Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, University of Rochester School of Medicine, Rochester, NY, USA.
Pediatr Infect Dis J. 2010 Aug;29(8):741-5. doi: 10.1097/INF.0b013e3181d9e639.
The 3 most commonly encountered bacteria in acute otitis media (AOM) are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Conventional culture methods detect these pathogens in only 60% to 70% of cases of AOM. Alloiococcus otitidis, another potential pathogen, has often been ignored.
Tympanocentesis was performed in 97 children with AOM presenting with a bulging tympanic membrane (TM) producing 170 middle ear fluids (MEFs). S. pneumoniae, H. influenzae, M. catarrhalis, and A. otitidis were isolated in 21%, 32%, 8%, and 0% of MEFs, respectively; no otopathogen was isolated in 29% of MEFs. In nasopharyngeal cultures at the time of AOM diagnosis, 34%, 36%, 17%, and 0% and in oropharyngeal cultures, 7%, 31%, 11%, and 0% grew S. pneumoniae, H. influenzae, M. catarrhalis, and A. otitidis, respectively. No otopathogen was isolated in 23% of nasopharyngeal and 20% of oropharyngeal cultures. Multiplex polymerase chain reaction (PCR) was used to detect DNA of the 4 bacterial species in culture negative samples.
All culture-positive MEF, nasopharyngeal and oropharyngeal samples tested were also multiplex-PCR positive, indicating the reliability of the method. Culture-negative samples of MEF from children with a bulging TM yielded S. pneumoniae, H. influenzae, M. catarrhalis, and A. otitidis DNA in 51%, 35%, 14%, and 32% of MEF, in 45%, 31%, 10%, and 9% of nasopharyngeal and in 31%, 23%, 0%, and 3% of oropharyngeal, respectively. In 9% of the cases A. otitidis DNA was found without detection of a second organism in MEF.
Conventional culture detected otopathogens in MEF of children with a bulging TM in 71%; using multiplex-PCR, otopathogens were detected in 88% of MEF (P < 0.01). Similar improved detection of otopathogens was noted with nasopharyngeal and oropharyngeal cultures.
急性中耳炎（AOM）中最常见的三种细菌是肺炎链球菌、流感嗜血杆菌和卡他莫拉菌。传统的培养方法只能在 60%至 70%的 AOM 病例中检测到这些病原体。另一种潜在病原体莫拉氏菌常被忽视。
对 97 例鼓膜膨出的 AOM 患儿进行鼓室穿刺，共获得 170 份中耳液（MEF）。在 21%、32%、8%和 0%的 MEF 中分别分离出肺炎链球菌、流感嗜血杆菌、卡他莫拉菌和莫拉氏菌，29%的 MEF 中未分离出病原体。在 AOM 诊断时的鼻咽培养中，分别有 34%、36%、17%和 0%，在口咽培养中分别有 7%、31%、11%和 0%的 S. pneumoniae、H. influenzae、M. catarrhalis 和 A. otitidis 生长。23%的鼻咽培养物和 20%的口咽培养物未分离出病原体。采用多重聚合酶链反应（PCR）检测培养阴性样本中 4 种细菌的 DNA。
所有培养阳性的 MEF、鼻咽和口咽样本均经多重 PCR 检测为阳性，表明该方法可靠。鼓膜膨出的患儿培养阴性的 MEF 样本中，S. pneumoniae、H. influenzae、M. catarrhalis 和 A. otitidis DNA 在 MEF 中分别占 51%、35%、14%和 32%，在鼻咽中分别占 45%、31%、10%和 9%，在口咽中分别占 31%、23%、0%和 3%。9%的病例中，A. otitidis DNA 检测阳性，而 MEF 中未检测到第二种病原体。
传统培养法在鼓膜膨出的患儿 MEF 中检出病原体的比例为 71%；使用多重 PCR 法，MEF 中检出病原体的比例为 88%（P<0.01）。鼻咽和口咽培养也同样提高了病原体的检出率。
