Objective To explore the distribution and drug resistance of pathogens isolated from patients with cholesteatoma otitis media so as to provide guidance for clinical use of antibiotics.Methods This survey analyzed the spectrum of organisms causing cholesteatoma otitis media and their sensitivities to commonly antimicrobial agents from Hebei province eye hospital in 2014.Results There was 86 positive speciments were cultured from 89 samples,the positive rate was 96.6％.A total of 90 strains of pathogens have been isolated,including 52 strains of gram-positive coccus (57.8％),35 strains of gram-negative bacilli (38.9％),3 strains of gram-positive bacilli (3.3 ％),and 0 strain of fungi.Staphylococcus epidermidis,Staphylococcus aureus and Staphylococcus chromogenes ranked the top three species of pathogens,accounting for 20.0％,16.7％,and 12.2％,respectively.The gram-positive cocci were susceptible to vancomycin,rifampicin and amikacin,and showed higher drug-resistancerate to penicillin,amoxicillin and azithromycin.When applied to gram-negative bacilli,the drugs with best resistance were penicillin and cefazolin,and the drugs with the highest sensitivity were levofloxacin and pipercillin/ sulbactam.Conclusion Staphylococcus is the predominant pathogens of cholesteatoma otitis media in hospital,and the bacteria have a high antibiotic resistance.Enhanced monitoring on pathogenic bacteria distribution and drug resistance analysis of cholesteatoma otitis media could benefitthe guide of clinical rational use of antimicrobial agents.

Objective To study the clinical application of laparoscopic cholecystectomy (LC) combined with intraoperative endoscopic sphincterotomy (IOEST) with the antegrade guidewire technique in the treatment of cholecystocholedocholithiasis.Methods This is a prospective controlled study comparing LC combined with preoperative endoscopic sphincterotomy (POEST) versus LC combined with IOEST in the treatment of cholecystocholedocholithiasis.Patients who were diagnosed to have cholecystocholedocholithiasis from June 2012 to February 2013 in our hospital were divided into the POEST group and the IOEST group.There were 50 patients in each group.The operation time,successful stone-extraction rate,residual stones rate,complication rate,postoperative stay and hospitalization cost between the groups were compared.Results The sex,age,stone size,number of stones and diameter of the common bile duct showed no significant difference between the two groups (P ＞ 0.05).There were no differences between the two groups in surgical time of EST,surgical time of LC combined with EST,successful stone-extraction rate and hospitalization cost (P ＞ 0.05).There were significant differences between the two groups in the residual stones rate,postoperative hyperamylasemia rate,postoperative acute pancreatitis rate and postoperative stay (P ＜0.05).LC combined with IOEST using the antegrade insertion of guidewire technique significantly reduced the residual stones rate (0 vs 8％),postoperative hyperamylasemia rate (4％ vs 18％),postoperative acute pancreatitis rate (0 vs 8％) and postoperative stay.Conclusions LC combined with IOEST using the antegrade guidewire technique could be performed safely when compared with the traditional sequential technique,LC combined with IOEST using the antegrade guidewire technique significantly reduced the postoperative acute pancreatitis rate and the residual stones rate.LC combined with IOEST using the antegrade guidewire technique should be the recommended technique to treat patients with cholecystocholedocholithiasis.