慢性化脓性中耳炎和中耳胆脂瘤病原学及药物敏感性临床对比分析OA

Objective To develop evidence-based perioperative antibiotic selection strategies for patients with chronic suppurative otitis media(CSOM)and cholesteatoma of middle ear in Southwest China.Methods A total of 80 patients with CSOM and 179 patients with cholesteatoma of middle ear who underwent surgery at the Affiliated Hospital of Southwest Medical University from January to December 2023 were enrolled.The CSOM group included 27 males(27 ears)and 53 females(53 ears),aged 5 to 71 years(mean=43.5±15.2 years).The cholesteatoma group included 96 males(96 ears)and 83 females(83 ears),aged 3 to 83 years(mean=42.1±18.8 years).External auditory canal secretions were collected 24 hours before surgery.Pathogenic bacteria and antibiotic susceptibility profiles were compared between the two groups using the Kirby-Bauer method.Patients were further stratified into underage,young,middle-aged,and elderly groups for age based analysis.Results(1)Pathogen detection rates were 50%in the CSOM group and 49.7%in the cholesteatoma group,respectively.(2)In the CSOM group,Gram-positive bacteria were detected in 56%,Gram-negative bacteria in 36%,and fungi in 8%of cases,whereas in the cholesteatoma group,the corresponding rates were 49%,44%and 7%.(3)The predominant pathogens in both diseases were Staphylococcus aureus,Pseudomonas aeruginosa,Acinetobacter baumannii and Staphylococcus epidermidis.(4)Staphylococcus aureus showed high susceptibility to antimicrobiotics such as daptomycin,but high resistance to drugs such as ampicillin.Pseudomonas aeruginosa was susceptible to agents such as piperacillin/tazobactam,but showed variable resistance to drugs such as ciprofloxacin.Notably,resistance to aztreonam was significantly higher in Pseudomonas.aeruginosa in the CSOM group than in the cholesteatoma group(P<0.05).(5)In CSOM,detection of pathogens reached 100%in the underage group,but was at 45%to 50%in the other age groups.In cholesteatoma,the middle-aged group had the lowest detection rate(35.9%),significantly lower than that in the young adult group(P<0.05).Gram-positive bacteria predominated across all groups in CSOM.In cholesteatoma,Gram-positive bacteria predominated only in the young group,with Gram-negative bacteria predominating in the other age groups.(6)Staphylococcus aureus was the predominant pathogen in the underage and elderly groups in CSOM,as well as in the underage and middle-aged groups in cholesteatoma.Conclusions Staphylococcus aureus,Pseudomonas aeruginosa,Acinetobacter baumannii,and Staphylococcus epidermidis were the major pathogens in both CSOM and middle ear cholesteatoma.Pathogen detection rates and profiles varied across age.