van Dongen Thijs M A, Venekamp Roderick P, Wensing Annemarie M J, Bogaert Debby, Sanders Elisabeth A M, Schilder Anne G M
From the *Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; †Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands; ‡Virology Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands; §Department of Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; and ¶ENT Clinical Trials Programme, Ear Institute, University College London, London, United Kingdom.
Pediatr Infect Dis J. 2015 Apr;34(4):355-60. doi: 10.1097/INF.0000000000000595.
Acute tympanostomy-tube otorrhea is a common sequela in children with tympanostomy tubes. Acute tympanostomy-tube otorrhea is generally a symptom of an acute middle ear infection, whereby middle ear fluid drains through the tube. The widespread use of pneumococcal conjugate vaccination (PCV) has changed the bacterial prevalence in the upper respiratory tract of children, but its impact on bacterial and viral pathogens causing acute tympanostomy-tube otorrhea is yet unknown.
This study was performed in the post-PCV7 era parallel to a randomized clinical trial of the clinical and cost-effectiveness of ototopical and systemic antibiotics and initial observation in 230 children aged 1 to 10 years with untreated, uncomplicated acute tympanostomy-tube otorrhea. Otorrhea and nasopharyngeal samples were collected at baseline (before treatment) and at 2 weeks (after treatment). Conventional bacterial culture was performed followed by antimicrobial-resistance assessment. Viruses were identified by polymerase chain reaction.
At baseline, Haemophilus influenzae (41%), Staphylococcus aureus (40%) and Pseudomonas aeruginosa (18%) were the most prevalent bacteria in otorrhea, followed by Streptococcus pneumoniae (7%) and Moraxella catarrhalis (4%). Most pneumococci were non-PCV7 serotypes. Viruses were detected in 45 otorrhea samples at baseline (21%). Most infections were polymicrobial and overall antimicrobial resistance was low.
H. influenzae, S. aureus and P. aeruginosa are the most common microorganisms in children with untreated uncomplicated acute tympanostomy-tube otorrhea. Prevalence of S. pneumoniae has decreased since the introduction of PCV and most pneumococci are nonvaccine serotypes.
急性鼓膜置管耳漏是鼓膜置管儿童常见的后遗症。急性鼓膜置管耳漏通常是急性中耳感染的症状，中耳积液通过置管排出。肺炎球菌结合疫苗（PCV）的广泛使用改变了儿童上呼吸道的细菌流行情况，但其对引起急性鼓膜置管耳漏的细菌和病毒病原体的影响尚不清楚。
本研究在PCV7时代进行，与一项关于耳用局部和全身用抗生素的临床及成本效益的随机临床试验平行，并对230名1至10岁未治疗、无并发症的急性鼓膜置管耳漏儿童进行了初步观察。在基线（治疗前）和2周（治疗后）收集耳漏和鼻咽样本。进行常规细菌培养，随后进行抗菌药物耐药性评估。通过聚合酶链反应鉴定病毒。
在基线时，耳漏中最常见的细菌是流感嗜血杆菌（41%）、金黄色葡萄球菌（40%）和铜绿假单胞菌（18%），其次是肺炎链球菌（7%）和卡他莫拉菌（4%）。大多数肺炎球菌是非PCV7血清型。在基线时，45份耳漏样本中检测到病毒（21%）。大多数感染是多微生物感染，总体抗菌药物耐药性较低。
流感嗜血杆菌、金黄色葡萄球菌和铜绿假单胞菌是未治疗的无并发症急性鼓膜置管耳漏儿童中最常见的微生物。自引入PCV以来，肺炎链球菌的流行率有所下降，大多数肺炎球菌是非疫苗血清型。
