Marchisio Paola, Claut Laura, Rognoni Alessandro, Esposito Susanna, Passali Desiderio, Bellussi Luisa, Drago Lorenzo, Pozzi Gianni, Mannelli Stefania, Schito Giancarlo, Principi Nicola
Department of Pediatrics, University of Milan, Italy.
Pediatr Infect Dis J. 2003 Mar;22(3):262-8. doi: 10.1097/01.inf.0000055063.40314.da.
The interactions between nasopharyngeal flora and the individual entities covered by the broad term otitis media have not been completely elucidated. We investigated in infants and children ages 6 months to 7 years with nonsevere recurrent acute otitis media (rAOM) or with chronic otitis media with effusion (cOME): (1) the nasopharyngeal carriage rate and bacterial density of respiratory pathogens and alpha-hemolytic streptococci in comparison with healthy children; (2) the resistance pattern of respiratory pathogens; and (3) the relationship between the type of nasopharyngeal colonization and long term outcome.
Nasopharyngeal cultures were obtained from 85 children with rAOM,113 children with cOME and 55 controls. A semiquantitative analysis was used in the reading of cultures. A 12-week follow-up without treatment was planned.
The carrier rate of respiratory pathogens was significantly greater in cOME (70%) than in rAOM (45%) (P = 0.0006) or controls (31%) (P < 0.0001). Similarly colonization density was significantly greater in cOME than in rAOM. The carriage rate and the colonization density of alpha-hemolytic streptococci were significantly lower in rAOM than in cOME or controls. The incidence of resistant (R) strains was greater in rAOM (Streptococcus pneumoniae penicillin-R, 24%; macrolide-R, 64%; Haemophilus influenzae amoxicillin-R, 24%) compared with cOME (S. pneumoniae penicillin-R,18%; macrolide-R, 44%; H. influenzae amoxicillin-R, 5%) or controls (S. pneumoniae penicillin-R, 8%; macrolide-R, 23%; H. influenzae amoxicillin-R, 10%). During the follow-up period persistence of OME and occurrence of AOM were greater among carriers of respiratory pathogens at baseline.
There are substantial differences in nasopharyngeal flora between children with nonsevere rAOM and children with cOME. The results of nasopharyngeal cultures should be taken into account to avoid treatment with drugs that are ineffective and likely to select resistant organisms.
鼻咽部菌群与广义中耳炎所涵盖的各个实体之间的相互作用尚未完全阐明。我们对6个月至7岁患有非重度复发性急性中耳炎（rAOM）或慢性中耳积液性中耳炎（cOME）的婴幼儿及儿童进行了调查：（1）与健康儿童相比，呼吸道病原体和α溶血性链球菌的鼻咽部携带率及细菌密度；（2）呼吸道病原体的耐药模式；（3）鼻咽部定植类型与长期预后的关系。
从85例rAOM患儿、113例cOME患儿及55例对照中获取鼻咽部培养物。培养物读数采用半定量分析。计划进行为期12周的无治疗随访。
cOME患儿呼吸道病原体的携带率（70%）显著高于rAOM患儿（45%）（P = 0.0006）或对照组（31%）（P < 0.0001）。同样，cOME患儿的定植密度也显著高于rAOM患儿。rAOM患儿中α溶血性链球菌的携带率和定植密度显著低于cOME患儿或对照组。与cOME患儿（肺炎链球菌青霉素耐药率为18%；大环内酯类耐药率为44%；流感嗜血杆菌阿莫西林耐药率为5%）或对照组（肺炎链球菌青霉素耐药率为8%；大环内酯类耐药率为23%；流感嗜血杆菌阿莫西林耐药率为10%）相比，rAOM患儿中耐药（R）菌株的发生率更高（肺炎链球菌青霉素耐药率为24%；大环内酯类耐药率为64%；流感嗜血杆菌阿莫西林耐药率为24%）。在随访期间，基线时呼吸道病原体携带者中OME的持续存在和AOM的发生率更高。
非重度rAOM患儿与cOME患儿的鼻咽部菌群存在显著差异。应考虑鼻咽部培养结果，以避免使用无效且可能选择耐药菌的药物进行治疗。
