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成人置入中耳通氣管後之耳漏細菌學分析

Bacteriology of Post-tympanostomy Tube Otorrhea in Adults

摘要


背景:積液性中耳炎的研究絕大多數集中在兒童身上,成人的病例雖然不少,但相關研究卻很少。本研究目的為探討成人積液性中耳炎患者,置入中耳通氣管後發生耳漏時,造成感染的致病微生物及其抗藥性等相關特性。方法:本研究為回朔性分析,研究期間從2004年7月到2010年2月,研究對象為成人因中耳積液裝置中耳通氣管,於門診追蹤時發生通氣管耳漏,取其通氣管分泌物做細菌培養,統計其菌種與藥物敏感性比例。結果:共收集62名病例,男性43人次與女性19人次,平均年齡58.6 ± 13.9歲,患者皆因中耳積液而有放置通氣管,平均放置時間為10.8個月。18名(29%)病人無法培養出菌種,其餘44名共培養菌株56株,其中細菌40株(71%),黴菌16株(29%),最常見的致病細菌為金黃色葡萄球菌(Staphylococcus aureus),共12例(21%)。其次為綠膿桿菌(Pseudomonas aeruginosa),占5例(9%),非綠膿桿菌的葛蘭氏陰性菌(Gram-negative Bacilli)則有7例(13%)。各菌種對第一線抗生素的敏感性比例都相當低。結論:成人植入通氣管後發生耳漏其感染的病菌種類呈現多樣性,其中黴菌、金黃色葡萄球菌、綠膿桿菌與葛蘭氏陰性菌為四類主要致病微生物,顯示致病微生物大多數來自外耳道而非中耳腔。成人通氣管置入後耳漏的藥物治療,應該以quinolone類耳滴劑為主,並輔以徹底的局部治療。若抗生素治療效果不彰,或有觀察到黴菌感染現象,宜改以抗黴菌耳滴劑或藥膏治療。

並列摘要


BACKGROUND: Most of the studies about otitis media with effusion are performed in pediatric population. The incidence of adult otitis media with effusion is not low, but there are few studies about this disease entity. Therefore, the aim of this study is to understand the microbiology and drug resistance in the post-tympanostomy tube otorrhea in adult otitis media with effusion.METHODS: This is a retrospective study. The study period was from July, 2004 through February, 2010. We had chart review of adult patients with otitis media with effusion and ventilation tube insertion. When post-tympanostomy tube otorrhea was noted, the ear discharge was collected and sent for microbiology studies. The pathogens were isolated and drug sensitivity tests were performed. The above data was collected for statistic analysis.RESULTS: There were 62 patients recruited, including 43 males and 19 females. The average age is 58.6 ± 13.9 years. The average duration of tube insertion is 10.8 months. There was no isolate found in 18 patients (29%). There were 56 isolates found in the other 44 patients (71%). The 56 isolates included 40 bacteria and 16 fungi. The most frequently isolated pathogen was Staphylococcus aureus (12 isolates, 21%). The second was Pseudomonas aeruginosa (5 isolates, 9%). There were 7 isolates (13%) of Gramnegative bacilli except Pseudomonas. Most of the pathogens had low rate of drug sensitivity to first line antibiotics.CONCLUSIONS: The microbiology of post-tympanostomy tube otorrhea in adults was diverse. There are four main categories of pathogens, including fungi, S. aureus, P. aeruginosa and Gram-negative bacilli. The microbiology indicates that most of the pathogens are from external ear canal, not from middle ear cavity. The first choice of treatment for post-tympanostomy tube otorrhea is topical use of quinolone ear drops, in accompany with aggressive local cleansing. If quinolone ear drops does not work well or there are some evidences of fungal infection, topical antifungal agents should be administered.

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