Rosenblüt A, Santolaya M E, González P, Corbalán V, Avendanõ L F, Martínez M A, Hormazabal J C
Otorhinolaryngology Service, Hospital Dr. Sótero del Río, Santiago, Chile.
Pediatr Infect Dis J. 2001 May;20(5):501-7. doi: 10.1097/00006454-200105000-00006.
Acute otitis media (AOM) is a main cause for antimicrobial prescription in Latin America. Pathogen diversity in different geographic regions underscores the need for updated knowledge on AOM microbiology.
To prospectively determine the role of bacteria and viruses in Chilean children with AOM.
Between July, 1998, and June, 1999, children >3 months with a presumptive diagnosis of AOM were referred to the study ear, nose and throat physician. Middle ear fluid and nasopharyngeal aspirates were obtained from children with confirmed AOM and processed for common bacteria, Mycoplasma pneumoniae, Chlamydia pneumoniae and viruses. Antimicrobial susceptibility patterns and serotypes of Streptococcus pneumoniae strains were determined.
An ear, nose and throat physician confirmed diagnoses for 222 (42%) of 529 children referred with diagnosis of AOM, and 170 children met eligibility criteria for the study. One or more pathogens were detected in 140 of 170 (82%) children. Predominant bacteria were S. pneumoniae (37%), Haemophilus influenzae (24%) and Streptococcus pyogenes (13%). M. catarrhalis was detected in 2 children, C. pneumoniae was found in 1 and M. pneumoniae was not detected. Viruses were detected in 22 children (13%) from nasopharyngeal aspirates, and in 6 of them the same virus was detected in middle ear fluid. Penicillin-resistant (intermediate and high) S. pneumoniae represented 40% of isolates and 10% of H. influenzae were beta-lactamase producers. All 10 penicillin-resistant S. pneumoniae strains were resistant to cefuroxime. Eighteen S. pneumoniae serotypes were detected and 19F was associated with high level penicillin resistance.
This study can impact local management of AOM, and it should encourage continuous surveillance of AOM microbiology in Chile and other developing countries.
急性中耳炎（AOM）是拉丁美洲抗菌药物处方的主要原因。不同地理区域的病原体多样性凸显了更新AOM微生物学知识的必要性。
前瞻性地确定细菌和病毒在智利患AOM儿童中的作用。
在1998年7月至1999年6月期间，将年龄大于3个月、初步诊断为AOM的儿童转诊给研究耳鼻喉科医生。从确诊为AOM的儿童中获取中耳液和鼻咽抽吸物，进行常见细菌、肺炎支原体、肺炎衣原体和病毒的检测。确定肺炎链球菌菌株的抗菌药物敏感性模式和血清型。
耳鼻喉科医生对转诊来诊断为AOM的529名儿童中的222名（42%）进行了确诊，170名儿童符合研究纳入标准。170名儿童中有140名（82%）检测到一种或多种病原体。主要细菌为肺炎链球菌（37%）、流感嗜血杆菌（24%）和化脓性链球菌（13%）。在2名儿童中检测到卡他莫拉菌，1名儿童中发现肺炎衣原体，未检测到肺炎支原体。在22名（13%）儿童的鼻咽抽吸物中检测到病毒，其中6名儿童的中耳液中检测到相同病毒。耐青霉素（中度和高度）肺炎链球菌占分离株的40%，10%的流感嗜血杆菌为β-内酰胺酶产生菌。所有10株耐青霉素肺炎链球菌菌株均对头孢呋辛耐药。检测到18种肺炎链球菌血清型，19F型与高水平青霉素耐药相关。
本研究可影响AOM的当地管理，并应鼓励在智利和其他发展中国家持续监测AOM微生物学。
