耳前瘻管合併膿瘍之細菌學研究－某醫學中心十年經驗

The Bacteriology of Preauricular Fistula with Abscess Formation-A 10-Year Experience in a Medical Center

郭紀榮(Ji-Rung Kuo) ； 林明毅(Ming-Yee Lin) ； 朱繡棟(Sau-Tung Chu)

《台灣耳鼻喉頭頸外科雜誌》 46卷3期 (2011/07) Pp. 127-135

https://doi.org/10.6286/2011.46.3.127

摘要

背景：耳前瘻管往往易發生細菌感染而造成反覆性膿瘍，因此有必要去探討常見之菌種及抗生素的效用，近10年內，國內文獻已鮮少論及耳前瘻管合併膿瘍之細菌學，特報告高雄榮總近10年內耳前瘻管合併膿瘍之細菌學培養的結果。材料及方法：本研究以回溯性方式，經由病歷紀錄，收集2000年1月至2009年12月，耳前瘻管合併膿瘍至本院住院，於手術室中進行切開引流術，共計173名（男77名，女96名），平均年齡爲24.1歲（範圍：11個月至89歲），共計176耳的手術（3名患者經歷雙耳手術），術中採集切開引流之膿液，進行嗜氧及厭氧菌的培養，併測試其對抗生素的敏感性。結果：陽性培養率爲59.1%。共培養出129株優勢菌種，其中39.5%爲嗜氧性革蘭氏陽性菌，31.0%爲嗜氧性革蘭氏陰性菌，24.8%爲厭氧菌。其中較常見之菌種，依序爲Staphylococcus屬(20.2%)，Pseudomonas aeruginosa (8.5%)，Staphylococcus屬(8.5%)屬，Proteus屬(6.2%)，Prevotella屬(6.2%)，Bacteroids屬、Citrobacter屬、Enterococcus屬、Klebsiella屬及Peptostreptococcus屬皆佔5.4%，各菌種抗生素敏感性測試結果不盡相同，雖然經常用之第一線抗生素，對大部分菌種的敏感性均高，但仍有部分菌種具高抗藥性。結論：本院耳前瘻管合併感染時，以Staphylococcus、Pseudomonas aeruginosa、Streptococcus及厭氧菌爲主。針對常用之第一線抗生素包括Penicillin、Cefazolin、Gentamicin、Oxacillin及口服Cephalexin、Trimethoprim/Sulfamcthoxazole (TMP/SMX)、Cloxacillin，仍保有很高的敏感性，一旦發生感染時，儘管細菌培養報告未出來，仍應儘早使用經驗性抗生素，以避免膿瘍之產生。

關鍵字

膿瘍 ； 抗生素 ； 耳前瘻管

並列摘要

BACKGROUND: Preauricular fistula is prone to recurrent bacterial infections, and thus resulting in subsequent abscess formation. Appropriate antibiotics must be prescribed in the right way and timing for better infection control. Then, the fistulectomy thereafter could done radically with lower recurrence rate due to better infection control and less scar formation. Reports of the bacteriology of the above infections were limited in Taiwan's scientific literature over the last decade. The necessity to discuss the common bacterial colony and the effectiveness of antibiotics treatment is therefore very imperative. We will report the result of cultures from the abscess drainage operations that were held at Kaoshing Veteran General Hospital during the last ten years.MATERIALS AND METHODS: A retrospective chart review from January 2000 to December 2009 was held, 173 preauricular fistula abscess patients were enrolled, there were 77 males and 96 females with an average age of 24.1 years ranged from 11 months to 89 years old. Incision was made over the abscess and pus was collected intra-operatively and then sent for aerobic and anaerobic cultures, including antibiotic sensitivity testing.RESULTS: The positive culture rate was 59.1%. A total of 129 dominant strains were obtained. 39.5% was aerobic Gram-positive bacteria, 31.0% was aerobic Gram-negative bacteria, and 24.8% was anaerobic bacteria. In terms of the strains, 20.2% was Staphylococcus species, 8.5% were Pseudomonas aeruginosa and Streptococcus species, 6.2% were Proteus species and Prevotella species, 5.4% were Bacteroids species, Citrobacter species, Enterococcus species, Klebsiella species and Peptostreptococcus species. Antibiotic susceptibility test results were varied, but the most frequently used first-line antibiotics, including Penicillin, Cefazolin, Gentamicin, Oxacillin and Trimethoprim/Sulfamethoxazole (TMP/SMX) could still have sensitivities in most of these strains.CONCLUSION: In our study, Staphylococcus species, Pseudornonas aeruginosa, Streptococcus species and Anaerobes predominated in the preauricular fistula abscess, and the antibiotic susceptibility test results were varied. However, the commonly used first-line antibiotics such as Penicillin, Cefazolin, Gentamicin, Oxacillin, Cephalexin, Trimethoprim/Sulfamethoxazole (TMP/SMX) and Cloxacillin still retain a very high sensitivity to the above strains. Therefore, empirical first-line antibiotics should be introduced as early as possible before the results of bacterial culture obtained to avoid subsequent abscess formation.

並列關鍵字

abscess ； antibiotics ； preauricular fistula