专科鼻窦中心慢性鼻窦炎患者细菌检出率及抗菌药物耐药性的演变

文献信息

中文摘要

背景： 抗生素常被用于慢性鼻窦炎（CRS）急性加重期的治疗。然而，抗菌药物耐药性对CRS患者当前及未来的管理构成了挑战。
目的： 本研究旨在探讨某三级鼻窦中心当前及过去的微生物检出率及抗菌药物耐药谱。
方法： 对2015年至2018年以及2019年至2024日历年度内，所有在门诊就诊时采集了鼻窦微生物样本且有既往内镜鼻窦手术（ESS）史的CRS患者，进行了回顾性结果审查。
结果： 共分析了来自338例患者的706份培养物。2015-2018年期间，60.0%的病例检出了具有临床意义的微生物，而2019-2024年期间为71.9%（p = 0.003）。尽管金黄色葡萄球菌在两组中仍是最主要的分离菌，但革兰阴性菌显著增加（32.9%-46.5%，p = 0.004），尤其是非假单胞菌和肠杆菌科菌种。有趣的是，经典急性细菌性鼻窦炎病原体（肺炎链球菌、卡他莫拉菌、流感嗜血杆菌）在两个研究期间分别仅占病例的28.0%和23.8%。金黄色葡萄球菌分离株对克拉霉素的耐药性从12.1%显著上升至27.5%（p = 0.0008），而对多西环素和阿莫西林的耐药性也有所上升，但这些变化无统计学显著性。2019-2024年期间，对阿莫西林克拉维酸的耐药性从0.3%上升至3.2%（p = 0.0276）。
结论： CRS鼻窦培养物中革兰阴性菌的发生率及抗生素耐药性均有所增加。这些发现强调了在管理术后CRS急性加重时，内镜引导下培养及根据培养结果指导抗生素治疗的重要性。

英文摘要

BACKGROUND: Antibiotics are frequently prescribed for acute exacerbations of chronic rhinosinusitis (CRS). However, antimicrobial resistance presents a challenge for the ongoing and future management of CRS patients.
OBJECTIVE: This study aims to examine the current and past microbiological yield and antimicrobial resistance profile in a tertiary sinus centre.
METHODOLOGY: A retrospective results review for the calendar years from 2015 to 2018 and 2019 to 2024 was conducted on all CRS patients who had sinonasal microbiological samples taken during their outpatient visits with a history of previous endoscopic sinus surgery (ESS).
RESULTS: A total of 706 cultures were analysed from 338 patients. Clinically significant organisms were identified in 60.0% of cases in 2015-2018 and 71.9% of cases in 2019-2024 (p = 0.003). Whilst Staphylococcus aureus remained the predominant isolate in both groups, Gram-negative organisms rose significantly (32.9%-46.5%, p = 0.004), particularly non-Pseudomonas and Enterobacteriaceae species. Interestingly, classical acute bacterial rhinosinusitis pathogens (Staphylococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae) were detected in only 28.0% and 23.8% of cases in the respective study periods. Resistance to clarithromycin in S. aureus isolates increased significantly from 12.1% to 27.5% (p = 0.0008), whilst resistance to doxycycline and amoxicillin also rose, though these changes were not statistically significant. Resistance to co-amoxiclav increased from 0.3% to 3.2% in 2019-2024. (p = 0.0276).
CONCLUSION: There has been an increase in the incidence of Gram-negative bacteria as well as antibiotic resistance in CRS sinonasal cultures. These findings emphasise the importance of endoscopically guided cultures and culture-directed antibiotic therapy when managing postoperative CRS exacerbations.