Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
J Microbiol Immunol Infect. 2013 Oct;46(5):382-8. doi: 10.1016/j.jmii.2013.04.001. Epub 2013 Jun 10.
BACKGROUND/PURPOSE(S): In Taiwan, clinical and microbiological data on acute otitis media (AOM) with spontaneous otorrhea in children are limited.
We retrospectively collected data on children with AOM and spontaneous otorrhea between January 2011 and June 2012. Otorrhea samples were collected using sterile swabs and sent for cultures. Pathogens found were Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pyogenes, and Staphylococcus aureus. Pneumococcal isolates collected from October 2011 to June 2012 were serotyped.
A total of 92 patients were enrolled in the study for demographic and microbiological analysis. Their median age was 2.5 years. After excluding those with lobar pneumonia, 84 patients were included for analysis of clinical manifestation. The mean febrile duration was 6 days. Leukocytosis and C-reactive protein (CRP) level >50 mg/L were noted in 29 (34.5%) patients and 38 (45.2%) patients, respectively. Patients with pneumococcal infection were older (p = 0.007) and had more severe symptoms [fever (p = 0.001), otalgia (p = 0.055), respiratory symptoms (p = 0.002-0.03), and higher CRP level (p = 0.015)] than children with other bacterial infection. Otorrhea cultures were obtained from 69 (75%) patients, of whom 52 had definitive AOM pathogens. The most common causative pathogen was S. pneumoniae (61.5%), followed by S. aureus (36.5%). Serotype 19A accounted for two-thirds of pneumococcal isolates and had a high rate of nonsusceptibility to penicillin (66.7%) and ceftriaxone (83.3%).
S. pneumoniae was found to be the most important source of AOM with spontaneous otorrhea in children and caused more severe symptoms. Serotype 19A, which was usually nonsusceptible to antimicrobial agents, was the most prevalent serotype in these patients.
背景/目的：在台湾，关于儿童急性中耳炎（AOM）伴自发性耳漏的临床和微生物学数据有限。
我们回顾性收集了 2011 年 1 月至 2012 年 6 月期间患有 AOM 和自发性耳漏的儿童数据。使用无菌拭子采集耳漏样本，并进行培养。发现的病原体包括肺炎链球菌、流感嗜血杆菌、卡他莫拉菌、化脓性链球菌和金黄色葡萄球菌。从 2011 年 10 月至 2012 年 6 月收集的肺炎球菌分离株进行血清型分析。
共有 92 名患者入组进行人口统计学和微生物学分析。他们的中位年龄为 2.5 岁。排除大叶性肺炎患者后，84 名患者纳入临床表现分析。发热持续时间平均为 6 天。白细胞增多和 C 反应蛋白（CRP）水平>50mg/L分别见于 29 例（34.5%）和 38 例（45.2%）患者。肺炎球菌感染者年龄较大（p=0.007），症状更严重[发热（p=0.001）、耳痛（p=0.055）、呼吸症状（p=0.002-0.03）和更高的 CRP 水平（p=0.015）]。69 例（75%）患者获得了耳漏培养，其中 52 例有明确的 AOM 病原体。最常见的病原体是肺炎链球菌（61.5%），其次是金黄色葡萄球菌（36.5%）。血清型 19A 占肺炎球菌分离株的三分之二，对青霉素（66.7%）和头孢曲松（83.3%）的耐药率较高。
肺炎链球菌是儿童自发性耳漏性 AOM 的最重要病原体，引起更严重的症状。血清型 19A 通常对抗菌药物不敏感，是这些患者中最常见的血清型。
