Aguilar Lara, Alvarado Oscar, Soley Carolina, Abdelnour Arturo, Dagan Ron, Arguedas Adriano
Instituto de Atención Pediátrica, San José, Costa Rica.
Int J Pediatr Otorhinolaryngol. 2009 Oct;73(10):1407-11. doi: 10.1016/j.ijporl.2009.07.005. Epub 2009 Aug 14.
Because the microbiology and susceptibility patterns of middle ear fluid pathogens in children with otitis media change over time, an active surveillance is recommended to establish appropriate therapeutic guidelines.
To analyze the microbiology and susceptibility pattern of middle ear pathogens obtained from Costa Rican children with acute otitis media (AOM), recurrent otitis media (ROM) and therapeutic failure otitis media (OMTF) between 2002 and 2007.
1108 children aged 2-92 months who participated in various otitis media clinical trials between the years 2002 and 2007.
Among the study population, 880 were children with AOM (61% <24 months of age), 138 were children with ROM (54% <24 months of age) and 90 were children with OMTF (67% <24 months of age). Bilateral otitis media was more frequent in children with OMTF (44%) than in children with AOM (37%) (P=0.19) and ROM (27%) (P=0.009). Presence of siblings <8 years of age was more frequently observed in children with OMTF (73%) than in children with ROM (65%) (P=0.0001) and AOM (47%) (P=0.000002). Overall Streptococcus pneumoniae (44%) was the most common pathogen isolated followed by Haemophilus influenzae (37%), Moraxella catarrhalis (11%) and Streptococcus pyogenes (4%). S. pneumoniae was the most common pathogen in AOM (44%) and ROM (47%), however, H. influenzae was the most common pathogen in OMTF (40%). Among all H. influenzae, an increase in the number of β-lactamase producing strains was observed from 5.2% in 2001 to 14% (P=0.04) in 2007 and this was associated with an increase in the use of amoxicillin. An increase in the number of M. catarrhalis was also observed, from 3% (9/350) in 2001 to 11% (71/628) (P=0.000003) in 2007. During the study period the incidence of penicillin non-susceptible S. pneumoniae was 42/211 (20%) in children with AOM; 5/35 (17%) in children with ROM and 5/17 (42%) in children with OMTF. M. catarrhalis cases increased from 8% in 2004 to 17% in 2007 (P=0.0005) and S. pyogenes decreased from 7% in 2002-2004 to 1% in 2005-2007 (P=0.001).
In Costa Rica, S. pneumoniae remains the most common pathogen in children with AOM and ROM whereas non-typable H. influenzae remains the most common pathogen in children with OMTF. A significant increase in the number of β-lactamase positive H. influenzae and M. catarrhalis has been observed in recent years.
由于中耳炎患儿中耳积液病原体的微生物学特征和药敏模式会随时间变化，因此建议进行主动监测以制定合适的治疗指南。
分析2002年至2007年间从患有急性中耳炎（AOM）、复发性中耳炎（ROM）和治疗失败的中耳炎（OMTF）的哥斯达黎加儿童中获取的中耳病原体的微生物学特征和药敏模式。
1108名年龄在2至92个月之间的儿童参与了2002年至2007年间的各种中耳炎临床试验。
在研究人群中，880名是AOM患儿（61%年龄小于24个月），138名是ROM患儿（54%年龄小于24个月），90名是OMTF患儿（67%年龄小于24个月）。OMTF患儿双侧中耳炎的发生率（44%）高于AOM患儿（37%）（P = 0.19）和ROM患儿（27%）（P = 0.009）。OMTF患儿中8岁以下有兄弟姐妹的情况比ROM患儿（65%）（P = 0.0001）和AOM患儿（47%）（P = 0.000002）更常见。总体而言，分离出的最常见病原体是肺炎链球菌（44%），其次是流感嗜血杆菌（37%）、卡他莫拉菌（11%）和化脓性链球菌（4%）。肺炎链球菌是AOM（44%）和ROM（47%）中最常见的病原体，然而，流感嗜血杆菌是OMTF中最常见的病原体（40%）。在所有流感嗜血杆菌中，产β-内酰胺酶菌株的数量从2001年的5.2%增加到207年的14%（P = 0.04），这与阿莫西林使用的增加有关。卡他莫拉菌的数量也有所增加，从2001年的3%（9/350）增加到2007年的11%（71/628）（P = 0.000003）。在研究期间，AOM患儿中青霉素不敏感肺炎链球菌的发生率为（20%）42/211；ROM患儿中为5/35（17%）；OMTF患儿中为5/17（42%）。卡他莫拉菌病例从2004年的8%增加到2007年的17%（P = 0.0005），化脓性链球菌从2002 - 年的7%下降到2005 - 2007年的1%（P = 0.001）。
在哥斯达黎加，肺炎链球菌仍然是AOM和ROM患儿中最常见的病原体，而不可分型流感嗜血杆菌仍然是OMTF患儿中最常见的病原体。近年来，产β-内酰胺酶的流感嗜血杆菌和卡他莫拉菌数量显著增加。
