Policlínica Metropolitana, Piso 1, consultorio 1-13, Urbanización Caurimare, Calle A-1, Caracas, Venezuela.
BMC Infect Dis. 2012 Feb 15;12:40. doi: 10.1186/1471-2334-12-40.
Non-typeable Haemophilus influenzae (NTHi) and Streptococcus pneumoniae are major causes of bacterial acute otitis media (AOM). Data regarding AOM are limited in Latin America. This is the first active surveillance in a private setting in Venezuela to characterize the bacterial etiology of AOM in children < 5 years of age.
Between December 2008 and December 2009, 91 AOM episodes (including sporadic, recurrent and treatment failures) were studied in 87 children enrolled into a medical center in Caracas, Venezuela. Middle ear fluid samples were collected either by tympanocentesis or spontaneous otorrhea swab sampling method. Standard laboratory and microbiological techniques were used to identify bacteria and test for antimicrobial resistance. The results were interpreted according to Clinical Laboratory Standards Institute (CLSI) 2009 for non-meningitis isolates. All statistical analyses were performed using SAS 9.1 and Microsoft Excel (for graphical purposes).
Overall, bacteria were cultured from 69.2% (63 of the 91 episodes); at least one pathogen (S. pneumoniae, H. influenzae, S. pyogenes or M. catarrhalis) was cultured from 65.9% (60/91) of episodes. H. influenzae (55.5%; 35/63 episodes) and S. pneumoniae (34.9%; 22/63 episodes) were the most frequently reported bacteria. Among H. influenzae isolates, 62.9% (22/35 episodes) were non-capsulated (NTHi) and 31.4% (11/35 episodes) were capsulated including types d, a, c and f, across all age groups. Low antibiotic resistance for H. influenzae was observed to amoxicillin/ampicillin (5.7%; 2/35 samples). NTHi was isolated in four of the six H. influenzae positive samples (66.7%) from recurrent episodes.
We found H. influenzae and S. pneumoniae to be the main pathogens causing AOM in Venezuela. Pneumococcal conjugate vaccines with efficacy against these bacterial pathogens may have the potential to maximize protection against AOM.
非定型流感嗜血杆菌（NTHi）和肺炎链球菌是细菌性急性中耳炎（AOM）的主要病因。拉丁美洲关于 AOM 的数据有限。这是委内瑞拉一家私人医疗机构首次对 5 岁以下儿童 AOM 的细菌病因进行的主动监测。
2008 年 12 月至 2009 年 12 月，在委内瑞拉加拉加斯的一家医疗中心，对 87 名入组儿童的 91 例 AOM 发作（包括散发性、复发性和治疗失败）进行了研究。采用鼓室穿刺或自发性耳漏拭子采样法采集中耳液样本。采用标准实验室和微生物学技术鉴定细菌并检测抗生素耐药性。根据临床实验室标准协会（CLSI）2009 年标准，对非脑膜炎分离株进行结果解读。所有统计分析均使用 SAS 9.1 和 Microsoft Excel（用于图形目的）进行。
总体而言，69.2%（91 例中的 63 例）培养出细菌；65.9%（91 例中的 60 例）至少培养出一种病原体（肺炎链球菌、流感嗜血杆菌、化脓性链球菌或卡他莫拉菌）。流感嗜血杆菌（55.5%；63 例中的 35 例）和肺炎链球菌（34.9%；63 例中的 22 例）是最常报告的细菌。在流感嗜血杆菌分离株中，62.9%（35 例中的 22 例）为无荚膜（NTHi），31.4%（35 例中的 11 例）为荚膜菌，包括所有年龄组的 d、a、c 和 f 型。观察到流感嗜血杆菌对阿莫西林/氨苄西林的低抗生素耐药率（5.7%；35 例样本中的 2 例）。在 6 例流感嗜血杆菌阳性样本中的 4 例（66.7%）复发性发作中分离出 NTHi。
我们发现流感嗜血杆菌和肺炎链球菌是委内瑞拉引起 AOM 的主要病原体。具有针对这些细菌病原体的功效的肺炎球菌结合疫苗可能具有最大限度地预防 AOM 的潜力。
