Alexander Nathan S, Kulbersh Brian D, Heath C Hope, Desmond Renee A, Caron Eric, Woolley Audie L, Hill Jimmy Scott, Shirley W Peyton, Wiatrak Brian J
Pediatric ENT Associates of Alabama, Children's Hospital of Alabama, 1940 Elmer J. Bissell Road, Birmingham, AL 35243, USA.
Arch Otolaryngol Head Neck Surg. 2011 Dec;137(12):1223-7. doi: 10.1001/archoto.2011.198.
To test the perception that post-tympanostomy tube otorrhea caused by methicillin-resistant Staphylococcus aureus (MRSA) is a more virulent disease than otorrhea caused by other pathogens by analyzing the clinical differences and disease courses in children diagnosed with otorrhea caused by MRSA bacteria vs non-MRSA bacteria.
Retrospective review.
Tertiary children's hospital.
We retrospectively examined the medical records of children who presented to a tertiary children's hospital from January 1, 2003, to December 31, 2008, with otorrhea that occurred after tympanostomy tube insertion.
Otorrhea culture records were used to group the 1079 patients into those whose otitis media was due to MRSA (n = 170) and those with non-MRSA otitis media (n = 909). From the non-MRSA group, we randomly selected an age-matched group of 170 and examined the differences between the MRSA and age-matched non-MRSA groups in organisms isolated by culture, demographic factors (including type of medical insurance), medical history, treatments, surgical procedures performed, audiometric data, and other admissions for infection-related illnesses.
The overall incidence of MRSA in this series was about 16% (170 of 1079 patients). Of the 170 eligible children in each age-matched group, 135 with MRSA otorrhea and 141 with non-MRSA otorrhea had data in every category selected for statistical analysis. The groups did not differ significantly in type of insurance; history of tympanostomy tube placement, cholesteatoma, or prematurity; number or type (minor/major) of surgical procedures performed; or risk of subsequent infection-related diagnoses. More patients in the MRSA group received intravenous antibiotic therapy (11% vs 3.6%; P < .001).
In this study, a diagnosis of otorrhea due to MRSA did not carry an increased risk for surgical procedures or infection-associated sequelae compared with a diagnosis of non-MRSA otorrhea.
通过分析诊断为耐甲氧西林金黄色葡萄球菌（MRSA）引起的耳漏与非MRSA细菌引起的耳漏的儿童的临床差异和病程，来检验一种观点，即MRSA引起的鼓膜置管后耳漏比其他病原体引起的耳漏更具致病性。
回顾性研究。
三级儿童医院。
我们回顾性检查了2003年1月1日至2008年12月31日期间到一家三级儿童医院就诊、鼓膜置管后出现耳漏的儿童的病历。
耳漏培养记录用于将1079例患者分为中耳感染由MRSA引起的患者（n = 170）和非MRSA引起的中耳感染患者（n = 909）。从非MRSA组中，我们随机选择了170例年龄匹配的患者，并检查了MRSA组和年龄匹配的非MRSA组在培养分离出的病原体、人口统计学因素（包括医疗保险类型）、病史、治疗、实施的外科手术、听力数据以及其他与感染相关疾病的入院情况方面的差异。
本系列中MRSA的总体发病率约为16%（1079例患者中的170例）。在每个年龄匹配组的170例符合条件的儿童中，135例MRSA耳漏患儿和141例非MRSA耳漏患儿在为统计分析所选的每个类别中都有数据。两组在保险类型、鼓膜置管史、胆脂瘤或早产史、实施的外科手术数量或类型（小手术/大手术）或后续感染相关诊断风险方面没有显著差异。MRSA组中接受静脉抗生素治疗的患者更多（11%对3.6%；P <.001）。
在本研究中，与非MRSA耳漏的诊断相比，MRSA引起的耳漏诊断在外科手术或感染相关后遗症方面没有增加风险。
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