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Kuang Tien Medical Journal Vol.3 No.6 2008 光田醫學雜誌 第3卷 第6期 2008Kuang Tien Medical Journal Vol.3 No.6 2008 光田醫學雜誌 第3卷 第6期 2008 69
原著研究
某區域醫院近3年內急性化膿性外耳道炎之細菌學研究陳建志1,2,3 陳登郎4*
行政院衛生署桃園醫院耳鼻喉科1;行政院衛生署竹東醫院耳鼻喉科2;
天主教輔仁大學醫學院醫學系3;吉豐耳鼻喉科診所4
摘 要
目的:急性外道炎是耳鼻喉科常見的疾病,本文報告近3年內本院門診中,所有急性化膿
性外耳道炎患者細菌培養的結果。
材料及方法:收集本院自2005年1月到2008年3月間,所有急性化膿性外耳道炎的病患,
共計37名(男21名,女16名),年齡為52.9±27.6(平均值±標準差),其中1名為惡性外耳道
炎患者。採集耳道內之膿液,進行嗜氧菌與厭氧菌的培養,並測試其對抗生素的敏感性。
結果:5名無法分離出優勢菌種,30名培養出1種細菌,2名培養出2種細菌。共培養
出34株優勢菌種,尚無厭氧菌,其中52.9%(18 of 34)為Staphylococcus屬,20.6%(7 of 34)
為Pseudomonas aeruginosa,17.6%(6 of 34)為真菌類。Trimethoprim/Sulfamethoxazole對
Amikacin、Amoxicllin/Clavulanate、Ampicillin/Sulbactum、Ampicillin、Cefaclor、Cefazolin、C e f e p i m e、C e f o t a x i m e、C e f t a z i d i m e、Ceftr iaxone、Cefuroxime、Ciprof loxacin、Clarithromycin、Clindamycin、Erythromycin、
R i f a m p i n、Te t r a c y c l i n、T r i m e t h o p r i m /Sulfamethoxazole(TMP/SMX)或Vancomycin等抗生素測定其最低抑菌濃度 (Minimal inhibitory concentration,MIC),以鑑定其敏感性,當MIC值在0.06μg/mL以下定義為敏感性菌株,2μg/mL以上定義為高度抗藥性菌株,介於兩者之間
為中度抗藥性(例如1.0μg/mL)。
結果
有5名無法分離出優勢菌種,30名培養出
1種細菌,2名培養出2種細菌。共培養出34株優勢菌種,尚無厭氧菌,其中52.9%(18 of 34)為Staphylococcus屬(表一),20.6%(7 of 34)為Pseudomonas aeruginosa,17.6%(6 of 34)為真菌類(Aspergillus屬4株與Candida屬2株),
其他為Klebsiel la oxytoca 1株、Branhamella catarrhalis 1株及Streptococcus pneumonia 1株。
在Staphylococcus屬中有高達44.4%(8 of 18)為Methicillin-resistant Staphylococcus aureus(表
一)。
陳建志 陳登郎
表一、Staphylococcus屬的種類及數量
種類 數量
Methicillin-sensitive Staphylococcus aureus
8
Methicillin-resistant Staphylococcus aureus
8
Coagulase(-) Staphylococcus 2
Kuang Tien Medical Journal Vol.3 No.6 2008 光田醫學雜誌 第3卷 第6期 2008Kuang Tien Medical Journal Vol.3 No.6 2008 光田醫學雜誌 第3卷 第6期 2008 71
Staphy lococcus屬對抗生素的敏感性依序
為Va n c o m y c i n(100%)、R i f a m p i n(94.4%)、TMP/SMX (94.4%)、Levofloxacin(88.9%)、O x a c i l l i n(55.6%)、Te t r a c y c l i n e(55.6%)、Clindamycin(50%)、Erythromycin(38.9%)及Penicillin(5.6%)。而Pseudomonas aeruginosa對抗生素的敏感性依序為C e f e p i m e(100%)、G e n t a m y c i n ( 1 0 0 % )、 I m i p e n e m ( 1 0 0 % )、C e f a z o l i n ( 1 0 0 % ) 、 P i p e r a c i l l i n -Tazobactam(100%)、Ciprofloxacin(85.7%)及TMP/SMX(0%)。
討論
急性外耳道炎好發於成人,嬰幼兒較不常
見,大多會有耳痛及耳漏的症狀,少數病症嚴
重者會造成聽障,與急慢性中耳炎最重要的差
異在於鼓膜一定是完整的,固然慢性中耳炎的
分泌物過多時,亦有可能續發濕疹性外耳道炎
(eczematous otitis externa),但是,致病機轉與
單純的急性外耳道炎不同 (1 ),加上病例數不
多,故排除於本文。
急性外耳道炎可由各種病原體感染外耳道
上的傷口所造成,據文獻記載以Staphylococcus a u r e u s 感染最多,其次為 P s e u d o m o n a s a e r u g i n o s a,真菌類也有可能 (1),本文研究
結果亦呈現以Staphylococcus屬為主(52.9%),其次為P s e u d o m o n a s a e r u g i n o s a(20.6%)與真菌類 ( 1 7 . 6 % )。本文S t a p h y l o c o c c u s屬對
於Pen ic i l l in或Ery th romyc in的敏感性過低,
所幸對Vancomyc in、Ri famp in、TMP/SMX或L e v o f l o x a c i n等抗生素的敏感性較高,
而P s e u d o m o n a s a e r u g i n o s a對C e f e p i m e、G e n t a m y c i n、 I m i p e n e m、C e f a z o l i n、Piperacillin-Tazobactam或Ciprofloxacin等抗生素
Kuang Tien Medical Journal Vol.3 No.6 2008 光田醫學雜誌 第3卷 第6期 200874 Kuang Tien Medical Journal Vol.3 No.6 2008 光田醫學雜誌 第3卷 第6期 2008
The Bacteriology of Acute Suppurative Otitis Externa at a Regional Hospital in Recent 3 Years
Jiann-Jy Chen1,2,3and Dem-Lion Chen4*
Department of Otorhinolaryngology, Tao-Yuan Hospital1, Department of Health, Executive Yuan,
Taoyuan2; Department of Otorhinolaryngology, Chu-Tung Hospital3, Department of Health, Executive
Yuan, Hsinchu4
*Corresponding authorReceived:6 Feb 2008;Accepted:7 Apr 2008
Abstract
Purpose: Acute otitis externa is a common otorhinolaryngologic disease. We report the result of bacterial culture of acute suppurative otitis externa (AsOE) at outpatient department in recent 3 years.
Materials and methods: From January 2005 to March 2008, 37 AsOE patients were enrolled, including 21 males and 16 females. They were aged 52.9±27.6 (average±standard deviation). Only one of them suffered malignant otitis externa. The suppurative discharge was collected from the infected external auditory canal, and then was sent for bacterial culture with sensitivity to antibiotics.
Results: Five specimens did not have any significant bacterial growth. Thirty specimens had one significant bacterial growth, and two specimens had two significant bacterial growths. There were total 34 significant bacterial growths, but there were no anaerobic bacterial growth. Of them, 52.9% (18 of 34) were Staphylococcus species; 20.6% (7of 34), Pseudomonas aeruginosa; and 17.6% (6 of 34), fungi. There is a quite different sensitivity to Trimethoprim/Sulfamethoxazole between Staphylococcus species and Pseudomonas aeruginosa.
Conclusions: Staphylococcus species, Pseudomonas aeruginosa or fungi predominate in AsOE. The eardrops should be applied according to the result of bacterial culture.