| 【Research background and intention】 Chronic nasal- sinusitis(Chronic rhinosinusitis CRS) is one of the most common Chronic disease of otolaryngology head and neck surgery department. Because of complex learning method, bacterial infection has been considered as one of the pathogenic factors of CRS. Recently, important significance has been drew on selecting antibiotics in CRS treatment with bacterial culture method, which mainly focus on study the bacterial infection of the CRS cases rate, the bacteria distribution and drug resistance situation by using of antibiotics in CRS treatment with great significance. Enormous difference lies in the treatment and antibiotic usage of species, dosage and course between the patients living in the urban city and rural area, resulting in the similar difference of bacteria distribution and body sensitivity of antibiotic. Because of the fact that relatively less concern were concentrated on pathogenic bacteria istribution characteristics of CRS patients from rural areas according to previous research, this study demonstrate and analyze By using rural chronic nasal sinusitis(CRS)- bacteria distribution and characteristic drug sensitivity characteristic of influence on culture, and antibiotic use for grassroots otolaryngology clinical rational use of antibiotics, provide theoretical basis for improving clinical cure rate.【Methods】 In the research of this paper, patients living in rural areas CRS of nasal sinus secretions have been chosen as specimen, followed by aerobic bacteria, anaerobic bacteria cultivation, separation and identification respectively; Based on the process mentioned above, bacterial antibiotic sensitivity tests were taken by using the disc AGAR diffusion method. At the same time, the using statics of antibiotics of the patients in the lately 2 months and 2 weeks were counted and analyzed for understanding the influence of bacterial cultivation caused by antibiotic abuse. According to "chronic nasal sinusitis diagnosis and treatment guidelines" standard which was proposed in the Kunming meeting in 2012, the CRS patients were divided into different groups, and the difference of rate of bacterial cultivation between groups were figured out, followed by statistical analysis, and exploring the correlation between bacterial infection and nasal polyps. All cases of CRS disease progression are grouped, and then germiculture results were counted between different groups, in order to summarize the relationship between the length of the course and positive rate of germiculture.【Results】 Among all the specimens of 146 patients with CRS nasal secretions, a total of 49 patients detached with bacteria(positive rate 33.56%), in which 2 cases of unknown bacteria(considered as L- type bacteria), 5 cases of mixed growth of more than 2 kinds of bacteria, 42 cases of single bacteria. After being anaerobic bacteria cultivated of the 17 cases of maxillary sinus source line, the results were negative. 20 kinds of thebacteria were involved in all the 42 case of single bacteria, and species distribution were quite extensive, including 10 strains of staphylococcus epidermidis and 5 strains of gas enterbacteriaceae, 4 strains of staphylococcus aureus, 3 strains of staphylococcus saprophytic, 3 strains of shallow green gas aureus, 2 strains of staphylococcus aureus, 2 strains of klebsiella acid bacteria, 2 strains of staphylococcus aureus, 1 strain of staphylococcus aureus golden subspecies, staphylococcus aureus, dolphins among staphylococcus, al Wright staphylococcus aureus, group B streptococcus, group A streptococcus, proteus, singular deformation bacteria, fecal bacteria, sewer micrococcus, micro bacillus genus enterobacteriaceae, differences subspecies. Vivid evident shows that epidermis staphylococcus aureus is the most common type of aerobe rural CRS patients. There was on relationship between the positive rate and the gender, age among all the 146 CRS patients. In specimens of146 patients, 91 cases were related with nasal passages, in which the results of 21 cases were positive with the positive rate of 23.08%, and 55 cases were related with maxillary sinus, in which 28 cases were positive with a positive rate of 50.91%. By using the x2 test, x2 equals to 11.906, P < 0.01, so there is statistical significance.(from the results of the cultivation of the left and right sides of the nasal passages in x2 test, x2 equals to 0.0015, P = 0.995, P > 0.05, so there is no statistical significance; on the cultivation of the left and right sides of the results from maxillary sinus x2 test, x2 equals to 0.449, P = 0.5, P > 0.05, so there is no statistical significance). According to the "chronic nasal sinusitis diagnosis and treatment guidelines" standards proposed in the Kunming meeting in the year 2012, the CRS patients were divided into different groups, 96 cases of CRSs NP, 23 cases of positive results, CRSw NP group of 50 cases, 26 patients, according to x2 test, x2 equals to 11.595, P < 0.01, so there is statistical significance, indicating that bacterial factors associated with polyp formation.91 in all the 146 CRS patients has used antibiotic in the latest 2 weeks, accounting for 62.33%; 55 patients who did not use antibiotic, accounting for 37.67%. As much as 107 patients in all the 146 CRS patients has used antibiotic in the latest 2 months, accounting for 73.28%, indicating that CRS patients in rural areas abused antibiotic.146 rural CRS patients who is germiculture positive is sensitive to ofloxacin, cefotaxime, cefazolin organism, cefepime, imine south, ciprofloxacin and vancomycin, and insensitive to the penicillin G, ampicillin, erythromycin, SMZ- CO have higher resistance phenomenon. Thus, for doctors of Otolaryngology at the grass-roots level, in view of the CRS patients should be rational use of antimicrobial agents, strictly grasp the principle of the use of antibiotics, avoiding misuse of antibiotics.【 Conclusion 】 On the basis of relevant data reported in literatures, compared with urban areas, rural areas no specificity differences CRS bacteria distribution. Rural CRS patients antibiotics abuse and the cause of the anaerobic bacteria culture techniques is the main factor resulting in low culture. For rural grassroots medical institutions at the same time technical force condition, cannot carry out CRS patients secretion culture, etc., lead to the comprehensive understanding of performance in CRS patients with bacterial infection. Rational use of antimicrobial agents should be established on the basis of the bacterial culture and drug sensitive test, to prevent drug abuse. |
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