中台灣小兒慢性鼻竇炎之微生物學：2001至2005年的研究

小兒慢性鼻竇炎是一複雜的疾病，導致這疾病的細菌學一直是研究探討的焦點，但許多研究卻呈現不一致的結果。值得注意的是，致病菌種類以及抗藥性形態在不同區域及不同國家可能會有明顯的差異，因此本研究目的是檢視中台灣兒童慢性鼻竇炎的菌種特色以及這些致病菌抗藥性的形式。我們以回顧病歷的方式蒐集2001年一月到2005年十二月在中山醫學大學附設醫院耳鼻喉科經X光證實罹患鼻竇炎並接受上頷竇穿刺的小兒個案，所有病例皆經標準程序採集簡體，還原致病菌株並分析其抗藥性菌。本研究有116名兒童，共獲得200份檢體，其中分離出274支菌株。最常見的菌種依序是α-hemolytic streptococcus (21.2%)、Hemophilus influenzae (17.9%)、Streptococcus pneumonia (15.3%)、coagulase-negative staphylococcus (13.1%)以及Staphylococcus aureus (8.8%)，厭氧菌則占所有菌株的8.4%。在這五年的研究期間，對ampilillin不具敏感性的H. influenzae占63.3%，對co-trimoxazole不具敏感性的占61.2%，對ciprofloxacin及cefuroxine皆具敏感性。對penicillin不具敏感性的S. pneumonia占26.2%，對erythromycin不具敏感性的占92.9%，對clindamycin不具敏感性的占66.7%。對penicllin不具敏感性的staphylococcus aureus占79.2%，對vancomycin則皆具敏感性。總結而言，我們培養出小兒慢性鼻竇炎的主要菌株除了與成人慢性鼻竇炎的菌株不同外，也與其他地區的研究結果不同因此，對罹患慢性鼻竇炎的小兒族群施與抗生素治療時，需考慮此一疾病的微生物特色及其目前的抗藥性形式。
Pediatric chronic rhinosinusitis is a complex disease with varying patterns of bacteriology. The patterns of causative pathogens and antibiotic resistance may differ by region or country. We conducted a study to characterize the patterns of pathogens and antibiotic resistance in children with chronic rhinosinusitis in the middle region of Taiwan. A retrospective chart review was conducted on pediatric patients with radiograph-proven chronic rhinosinusitis who underwent maxillary sinus puncture at Chung Shan Medical University Hospital from January 2001 through December 2005. Pathogens were recovered and identified, and their resistance to antibiotics was tested. A total of 200 samples from 116 children were collected through maxillary sinus puncture, and yielded 274 isolates. The most common identified bacteria were o-hemolytic streptococcus (21.2%), Hemophilus influenzae (17.9%), Streptococcus pneumonia (15.3%), coagulase-negative staphylococcus (13.1%). and Staphylococcus aureus (8.8%). Anaerobes were found in 8.4% of all isolates. Of all the H. influenzae tested for susceptibility, 63.3% was nonsusceptible to ampicillin. 61.2% to co-trimoxazole, 0% to ciprofloxacin, and 0% to cefuroxime. Among S. pneumoniae isolates, 26.2% were nonsusceptible to penicillin. 92.9% to erythromycin, and 66.7% to clindamycin. Of S. aureus isolates, 79.2% were nonsusceptible to penicillin and 0% to vancomycin. We concluded that the microbiology of chronic rhinosinusitis in these children was different from that in adult patients and previous studies in other regions. Antibiotic therapy for pediatric patients with chronic rhinosinusitis should consider individual microbiology of the disease and the local patterns of resistance.