Esposito Susanna, Marchisio Paola, Capaccio Pasquale, Bellasio Marta, Semino Margherita, Dusi Elisa, Colombo Rosaria, Pignataro Lorenzo, Principi Nicola
Institute of Pediatrics, University of Milan, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy.
J Infect. 2009 Feb;58(2):113-8. doi: 10.1016/j.jinf.2008.12.003. Epub 2009 Jan 7.
To evaluate the incidence and persistence of bacteremia in children undergoing adenoidectomy or adenotonsillectomy for different medical reasons.
We enrolled 130 children scheduled for adenoidectomy because of recurrent acute otitis media (rAOM, 15) or persistent otitis media with effusion (pOME, 33), or for adenotonsillectomy because of obstructive sleep apnea syndrome (OSAS, 41) or recurrent tonsillopharyngitis (rTF, 41). Nasopharyngeal aspirates taken just before surgery, swabs of the ablated central adenoidal and tonsillar tissues, and blood samples taken within the first 30s of beginning the operation and 20min after its end were used for bacterial cultures.
The incidence of positive blood cultures after the beginning of the operation was significantly higher in the children who underwent adenotonsillectomy than in those who underwent adenoidectomy, and in those with rAOM or rTF than in those with pOME or OSAS. Children with nasopharyngeal colonisation were significantly more likely to have a positive blood culture than those without. Twenty of the 25 children with a positive blood culture (80.0%), had the same bacteria in their nasopharyngeal and adenoidal/tonsillar tissues.
Our results show that bacteremia is significantly more frequently associated with adenotonsillectomy than with adenoidectomy, and significantly more frequent in patients with a history of rAOM or rTF.
评估因不同医学原因接受腺样体切除术或腺样体扁桃体切除术的儿童菌血症的发生率及持续情况。
我们纳入了130名计划接受腺样体切除术的儿童，其中因复发性急性中耳炎（rAOM，15例）或持续性中耳积液（pOME，33例），或因阻塞性睡眠呼吸暂停综合征（OSAS，41例）或复发性扁桃体咽炎（rTF，41例）而接受腺样体扁桃体切除术。术前采集的鼻咽抽吸物、切除的腺样体和扁桃体中央组织拭子，以及手术开始后前30秒和结束后20分钟采集的血样用于细菌培养。
接受腺样体扁桃体切除术的儿童术后血培养阳性率显著高于接受腺样体切除术的儿童，rAOM或rTF患儿的血培养阳性率显著高于pOME或OSAS患儿。鼻咽部有细菌定植的儿童血培养阳性的可能性显著高于无细菌定植的儿童。25例血培养阳性的儿童中有20例（80.0%）在鼻咽部和腺样体/扁桃体组织中发现相同细菌。
我们的结果表明，菌血症与腺样体扁桃体切除术的相关性显著高于腺样体切除术，且在有rAOM或rTF病史的患者中更为常见。
