Zielnik-Jurkiewicz Beata, Bielicka Anna
ENT Department, Children's Hospital, 4/24 Niekłańska Str. 03-924 Warsaw, Poland.
ENT Department, Children's Hospital, 4/24 Niekłańska Str. 03-924 Warsaw, Poland.
Int J Pediatr Otorhinolaryngol. 2015 Dec;79(12):2129-33. doi: 10.1016/j.ijporl.2015.09.030. Epub 2015 Sep 30.
The emergence of antibiotic-resistant bacteria is a major cause of treatment failure in children with acute otitis media (AOM). This study aimed to analyze the types of bacterial strains in fluid isolated from the middle ear of children with AOM who did not respond to oral antibiotic treatment. We also determined the antibiotic resistance of the most frequently isolated bacterial strain (Streptococcus pneumoniae) found in these children.
This was a prospective study of 157 children with AOM aged from 6 months to 7 years admitted due to unsuccessful oral antibiotic treatment. All children underwent a myringotomy, and samples of the middle ear fluid were collected for bacteriological examination.
Positive bacterial cultures were obtained in 104 patients (66.2%), with Streptococcus pneumoniae (39.69%), Haemophilus influenzae (16.03%) Staphylococcus aureus (16.03%), Staphylococcus haemolyticus (6.9%) and Streptococcus pyogenes (5.34%) found most frequently. The majority (65.4%) of S. pneumoniae strains were penicillin-intermediate-resistant or penicillin-resistant, and 67.2% strains of S. pneumoniae were multidrug-resistant.
We identified S. pneumoniae as the most frequently isolated pathogen from the middle ear in children with AOM treatment failure and determined that the majority of strains were antibiotic-resistant. We propose that the microbiological identification of bacterial strains and their degree of antibiotic resistance should be performed prior to therapy in order to choose the most appropriate antibiotic therapy for children with AOM treatment failure.
抗生素耐药菌的出现是急性中耳炎（AOM）患儿治疗失败的主要原因。本研究旨在分析对口服抗生素治疗无反应的AOM患儿中耳液中分离出的细菌菌株类型。我们还确定了这些患儿中最常分离出的细菌菌株（肺炎链球菌）的抗生素耐药性。
这是一项对157例因口服抗生素治疗失败而入院的6个月至7岁AOM患儿的前瞻性研究。所有患儿均接受鼓膜切开术，并收集中耳液样本进行细菌学检查。
104例患者（66.2%）细菌培养呈阳性，最常见的是肺炎链球菌（39.69%）、流感嗜血杆菌（16.03%）、金黄色葡萄球菌（16.03%）、溶血葡萄球菌（6.9%）和化脓性链球菌（5.34%）。大多数（65.4%）肺炎链球菌菌株对青霉素中度耐药或耐药，67.2%的肺炎链球菌菌株对多种药物耐药。
我们确定肺炎链球菌是治疗失败的AOM患儿中耳最常分离出的病原体，并确定大多数菌株具有抗生素耐药性。我们建议在治疗前对细菌菌株进行微生物鉴定及其抗生素耐药程度，以便为治疗失败的AOM患儿选择最合适的抗生素治疗。
