| Objective The aim of this study is to analyze the surface and corebacteria in tonsil and adenoid tissue in children diagnosed withobstructive sleep apnea hypopnea syndrome in order to guide the clinicaltreatment. Analysis of the relationships between the result of bacterialculture and otitis media with effusion, allergic rhinitis as well as thedegree of tonsil and adenoid hypertrophy.Methods In our study, we selected213children(73females and140males)) between1year and12years of age diagnosed with OSAHSin Shanghai Jiaotong University Affiliated Children’s Hospital receivedadenoidectomy and tonsillectomy during7months (July2012—February2013).Bacterial aerobic cultures and drug sensitivity tests were taken bynasopharyngeal swabs and throat swabs of children after tonsillectomyand adenoidectomy. As well as the removed tonsil and adenoidtissue.Average age was4.96±2.29years. Comparison of four groups： ①the differences between bacterial culture;②divided into groups ofallergic rhinitis (AR group,60cases) and non-allergic rhinitis (NARgroup,91cases), comparing the differences in pathogen detection rate byAR group and NAR group;③divided into otitis media with effusiongroup (OME group,22cases) and NOME group,80cases,comparison thedifferences in the detection rate of pathogens between OME group andNOME group;④Depending on the degree of tonsillar hypertrophy,comparing the detection rate of pathogens between Ⅱ degree group（168cases） and Ⅲ egree group（45cases）;⑤Depending on the degree ofadenoid hypertrophy, comparing the detection rate of pathogens betweenⅢ degree group （44cases）and Ⅳ egree group（78cases）.Result1. There was no statistically significant difference between adenoidsurface and substance of bacterial culture results（2=0.162～1.554，P>0.05）.2. Tonsil surface and the substance of the results of bacterial culturewas no significant difference（2=0.101～4.512，P>0.05）.3.The pathogen detection rate in OME group was lower than NOMEgroup （2=4.8014， P=0.0284<0.05）. Further analysis found thatStaphylococcus aureus detection rate was lower in OME group （2=0.0025，P=0.0054<0.05）.Other six kinds of bacteria was nosignificant difference in detection rates between the two groups（2=0.0924～0.7609，P=0.2034～1.0000>0.05）.4. There was no statistically significant difference of pathogendetection rate between AR group and NAR group（2=0.1347～1.1828，P=0.2768～0.7136>0.05）.5.Pathogen detection rate of tonsillar hypertrophy degree Ⅲ groupwas higher than the degree of tonsillar hypertrophy group Ⅱ（2=5.3036，P=0.0213<0.05）. Further analysis found that Streptococcus pyogenesdetection rate in Ⅲ group was higher than in group Ⅱ（2=9.3431，P=0.0022<0.05）. Other six kinds of bacteria was no significant differencein detection rates between the two groups （2=0.2205～0.3975，P=0.2852～1.0000>0.05）.6.There was no statistically significant difference of pathogendetection rate between Ⅲ degree of adenoid hypertrophy group and Ⅳdegree of adenoid hypertrophy group（2=0.0000～1.5127，P=0.2187～0.1.0000>0.05）.7.①Staphylococcus aureus was100%sensitive to vancomycin, over80%to cephalosporins (eg, cefazolin, cefuroxime), β-lactamaseinhibitor combinations (ampicillin/sulbactam). To clindamycin, ampicillin, erythromycin-sensitive rates were reduced in turn,forpenicillin-resistant rate of more than90%. MRSA to penicillin,cephalosporins, β-lactamase inhibitor combinations100%resistance,but sulfa antibiotic cotrimoxazole100%sensitive.②Streptococcuspneumoniae: oxacillin, erythromycin, clindamycin resistance rate wasover95%, quinolones (eg, moxifloxacin), vancomycin-sensitive rate of100%.③Streptococcus pyogenes: for pure penicillin, vancomycin,ceftriaxone100%sensitive to clindamycin, erythromycin resistance ratewas high up to94%.④Haemophilus influenzae, Hemophilusparainfluenzae: amoxicillin/clavulanic acid, azithromycin sensitivity rateof90%, and more than80%of cefuroxime sensitive, quinolones,ampicillin/sulbactam, ampicillin-sensitive rates were reduced in turn,for clindamycin resistance rate of80%. β-lactam enzyme-positiveHIN, HHE was100%for cefuroxime resistant to ampicillin/sulbactamrate of90%.⑤Klebsiella pneumoniae and Pseudomonas aeruginosawere almost100%sensitive to selected antibiotics such as cephalosporins，β-lactamase inhibitor combinations, imipenem.Conclusion1. Swab bacterial culture and sensitivity test results can represententities tonsil tissue bacterial species, the distribution and extent of drug sensitivity.2. Nasal swabs for bacterial culture and sensitivity test results canrepresent physical organization adenoids bacterial species, distributionand extent of drug sensitivity.3. OSAHS in children with otitis media with effusion, the pathogendetection rate was lower than the non-otitis media with effusion, webelieve that children with OME may be a result of the use of preoperativeantibiotics intervention,or of the inflammatory response in patients withotitis media and produce local immunity leaving the decreased bacterialdetection rate.4. There was no significant difference in pathogen detection ratebetween children with AR and NAR.5. The pathogen detection rate was higher in tonsillar hypertrophy ofⅢ degree in children with OSAHS than Ⅱ degree, Staphylococcusaureus detection rates having differences mainly, closely related to S.aureus infection with tonsillar hypertrophy.6. There was no significant difference in pathogen detection ratebetween adenoid hypertrophy with degree Ⅲand Ⅳ in children withOSAHS, which was still unable to explain,and further studies need largersample. 7. The use of antibiotics is a reasonable standard bacterial cultureand drug sensitivity test basis, therefore, based on the characteristics ofpathogens sensitive test results and a targeted selection of antibioticdrugs, and the application of adequate dose and duration of treatment,can improve efficacy and slows the development of resistant strains. |
