Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston Salem, NC 27101, USA.
BMC Pediatr. 2012 Jun 28;12:87. doi: 10.1186/1471-2431-12-87.
Because previous studies have indicated that otitis media may be a polymicrobial disease, we prospectively analyzed middle ear effusions of children undergoing tympanostomy tube placement with multiplex polymerase chain reaction for four otopathogens.
Middle ear effusions from 207 children undergoing routine tympanostomy tube placement were collected and were classified by the surgeon as acute otitis media (AOM) for purulent effusions and as otitis media with effusion (OME) for non-purulent effusions. DNA was isolated from these samples and analyzed with multiplex polymerase chain reaction for Haemophilus influenzae, Streptococcus pneumoniae, Alloiococcus otitidis, and Moraxella catarrhalis.
119 (57%) of 207 patients were PCR positive for at least one of these four organisms. 36 (30%) of the positive samples indicated the presence of more than one bacterial species. Patient samples were further separated into 2 groups based on clinical presentation at the time of surgery. Samples were categorized as acute otitis media (AOM) if pus was observed behind the tympanic membrane. If no pus was present, samples were categorized as otitis media with effusion (OME). Bacteria were identified in most of the children with AOM (87%) and half the children with OME (51%, p < 0.001). A single bacterial organism was detected in middle ear effusions from children with AOM more often than those with OME (74% versus 33%, p < 0.001). Haemophilus influenzae was the predominant single organism and caused 58% of all AOM in this study. Alloiococcus otitidis and Moraxella catarrhalis were more frequently identified in middle ear effusions than Streptococcus pneumoniae.
Haemophilus influenzae, Streptococcus pneumoniae, Alloiococcus otitidis, and Moraxella catarrhalis were identified in the middle ear effusions of some patients with otitis media. Overall, we found AOM is predominantly a single organism infection and most commonly from Haemophilus influenzae. In contrast, OME infections had a more equal distribution of single organisms, polymicrobial entities, and non-bacterial agents.
由于先前的研究表明中耳炎可能是一种多微生物疾病，我们前瞻性地分析了 207 例行鼓膜切开术置管的儿童的中耳积液，采用多重聚合酶链反应检测四种耳病原体。
收集 207 例行常规鼓膜切开术置管的儿童的中耳积液，外科医生将其分类为急性中耳炎（AOM）的脓性积液和分泌性中耳炎（OME）的非脓性积液。从这些样本中提取 DNA，并用多重聚合酶链反应分析流感嗜血杆菌、肺炎链球菌、嗜沫醋酸菌和卡他莫拉菌。
207 例患者中，119 例（57%）至少有一种上述四种病原体的 PCR 阳性。36 例（30%）阳性样本表明存在两种以上细菌。根据手术时的临床表现，将患者样本进一步分为两组。如果鼓膜后观察到脓液，则将样本归类为急性中耳炎（AOM）。如果没有脓液，则将样本归类为分泌性中耳炎（OME）。在大多数 AOM 患儿（87%）和一半的 OME 患儿（51%，p < 0.001）中均鉴定出细菌。在 AOM 患儿的中耳积液中，单一细菌的检出率高于 OME 患儿（74%比 33%，p < 0.001）。流感嗜血杆菌是最常见的单一病原体，在本研究中引起了 58%的所有 AOM。嗜沫醋酸菌和卡他莫拉菌在中耳积液中的检出率高于肺炎链球菌。
流感嗜血杆菌、肺炎链球菌、嗜沫醋酸菌和卡他莫拉菌在一些中耳炎患者的中耳积液中被鉴定出来。总的来说，我们发现 AOM 主要是单一病原体感染，最常见的病原体是流感嗜血杆菌。相比之下，OME 感染的单一病原体、多种微生物实体和非细菌因子的分布更为均衡。
