Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; Department of Pediatrics, Taiwan Adventist Hospital, Taipei, Taiwan.
Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.
J Microbiol Immunol Infect. 2019 Feb;52(1):75-80. doi: 10.1016/j.jmii.2017.08.020. Epub 2017 Sep 18.
Concerns about non-typeable Haemophilus influenzae (NTHi) in otitis media (OM) have grown after the introduction of pneumococcal conjugate vaccine (PCV). We aim to better understand the clinical role of NTHi in pediatric OM.
Middle ear fluid samples from children <18 years with OM were obtained from 2010 to 2015. For culture-positive episodes (Streptococcus pneumoniae, H. influenzae, Moraxella catarrhalis, and Streptococcus pyogenes), patients' demographic and clinical information were reviewed and analyzed.
A total of 783 episodes were included with 31.8% of isolates as positive. S. pneumoniae was recovered in 69.4%, NTHi in 24.6%, M. catarrhalis in 5.6%, and S. pyogenes in 4.0% of culture-positive episodes. The proportion of pneumococcal OM has declined since 2012 (P for trend <0.005), but NTHi OM rose simultaneously (P for trend = 0.009). Factors associated with increased risk of NTHi infection included less spontaneous otorrhea (OR 0.15, 95% CI 0.06-0.39, P < 0.001), absence of fever (OR 0.30, 95% CI 0.14-0.66, P = 0.003), concurrent sinusitis (OR 2.91, 95% CI 1.36-6.20, P = 0.006), previous ventilation tube insertion (OR 12.02, 95% CI 3.15-45.92, P < 0.001) and recurrent OM (OR 3.43, 95% CI 1.01-11.71, P = 0.049). The susceptibility of NTHi to amoxicillin/clavulanate was 82.0%.
NTHi OM has trended upward in the post-PCV era. Concurrent sinusitis, previous ventilation tube insertion, and recurrent OM were associated with NTHi OM implicated a correlation between NTHi and complex OM. In consideration of NTHi infection, we suggest amoxicillin/clavulanate as the first-line therapy for OM among Taiwanese children.
在接种肺炎球菌结合疫苗（PCV）后，人们对非典型流感嗜血杆菌（NTHi）在中耳炎（OM）中的作用愈发关注。我们旨在更好地了解 NTHi 在儿科 OM 中的临床作用。
我们收集了 2010 年至 2015 年期间年龄小于 18 岁的 OM 患儿的中耳液样本。对于培养阳性的病例（肺炎链球菌、流感嗜血杆菌、卡他莫拉菌和化脓性链球菌），我们回顾并分析了患者的人口统计学和临床资料。
共纳入 783 例 OM 发作，其中 31.8%的分离株呈阳性。69.4%的培养阳性病例中分离出肺炎链球菌，24.6%的分离株中分离出 NTHi，5.6%的分离株中分离出卡他莫拉菌，4.0%的分离株中分离出化脓性链球菌。自 2012 年以来，肺炎球菌性 OM 的比例有所下降（趋势 P<0.005），但 NTHi OM 同时上升（趋势 P=0.009）。与 NTHi 感染风险增加相关的因素包括自发性耳漏较少（比值比 0.15，95%置信区间 0.06-0.39，P<0.001）、无发热（比值比 0.30，95%置信区间 0.14-0.66，P=0.003）、并发鼻窦炎（比值比 2.91，95%置信区间 1.36-6.20，P=0.006）、既往使用通气管（比值比 12.02，95%置信区间 3.15-45.92，P<0.001）和复发性 OM（比值比 3.43，95%置信区间 1.01-11.71，P=0.049）。NTHi 对阿莫西林/克拉维酸的敏感性为 82.0%。
在 PCV 时代后，NTHi OM 呈上升趋势。并发鼻窦炎、既往通气管使用和复发性 OM 与 NTHi OM 相关，提示 NTHi 与复杂性 OM 之间存在关联。考虑到 NTHi 感染，我们建议在台湾儿童中使用阿莫西林/克拉维酸作为 OM 的一线治疗药物。
