Brook Itzhak, Yocum Paula, Shah Kiran, Feldman Bruce, Epstein Stephen
Department of Paediatrics of Georgetown and George Washington University, School of Medicine, Washington DC, USA.
J Laryngol Otol. 2003 Jun;117(6):449-53. doi: 10.1258/002221503321892271.
Previous studies concerning the microbiology of otitis media with effusion (OME) did not correlate the past use of antimicrobial agents with the recovered organism's antimicrobial susceptibility. A retrospective analysis of cultures obtained from aspirates of 129 children with OME was performed. The study identified the isolated organisms and determined their susceptibility to the most recently administered antimicrobials. Bacterial growth was noted in 58 (45 per cent) patients. Aerobic organisms only were recovered in 37 aspirates (63 per cent of the culture-positive aspirates); anaerobic bacteria in seven (12 per cent); and mixed aerobic and anaerobic bacteria in 14 (24 per cent). A total of 92 bacterial isolates were recovered, accounting for 1.6 isolates per specimen (1.1 aerobes and 0.5 anaerobes). There were a total of 66 aerobic isolates, including Haemophilus influenzae non type-b (20 isolates), Streptococcus pneumoniae (17), and Staphylococcus spp. (seven). Twenty-six anaerobes were recovered, including Peptostreptococcus spp. and Prevotella spp. (eight each) and Propionibacterium acnes (four). Resistance to the antimicrobial used was found in 60 (65 per cent) isolates, recovered from 41 (71 per cent) of the patients. Of the 41 patients in whom resistance was detected, 37 (90 per cent) had been treated within three months of culture and four (10 per cent) had completed treatment more than three months before the cultures were taken (p < 0.01). The highest rate of recovery of resistant organisms was following trimethoprim-sulfamethoxazole (96 per cent), amoxycillin (71 per cent), and azithromycin (56 per cent). Of the patients treated with amoxycillin, H influenzae predominated. S pneumoniae was recovered from four of the seven (57 per cent) after trimethoprim-sulfamethoxazole, four of 14 (29 per cent) following amoxycillin, and three of 11 (27 per cent) after azithromycin. The data illustrate the relationship between resistance to the antimicrobials given to children and their recovery from the middle ear of patients with OME.
以往关于分泌性中耳炎（OME）微生物学的研究并未将既往使用抗菌药物的情况与所分离出微生物的药敏性相关联。我们对129例OME患儿抽吸物的培养结果进行了回顾性分析。该研究确定了分离出的微生物，并测定了它们对最近使用的抗菌药物的敏感性。58例（45%）患者有细菌生长。仅需氧菌在37份抽吸物中生长（占培养阳性抽吸物的63%）；厌氧菌在7份抽吸物中生长（占12%）；需氧菌和厌氧菌混合生长在14份抽吸物中（占24%）。共分离出92株细菌，每份标本平均分离出1.6株（1.1株需氧菌和0.5株厌氧菌）。共有66株需氧菌，包括非b型流感嗜血杆菌（20株）、肺炎链球菌（17株）和葡萄球菌属（7株）。分离出26株厌氧菌，包括消化链球菌属和普雷沃菌属（各8株）以及痤疮丙酸杆菌（4株）。在所分离出的60株（65%）细菌中发现了对所用抗菌药物的耐药性，这些细菌来自41例（71%）患者。在检测到耐药性的41例患者中，37例（90%）在培养前三个月内接受过治疗，4例（10%）在培养前三个月以上完成治疗（p<0.01）。耐药菌回收率最高的是在使用甲氧苄啶-磺胺甲恶唑（96%）、阿莫西林（71%）和阿奇霉素（56%）之后。在接受阿莫西林治疗的患者中，以流感嗜血杆菌为主。在使用甲氧苄啶-磺胺甲恶唑治疗的7例患者中有4例（57%）分离出肺炎链球菌，在使用阿莫西林治疗的14例患者中有4例（29%），在使用阿奇霉素治疗的11例患者中有3例（27%）。这些数据说明了儿童使用抗菌药物后的耐药性与OME患者中耳细菌清除之间的关系。
