Pichichero Michael E, Casey Janet R
University of Rochester and Legacy Pediatrics, Rochester, New York, USA.
JAMA. 2007 Oct 17;298(15):1772-8. doi: 10.1001/jama.298.15.1772.
Concern has been raised about the possible emergence of a bacterial strain that is untreatable by US Food and Drug Administration (FDA)-approved antibiotics and that causes acute otitis media (AOM) in children.
To monitor continuing shifts in the strains of Streptococcus pneumoniae that cause AOM, with particular attention to capsular serotypes and antibiotic susceptibility, following the introduction of a pneumococcal 7-valent conjugate vaccine (PCV7).
DESIGN, SETTING, AND PATIENTS: Prospective cohort study using tympanocentesis to identify S pneumoniae strains that caused AOM in children receiving PCV7 between September 2003 and June 2006. All children were from a Rochester, New York, pediatric practice.
Determination of serotypes and antibiotic susceptibility of S pneumoniae causing AOM.
Among 1816 children in whom AOM was diagnosed, tympanocentesis was performed in 212, yielding 59 cases of S pneumoniae infection. One strain of S pneumoniae belonging to serotype 19A was a new genotype and was resistant to all antibiotics approved by the FDA for use in children with AOM. This strain was identified in 9 cases (2 in 2003-2004, 2 in 2004-2005, and 5 in 2005-2006). Four children infected with this strain had been unsuccessfully treated with 2 or more antibiotics, including high-dose amoxicillin or amoxicillin-clavulanate and 3 injections of ceftriaxone; 3 had recurrent AOM; and for 2 others, the infection was their first in life. The first 4 cases required tympanostomy tube insertion after additional unsuccessful antibiotic therapies. Levofloxacin was used in the subsequent 5 cases, with resolution of infection without surgery.
In the years following introduction of PCV7, a strain of S pneumoniae has emerged in the United States as an otopathogen that is resistant to all FDA-approved antibiotics for treatment of AOM in children.
人们越来越担心可能会出现一种对美国食品药品监督管理局（FDA）批准的抗生素无反应、可导致儿童急性中耳炎（AOM）的细菌菌株。
在引入7价肺炎球菌结合疫苗（PCV7）后，监测引起AOM的肺炎链球菌菌株的持续变化，尤其关注荚膜血清型和抗生素敏感性。
设计、地点和患者：采用前瞻性队列研究，通过鼓膜穿刺术确定2003年9月至2006年6月期间接受PCV7的儿童中引起AOM的肺炎链球菌菌株。所有儿童均来自纽约罗切斯特的一家儿科诊所。
确定引起AOM的肺炎链球菌的血清型和抗生素敏感性。
在1816名被诊断为AOM的儿童中，212名接受了鼓膜穿刺术，其中59例为肺炎链球菌感染。一株19A血清型的肺炎链球菌是一种新的基因型，对FDA批准用于治疗AOM儿童的所有抗生素均耐药。该菌株在9例病例中被鉴定出来（2003 - 2004年2例，2004 - 2005年2例，2005 - 2006年5例）。4名感染该菌株的儿童接受了2种或更多种抗生素治疗均未成功，包括高剂量阿莫西林或阿莫西林 - 克拉维酸以及3次头孢曲松注射；3名儿童出现复发性AOM；另外2名儿童是首次感染。前4例在额外的抗生素治疗失败后需要插入鼓膜造孔管。随后的5例使用左氧氟沙星治疗，感染得以缓解，无需手术。
在引入PCV7后的几年里，美国出现了一种肺炎链球菌菌株，作为一种耳病原体，对FDA批准用于治疗儿童AOM的所有抗生素均耐药。
