Gisselsson-Solén Marie, Bylander Anita, Wilhelmsson Christina, Hermansson Ann, Melhus Asa
Department of Oto-Rhino-Laryngology, Lund University Hospital, Lund, Sweden.
J Clin Microbiol. 2007 Sep;45(9):3003-7. doi: 10.1128/JCM.00299-07. Epub 2007 Jul 18.
The diagnosis of acute otitis media (AOM) is often difficult, depending heavily on the experience and skills of the examiner. However, it is important to identify episodes of AOM that involve the risk of complications and to treat these episodes appropriately. The present study was performed in order to evaluate the use of a rapid antigen assay for Streptococcus pneumoniae, the Binax NOW test, as a diagnostic tool in patients with severe AOM and associated complications. The study included 70 patients with 74 episodes of AOM, 18 of them with complications. Cultures, Binax NOW tests, and a PCR assay were performed on nasopharyngeal secretions, middle ear fluid, and in some cases mastoid bone, cerebrospinal fluid, and urine. According to culture and PCR of the middle ear fluid, 30 (41%) of the episodes were caused by S. pneumoniae. The Binax NOW test was positive in 24 of these episodes (80%). It identified pneumococcal AOM independent of antibiotic treatment, and it was easily adapted to bone tissue. The test yielded sensitivity, specificity, and positive and negative predictive values for middle ear specimens of 85%, 100%, 100%, and 89%, respectively. The corresponding positive and negative values for predicting the bacterial etiology with nasopharyngeal secretions were 51% and 75%. This study showed that the Binax NOW test is a useful diagnostic tool for patients with severe AOM with or without complications.
急性中耳炎（AOM）的诊断往往很困难，很大程度上取决于检查者的经验和技能。然而，识别有并发症风险的AOM发作并进行适当治疗很重要。本研究旨在评估一种用于检测肺炎链球菌的快速抗原检测方法——Binax NOW检测，作为重症AOM及相关并发症患者的诊断工具。该研究纳入了70例患者的74次AOM发作，其中18次伴有并发症。对鼻咽分泌物、中耳液，在某些情况下还对乳突骨、脑脊液和尿液进行了培养、Binax NOW检测及聚合酶链反应（PCR）检测。根据中耳液的培养和PCR结果，30次发作（41%）由肺炎链球菌引起。在这些发作中，Binax NOW检测有24次呈阳性（80%）。它能独立于抗生素治疗识别肺炎球菌性AOM，并且很容易应用于骨组织。该检测对中耳标本的敏感性、特异性、阳性预测值和阴性预测值分别为85%、100%、100%和89%。用鼻咽分泌物预测细菌病因的相应阳性和阴性值分别为51%和75%。这项研究表明，Binax NOW检测对于有或无并发症的重症AOM患者是一种有用的诊断工具。
