[西班牙肺炎球菌结合疫苗时代后急性中耳炎的细菌病因学]

[Bacterial etiology of acute otitis media in Spain in the post-pneumococcal conjugate vaccine era].

作者信息

Pumarola Felix, Salamanca de la Cueva Ignacio, Sistiaga-Hernando Alessandra, García-Corbeira Pilar, Moraga-Llop Fernando A, Cardelús Sara, McCoig Cynthia, Gómez Martínez Justo Ramón, Rosell Ferrer Rosa, Iniesta Turpin Jesús, Devadiga Raghavendra

机构信息

Hospital Vall d'Hebron, Unidad de ORL Pediátrica, Barcelona, España.

Instituto Hispalense de Pediatría, Unidad de Estudio e Investigación, Sevilla, España.

出版信息

An Pediatr (Barc). 2016 Nov;85(5):224-231. doi: 10.1016/j.anpedi.2015.10.016. Epub 2016 Mar 9.

DOI:10.1016/j.anpedi.2015.10.016

PMID:26969247

Abstract

INTRODUCTION

Acute otitis media (AOM) is common in children aged <3 years. A pneumococcal conjugate vaccine (PCV) (PCV7; Prevenar, Pfizer/Wyeth, USA) has been available in Spain since 2001, which has a coverage rate of 50-60% in children aged <5 years.

MATERIALS AND METHODS

Children aged ≥3 to 36 months with AOM confirmed by an ear-nose-throat specialist were enrolled at seven centers in Spain (February 2009-May 2012) (GSK study identifier: 111425). Middle-ear-fluid samples were collected by tympanocentesis or spontaneous otorrhea and cultured for bacterial identification. Culture-negative samples were further analyzed using polymerase chain reaction (PCR).

RESULTS

Of 125 confirmed AOM episodes in 124 children, 117 were analyzed (median age: 17 months (range: 3-35); eight AOM episodes were excluded from analyses. Overall, 69% (81/117) episodes were combined culture- and PCR-positive for ≥1 bacterial pathogen; 44% (52/117) and 39% (46/117) were positive for Haemophilus influenzae (Hi) and Streptococcus pneumoniae (Spn), respectively. 77 of 117 episodes were cultured for ≥1 bacteria, of which 63 were culture-positive; most commonly Spn (24/77; 31%) and Hi (32/77; 42%). PCR on culture-negative episodes identified 48% Hi- and 55% Spn-positive episodes. The most common Spn serotype was 19F (4/24; 17%) followed by 19A (3/24; 13%); all Hi-positive episodes were non-typeable (NTHi). 81/117 AOM episodes (69%) occurred in children who had received ≥1 pneumococcal vaccine dose.

CONCLUSIONS

NTHi and Spn were the main etiological agents for AOM in Spain. Impact of pneumococcal vaccination on AOM requires further evaluation in Spain, after higher vaccination coverage rate is reached.

摘要

引言

急性中耳炎（AOM）在3岁以下儿童中很常见。自2001年起，西班牙开始使用肺炎球菌结合疫苗（PCV）（PCV7；沛儿，辉瑞/惠氏，美国），该疫苗在5岁以下儿童中的覆盖率为50 - 60%。

材料与方法

2009年2月至2012年5月期间，在西班牙的七个中心招募了年龄≥3至36个月、经耳鼻喉科专家确诊为AOM的儿童（葛兰素史克研究标识符：111425）。通过鼓膜穿刺术或自然耳漏收集中耳液样本，并进行细菌培养以鉴定细菌。对培养阴性的样本进一步使用聚合酶链反应（PCR）进行分析。

结果

124名儿童中的125次确诊AOM发作中，117次进行了分析（中位年龄：17个月（范围：3 - 35个月）；8次AOM发作被排除在分析之外）。总体而言，69%（81/117）的发作在培养和PCR检测中至少有一种细菌病原体呈阳性；流感嗜血杆菌（Hi）和肺炎链球菌（Spn）分别有44%（52/117）和39%（46/117）呈阳性。117次发作中有77次进行了至少一种细菌的培养，其中63次培养呈阳性；最常见的是Spn（24/77；31%）和Hi（32/77；42%）。对培养阴性发作进行的PCR检测发现，Hi阳性发作占48%，Spn阳性发作占55%。最常见的Spn血清型是19F（4/24；17%），其次是19A（3/24；13%）；所有Hi阳性发作均为不可分型（NTHi）。117次AOM发作中有81次（69%）发生在已接种≥1剂肺炎球菌疫苗的儿童中。