the CSOM group was higher than that in the MEC group (= 8.881, P < 0.05). The dry ear rate of patients with sensitive drug was significantly higher than the patients with empirical drug (= 19.431, P < 0.001).
The detection rate of G+ bacteria in the CSOM group was higher than that in the MEC group. The detection rate of G- bacteria in the CSOM group was lower than that in the MEC group. The main pathogens in the two groups included S. aureus, P. aeruginosa, Proteus and coagulase negative Staphylococcus. The dry ear rate of patients who used sensitive drugs was significantly higher than the patients who used empirical drugs. Reducing the rate of empirical use of antibiotics as much as possible and selecting antibiotics reasonably were beneficial to the improvement of dry ear rate after surgery.
慢性化脓性中耳炎（CSOM）和中耳胆脂瘤（MEC）最近被分类为两种不同的疾病。由于发病机制不同，两种疾病的病原菌可能不同。然而，很少有研究比较这两种疾病的病原菌。
分析中国西南地区 CSOM 和 MEC 患者的主要病原菌和药敏情况，并比较经验性用药和敏感用药的干耳率差异。
根据耳分泌物培养和术后病理检查结果，将患者分为 CSOM 和 MEC 组。对 2015 年 1 月至 2019 年 6 月在华西医院耳鼻咽喉头颈外科住院的 CSOM 和 MEC 患者（共 1087 例）进行队列研究。
CSOM 组中 726 例患者中有 467 例（64.46%）、MEC 组中 361 例患者中有 190 例（52.63%）检出病原菌。阳性病例中，CSOM 组 G+ 细菌占 53.96%，G- 细菌占 46.04%；MEC 组 G+ 细菌占 41.05%，G- 细菌占 58.95%（P<0.05）。CSOM 组前 4 位病原菌分别为金黄色葡萄球菌（33.62%）、铜绿假单胞菌（23.98%）、变形杆菌（16.92%）和凝固酶阴性葡萄球菌（10.28%）。MEC 组前 4 位病原菌分别为变形杆菌（22.11%）、金黄色葡萄球菌（21.05%）、铜绿假单胞菌（15.26%）和凝固酶阴性葡萄球菌（8.42%）。金黄色葡萄球菌对 MEC 组中的环丙沙星和莫西沙星比 CSOM 组更敏感（=14.286，P<0.001；=8.244，P<0.01）。铜绿假单胞菌对 MEC 组中的庆大霉素和妥布霉素比 CSOM 组更敏感（=21.285，P<0.001；=4.060，P<0.05）。MEC 组凝固酶阴性葡萄球菌对庆大霉素的敏感率高于 CSOM 组（=5.126，P<0.05）。CSOM 组变形杆菌对哌拉西林他唑巴坦的敏感率高于 MEC 组（=8.881，P<0.05）。敏感药物组的干耳率明显高于经验性药物组（=19.431，P<0.001）。
CSOM 组 G+ 细菌检出率高于 MEC 组，CSOM 组 G- 细菌检出率低于 MEC 组。两组主要病原菌包括金黄色葡萄球菌、铜绿假单胞菌、变形杆菌和凝固酶阴性葡萄球菌。使用敏感药物的患者干耳率明显高于使用经验性药物的患者。尽量减少经验性使用抗生素，并合理选择抗生素，有利于提高术后干耳率。
