Dagan R, Leibovitz E, Cheletz G, Leiberman A, Porat N
Pediatric Infectious Disease Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel.
J Infect Dis. 2001 Mar 15;183(6):880-6. doi: 10.1086/319250. Epub 2001 Feb 9.
Antibiotic-resistant pneumococci are difficult to eradicate from middle ear fluid (MEF) and the nasopharynx (NP). Bacteriologic eradication from the NP and MEF during acute otitis media (AOM) by 3 common antibiotic drugs was prospectively evaluated. In 19 (16%) of 119 MEF culture-positive patients, an organism susceptible to the treatment drug (Haemophilus influenzae, Streptococcus pneumoniae, or both) was isolated from the initial MEF, whereas resistant S. pneumoniae was present in the NP; in 9 (47%) patients, the initial resistant NP organism (identified by serotyping, resistance to the administered drug, and pulsed-field gel electrophoresis) replaced the susceptible MEF organism within only a few days after initiation of treatment. In regions where resistant pneumococci are prevalent, antibiotics may not only fail to eradicate the organisms, but they may often induce MEF superinfection with resistant pneumococci initially carried in the NP. This is an important mechanism by which, in recently treated patients, AOM infections often become refractory to treatment.
耐抗生素肺炎球菌很难从中耳积液（MEF）和鼻咽部（NP）清除。前瞻性评估了3种常用抗生素药物在急性中耳炎（AOM）期间从NP和MEF中进行细菌清除的情况。在119例MEF培养阳性患者中的19例（16%）中，从初始MEF中分离出对治疗药物敏感的病原体（流感嗜血杆菌、肺炎链球菌或两者兼有），而NP中存在耐药肺炎链球菌；在9例（47%）患者中，初始耐药的NP病原体（通过血清分型、对所用药物的耐药性和脉冲场凝胶电泳鉴定）在治疗开始后的几天内就取代了MEF中的敏感病原体。在耐药肺炎球菌流行的地区，抗生素不仅可能无法清除病原体，而且它们常常可能导致MEF被NP中最初携带的耐药肺炎球菌超感染。这是一个重要机制，通过该机制，在近期接受治疗的患者中，AOM感染常常变得难以治疗。
