目的:(1)从一个为城市人口服务的三级/四级学术中心的病例系列中,通过对文献的回顾,确定耳朵排出的致病细菌学;(2)根据现有的最佳证据制定耐甲氧西林金黄色葡萄球菌(MRSA)耳漏的治疗指南。
方法:对圣保罗医院微生物学实验室的所有“耳”培养物进行回顾性分析,温哥华,进行是为了确定对药敏和细菌学数据的定性分析。对所有检查细菌学的研究进行了文献的系统回顾,易感性,和任何MRSA感染产生耳漏的治疗。
结果:金黄色葡萄球菌和铜绿假单胞菌(PA)分别为39.7%和13.5%,分别,在我们的机构获得的耳培养与文献中确定的研究中的9.9%至54.1%和25.0%至48.6%。甲氧西林敏感的金黄色葡萄球菌(MSSA)的出现频率高于MRSA(我们机构的31.2%对8.5%;文献中的16.9%对6.9%)。MRSA分离株通常对庆大霉素(14.8%)和环丙沙星(7.7%)耐药,但对甲氧苄啶-磺胺甲恶唑(TMP-SMX)(85.3%)和夫西地酸(96.3%)敏感,表明MRSA的“社区菌株”占优势。
结论:常用滴耳剂中MRSA对抗生素的敏感性(即,庆大霉素和环丙沙星)较低。根据现有数据,考虑到MRSA耳漏是社区还是医院获得性的,以及鼓膜是否完整,我们建议采用循证治疗方法.
OBJECTIVE: (1) To determine the causative bacteriology of discharging ears in a case series from a tertiary/quaternary academic centre serving an urban population and from a review of the literature and (2) to develop treatment
guidelines for methicillin-resistant Staphylococcus aureus (MRSA) otorrhea based on the best available evidence.
METHODS: A retrospective analysis of all \"ear\" cultures from the microbiology laboratory at St. Paul\'s Hospital, Vancouver, was performed to ascertain a qualitative analysis on the susceptibility and bacteriology data. A systematic review of the literature was performed for all studies examining the bacteriology, susceptibility, and treatment for any MRSA infection producing otorrhea.
RESULTS: Staphylococcus aureus and Pseudomonas aeruginosa (PA) were present in 39.7% and 13.5%, respectively, of ear cultures obtained at our institution versus 9.9 to 54.1% and 25.0 to 48.6% in identified studies in the literature. Methicillin-sensitive Staphylococcus aureus (MSSA) was present more frequently than MRSA (31.2% vs 8.5% at our institution; 16.9% vs 6.9% in the literature). MRSA isolates were often resistant to gentamicin (14.8%) and ciprofloxacin (7.7%) but susceptible to trimethoprim-sulfamethoxazole (TMP-SMX) (85.3%) and fusidic acid (96.3%), suggesting a preponderance of the \"community strain\" of MRSA.
CONCLUSIONS: The susceptibility of MRSA to antibiotics in commonly used otic drops (ie, gentamicin and ciprofloxacin) is low. Based on the available data, we suggest an evidence-based approach to the management of MRSA otorrhea considering whether the strain is community or hospital acquired and whether the tympanic membrane is intact.