Carlin S A, Marchant C D, Shurin P A, Johnson C E, Super D M, Rehmus J M
Department of Pediatrics, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio 44109.
J Pediatr. 1991 Feb;118(2):178-83. doi: 10.1016/s0022-3476(05)80479-2.
To evaluate the relationship between eradication of bacterial infection and clinical improvement in children with otitis media, we reviewed the clinical outcome of bacterial otitis media in patients enrolled in double-blind trials of antibacterial therapy from 1979 to 1988. Cultures of middle ear exudates showed the distribution of bacterial pathogens to be similar to that observed in other geographic areas. Two hundred ninety-three patients had otitis media caused by bacterial pathogens and underwent repeat tympanocentesis after 3 to 6 days of therapy. Bacteriologic success was demonstrated in 253 patients (86%); 40 patients (14%) had bacteriologic failure. Children who had bacteriologic failure were younger than those with bacteriologic success (median age 10.6 vs 18.5 months; p = 0.001); 38% of patients who had bacteriologic failure were black, compared with 18% of patients with bacteriologic success (p = 0.007). Gender, history of frequent otitis media, and presence of bilateral otitis media were not risk factors for bacteriologic failure. Clinical success was demonstrated in 261 patients (89%); 32 patients (11%) had clinical failure. Agreement between clinical and bacteriologic response was 86% (95% confidence interval: 81.6% to 89.6%). Ninety-three percent (236/253) of subjects whose infection was eliminated had clinical resolution, whereas 37% (15/40) of those with bacteriologic failure had persisting symptoms or signs of clinical failure. We conclude that failure to eliminate bacteria from the middle ear is often associated with persistent signs and symptoms. Bacteriologic failure affects children less than 18 months of age almost exclusively. Bacteriologic and clinical failure are frequently discordant; mechanisms unrelated to the bacterial infection may explain some of the persisting clinical signs.
为评估儿童中耳炎细菌感染根除与临床改善之间的关系，我们回顾了1979年至1988年参加抗菌治疗双盲试验患者的细菌性中耳炎临床结局。中耳渗出物培养显示细菌病原体分布与其他地理区域观察到的相似。293例由细菌病原体引起中耳炎的患者在治疗3至6天后接受了重复鼓膜穿刺术。253例患者（86%）细菌学治疗成功；40例患者（14%）细菌学治疗失败。细菌学治疗失败的儿童比治疗成功的儿童年龄小（中位年龄10.6个月对18.5个月；p = 0.001）；细菌学治疗失败的患者中38%为黑人，而细菌学治疗成功的患者中这一比例为18%（p = 0.007）。性别、频繁中耳炎病史及双侧中耳炎的存在不是细菌学治疗失败的危险因素。261例患者（89%）临床治疗成功；32例患者（11%）临床治疗失败。临床与细菌学反应的一致性为86%（95%置信区间：81.6%至89.6%）。感染消除的受试者中有93%（236/253）临床症状消退，而细菌学治疗失败的患者中有37%（15/40）仍有持续症状或临床失败体征。我们得出结论，中耳细菌未能清除常与持续的体征和症状相关。细菌学治疗失败几乎仅影响18个月以下儿童。细菌学和临床治疗失败常不一致；与细菌感染无关的机制可能解释一些持续的临床体征。
