[门诊环境下的急性中耳炎：7价肺炎球菌结合疫苗（PCV7）实施后的流行病学和临床特征]

[Acute otitis media in ambulatory practice: epidemiological and clinical characteristics after 7 valent pneumococcal conjugate vaccine (PCV7) implementation].

作者信息

Levy C, Thollot F, Corrard F, Lécuyer A, Martin P, Boucherat M, Koskas M, Romain O, Goldrey M, Hausdorff W-P, Cohen R

机构信息

Association clinique et thérapeutique infantile du Val-de-Marne (Activ), 27, rue Inkermann, 94100 Saint-Maur-des-Fossés, France.

出版信息

Arch Pediatr. 2011 Jun;18(6):712-8. doi: 10.1016/j.arcped.2011.03.010. Epub 2011 May 4.

DOI:10.1016/j.arcped.2011.03.010

PMID:21531540

Abstract

BACKGROUND

In US, pneumococcal conjugate vaccine (PCV7) had reduced the burden of AOM and changed the profile of the disease. Prior to PCV7 implementation in France, AOM represented 8% of pediatricians visits and failure rate was 12%. The aim of this study is to describe the epidemiologic characteristics of AOM after PCV7 implementation.

METHODS

From 2007 to 2008, 30 pediatricians enrolled 3141 patients 3 to 36 months old with AOM. Standardized history and physical examination findings were recorded. Factors related to AOM failures were identified by multivariate logistic regression.

RESULTS

AOM accounted for 5.8% of the 43 433 visits or 6.2 cases/week per pediatrician. Among 3141 evaluable AOM cases (mean age 16.7±8 months, peak incidence at 10 months), 99% had been vaccinated with PCV7 and 42.1% attended day care (DCC). Recurrent AOM comprised 24.5% of cases and 51% of children had received ATB in the last 3 months. At the time of diagnosis, 47.1% had fever≥38,5°C, 74.5% otalgia and 4.7% otorrhea. Febrile and painful AOM accounted for 29.5% of cases and cunjunctivitis-otitis syndrome for 18.2%. ATB was prescribed in 98.7% of cases (cefpodoxime proxetil, 59% and amoxicillin/clavulanate, 37%). The failure rate was 6.4% and failure risk was greater in children in DCC (OR=1.50, [1.10;2.05]), young age<18 months (OR=1.47, [1.06;2.04]) and history of recurrent AOM (OR=1.45, [1.02;2.06]).

CONCLUSION

Despite PCV7 implementation, AOM remains a very frequent childhood infection and a major reason for ATB prescriptions.

摘要

背景

在美国，肺炎球菌结合疫苗（PCV7）减轻了急性中耳炎（AOM）的负担并改变了该病的特征。在法国实施PCV7之前，AOM占儿科医生诊疗病例的8%，失败率为12%。本研究的目的是描述实施PCV7后AOM的流行病学特征。

方法

2007年至2008年，30名儿科医生纳入了3141例3至36个月大的AOM患者。记录标准化的病史和体格检查结果。通过多因素逻辑回归确定与AOM治疗失败相关的因素。

结果

AOM占43433次就诊病例的5.8%，即每位儿科医生每周6.2例。在3141例可评估的AOM病例中（平均年龄16.7±8个月，发病高峰在10个月），99%接种了PCV7，42.1%参加日托（DCC）。复发性AOM占病例的24.5%，51%的儿童在过去3个月内接受过抗生素治疗（ATB）。诊断时，47.1%的患者体温≥38.5°C，74.5%有耳痛，4.7%有耳漏。发热性和疼痛性AOM占病例的29.5%，结膜炎-中耳炎综合征占18.2%。98.7%的病例开具了ATB（头孢泊肟酯，59%；阿莫西林/克拉维酸，37%）。失败率为6.4%，DCC儿童、年龄<18个月的幼儿和复发性AOM病史儿童的失败风险更高（比值比[OR]=1.50，[1.10；2.05]）、（OR=1.47，[1.06；2.04]）和（OR=1.45，[1.02；2.06]）。