Brook Itzhak, Foote Perry A
Department of Pediatrics, Georgetown University School of Medicine, Washington, DC, USA.
Int J Pediatr Otorhinolaryngol. 2006 Dec;70(12):2099-102. doi: 10.1016/j.ijporl.2006.08.004. Epub 2006 Sep 7.
The rate of recovery methicillin resistant Staphylococcus aureus (MRSA) in tonsils that were removed because of recurrent Group A-beta-hemolytic streptococci (GABHS) tonsillitis was not previously reported. MRSA may serve as a potential source for the spread of these organisms to other body sites as well to other individuals. This study investigated the rate of recovery of MRSA as well as other aerobic organisms from tonsils that were removed because of recurrent GABHS infection.
Core and surface tonsillar cultures for aerobic bacteria were obtained from 44 children who had tonsillectomy because of recurrent GABHS tonsillitis.
A total of 167 aerobic isolates were recovered from the core of the tonsils (3.8/specimen) and 151 (3.4/specimen) were isolated from the surface. The predominant isolates were alpha-hemolytic streptococci, GABHS, S. aureus, gamma-hemolytic streptococci, Haemophilus influenzae and Moraxella catarrhalis. Concordance in the recovery of all organisms was noted in 117 instances. Certain organisms (i.e. GABHS, S. aureus) were recovered more often from the tonsillar cores, where other (i.e. alpha-hemolytic streptococci, gamma-hemolytic streptococci) were recovered more often from the tonsillar surface. Forty-four beta-lactamase-producing bacteria (BLPB) were recovered from 32 (75%) of the tonsillar cores, and 28 were isolated from 23 (52%) of the tonsillar surfaces. The predominant BLPB were S. aureus, H. influenzae and M. catarrhalis. Seven isolates of MRSA were recovered from the cores and two were isolated from the surface. Five of the core isolates and the two surface isolates were also BLPB. All of the MRSA isolates were resistant to oxacillin, penicillin and erythromycin and were susceptible to clindamycin, trimethoprim-sulfamethoxazole and vancomycin.
These data demonstrated that in recurrently GABHS infected tonsils, BLPB was recovered from over 75% of the tonsillar cores, core tonsillar cultures yielded more GABHS and S. aureus, and MRSA was isolated from 16% of the tonsils.
此前未报道因复发性A组β溶血性链球菌（GABHS）扁桃体炎而切除的扁桃体中耐甲氧西林金黄色葡萄球菌（MRSA）的检出率。MRSA可能是这些病原体传播至身体其他部位以及其他个体的潜在来源。本研究调查了因复发性GABHS感染而切除的扁桃体中MRSA以及其他需氧菌的检出率。
从44例因复发性GABHS扁桃体炎而接受扁桃体切除术的儿童获取扁桃体核心及表面的需氧菌培养物。
共从扁桃体核心分离出167株需氧菌（每标本3.8株），从扁桃体表面分离出151株（每标本3.4株）。主要分离菌为α溶血性链球菌、GABHS、金黄色葡萄球菌、γ溶血性链球菌、流感嗜血杆菌和卡他莫拉菌。117例中所有病原体的检出情况一致。某些病原体（如GABHS、金黄色葡萄球菌）在扁桃体核心中检出更频繁，而其他病原体（如α溶血性链球菌、γ溶血性链球菌）在扁桃体表面检出更频繁。从32例（75%）扁桃体核心中分离出44株产β-内酰胺酶细菌（BLPB），从23例（52%）扁桃体表面分离出28株。主要的BLPB为金黄色葡萄球菌、流感嗜血杆菌和卡他莫拉菌。从扁桃体核心分离出7株MRSA，从扁桃体表面分离出2株。核心分离株中的5株及表面分离株中的2株也是BLPB。所有MRSA分离株对苯唑西林、青霉素和红霉素耐药，对克林霉素、甲氧苄啶-磺胺甲恶唑和万古霉素敏感。
这些数据表明，在复发性GABHS感染的扁桃体中，超过75%的扁桃体核心中检出BLPB，扁桃体核心培养物中GABHS和金黄色葡萄球菌更多见，16%的扁桃体中分离出MRSA。
