Levy C, Thollot F, Corrard F, Lécuyer A, Martin P, Boucherat M, Koskas M, Romain O, Goldrey M, Hausdorff W-P, Cohen R
Association clinique et thérapeutique infantile du Val-de-Marne (Activ), 27, rue Inkermann, 94100 Saint-Maur-des-Fossés, France.
Arch Pediatr. 2011 Jun;18(6):712-8. doi: 10.1016/j.arcped.2011.03.010. Epub 2011 May 4.
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.
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.
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]).
Despite PCV7 implementation, AOM remains a very frequent childhood infection and a major reason for ATB prescriptions.
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。
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。
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]）。
尽管实施了PCV7，AOM仍然是儿童期非常常见的感染，也是开具ATB处方的主要原因。
