Arola M, Ziegler T, Ruuskanen O
Department of Pediatrics, University of Turku, Finland.
J Pediatr. 1990 May;116(5):697-701. doi: 10.1016/s0022-3476(05)82650-2.
We studied respiratory viruses in 22 children with acute otitis media who had failed to improve after at least 48 hours of antimicrobial therapy. The mean duration of preenrollment antimicrobial therapy was 4.8 days. For comparison we studied 66 children with newly diagnosed acute otitis media. Respiratory viruses were isolated from middle ear fluid or from the nasopharynx, or both, significantly more often in the patients unresponsive to initial antimicrobial therapy than in the comparison patients (68% vs 41%, p less than 0.05). Viruses were recovered from the middle ear fluid in 32% of the study patients and from 15% of the comparison group. Bacteria were isolated from the middle ear fluid of four (18%) children in the study group; one child had an isolate resistant to initial antimicrobial therapy. All four children with bacteria in the middle ear fluid had evidence of concomitant respiratory virus infection. Our results indicate that respiratory virus infection is often present in patients with acute otitis media unresponsive to initial antimicrobial therapy, and may explain the prolongation of symptoms of infection. Resistant bacteria seem to be a less common cause of failure of the initial treatment.
我们对22名患有急性中耳炎且在至少48小时抗菌治疗后病情未改善的儿童进行了呼吸道病毒研究。入组前抗菌治疗的平均时长为4.8天。作为对照，我们研究了66名新诊断为急性中耳炎的儿童。与对照组相比，在对初始抗菌治疗无反应的患者中，从中耳积液或鼻咽部或两者中分离出呼吸道病毒的情况明显更为常见（68% 对41%，p<0.05）。在32%的研究患者的中耳积液中检出病毒，而对照组为15%。在研究组的4名（18%）儿童的中耳积液中分离出细菌；1名儿童的分离菌对初始抗菌治疗耐药。中耳积液中有细菌的所有4名儿童均有合并呼吸道病毒感染的证据。我们的结果表明，呼吸道病毒感染在对初始抗菌治疗无反应的急性中耳炎患者中常常存在，并且可能解释了感染症状的延长。耐药菌似乎是初始治疗失败的较不常见原因。
