亞急性鼻及鼻竇炎之細菌學及抗藥性分析

Bacteriology and Antimicrobial Resistance in Subacute Rhinosinusitis

林伯鴻(Po-Hong Lin) ； 黃威雄(Wei-Hsiung Huang) ； 邱碩堯(Shuo-Yao Chiu) ； 賴美珠(Mei-Chu Lai)

《台灣耳鼻喉頭頸外科雜誌》 40卷5期 (2005/08) Pp. 185-192

https://doi.org/10.6286/2005.40.5.185

摘要

背景：亞急性鼻及鼻竇炎(subacute rhinosinusitis；SRS)是指鼻及鼻竇炎持續症狀至少4個星期，但少於3個月。了解SRS的細菌學及抗藥性分析，對於鼻及鼻竇炎病程的了解、抗生素和其他治療方式的選擇有很大的幫助。本研究針對門診之SRS患者，進行中鼻道之細菌培養，藉以了解細菌種類與分布比例，並對抗藥性進行分析。
方法：本研究收集連續兩年半本院耳鼻喉科門診之SRS患者，採集其中鼻道膿性分泌物進行好氧及厭氧細菌之培養，並測試其對抗生素之敏感性。
結果：病例人數共59名，培養菌株數目（好氧菌／厭氧菌）為84/18株。59名皆有做好氧菌培養，其中Streptococcus pneumoniae（成人／兒童）佔19/23.8%，Haemophilus influenzae佔14.2/20.6%，Moraxella catarrhalis佔9.5/30.1%。47名有做厭氧菌培養，其中厭氧菌（成人／兒童）佔24/19.6%。S. pneumoniae對抗生素的敏感性百分比為penicillin: 26.3%，sulfamethoxazole-trimethoprim: 47.3%，erythromycin: 0%，ofloxacin: 94.7%。H. influenzae對抗生素的敏感性百分比為ampicillin: 31.2%，sulfamethoxazole-trimethoprim: 50%，cefaclor: 68.7%，cefuroxime: 93.7%，amoxicillin-clavulanate/ampicillin-sulbactam: 100%，ofloxacin: 100%。M. catarrhalis對抗生素的敏感性百分比為ampicillin: 14.2%，sulfamethoxazole-trim ethoprim: 70%，cefaclor: 61.9%，cefuroxime: 90.4%，amoxicillin-clavulanate/ampicillin-sulbactam: 100%，ofloxacin: 95.2%。厭氧菌對抗生素的敏感性百分比為penicillin: 50%，clindamycin: 88.8%，ampicillin-sulbactam: 77.7%，metronidazole: 94.4%，chloramphenicol: 100%。
結論：本研究發現SRS主要好氧菌的種類與急性鼻及鼻竇炎(acute rhinosinusitis；ARS)相類似，且厭氧菌的比例高於一般文獻記載的ARS。好氧菌及厭氧菌已對部分常用抗生素產生抗藥性，且情況比ARS嚴重。

關鍵字

亞急性鼻及鼻竇炎 ； 細菌抗藥性 ； 細菌學

並列摘要

BACKGROUND: Subacute rhinosinusitis (SRS) refers to symptoms of rhinosinusitis that last for four to twelve weeks. An understanding of the bacteriology of SRS together with an assessment of the antimicrobial resistance of the organisms involved in SRS will be helpful when choosing antibiotic therapy and alternative treatments. Middle meatus discharge from outpatients diagnosed with SRS was used to identify the type and proportion of bacteria present as well as their resistance.to antimicrobial agents.
MATERIALS AND METHODS: This study was carried out over two and half years. The middle meatus discharge was collected from outpatients who had been diagnosed with SRS at our Otolaryngology Department clinic. These specimens were sent for aerobic/anaerobic culture and antibiotic susceptibility testing.
RESULTS: A total of 59 patients were recruited. The numbers of bacterial isolates that were positive aerobic or anaerobic bacterial were 84 and 18 respectively. All 59 specimens were sent for aerobic culture. Of these, 19%/23.8% (adults/children) were found to contain Streptococcus pneumoniae, 14.2%/20.6% Haemophilus influenzae and 9.5%/30.1% Moraxella catarrhalis . Anaerobic culture were carried out on samples from 47 cases and 24%/19.6% (adults/children) were found to contain anaerobic bacteria. The percentage antibiotic susceptibility for S. pneumoniae was 26.3% for penicillin, 47.3% for sulfamethoxazole-trimethoprim, 0% for erythromycin and 94.7% for ofloxacin. The percentage antibiotic susceptibility for H. influenzae was 31.2% for ampicillin, 50% for sulfamethoxazole-trimethoprim, 68.7% for cefaclor, 100% for amoxicillin-clavulanate/ ampicillin-sulbactam, 93.7% for cefuroxime and 100% for ofloxacin. The percentage antibiotic susceptibility for M. catarrhalis was 14.2% for ampicillin, 70% for sulfamethoxazoletrimethoprim, 61.9% for cefaclor, 100% for amoxicillin-clavulanate/ampicillinsulbactam, 90.4% for cefuroxime and 95.2% for ofloxacin. The percentage antibiotic susceptibility for anaerobic bacteria was 50% for penicillin, 88.8% for clindamycin, 77.7% for ampicillin-sulbactam, 94.4% for metronidazole and 100% for chloramphenicol.
CONCLUSION: The major aerobic bacteria involvd in SRS were found to be similar to those causing acute rhinos inusitis (ARS). Furthermore, the percentages of cultures that were positive for anaerobic bacteria 19.1% was higher than the previously published data for ARS. Aerobic and anaerobic bacteria were resistant to some common antibiotics. The proportion of resistant strains was higher for SRS than for ARS. SRS thus will require a longer treatment period with medication than ARS.

並列關鍵字

subacute rhinosinusitis ； antimicrobial resistance ； bacteriology