Coudert A, Ayari-Khalfallah S, Suy P, Truy E
Service d'ORL Pédiatrique, Hôpital Femme Mère Enfants, Centre Hospitalier et Universitaire, Lyon, France; Service d'ORL, Hôpital Edouard Herriot, Centre Hospitalier et Universitaire, Lyon, France.
Service d'ORL Pédiatrique, Hôpital Femme Mère Enfants, Centre Hospitalier et Universitaire, Lyon, France; Service d'ORL, Hôpital Edouard Herriot, Centre Hospitalier et Universitaire, Lyon, France; Université de Lyon, Lyon, France; INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, IMPACT Team, Lyon, France.
Int J Pediatr Otorhinolaryngol. 2018 Mar;106:91-95. doi: 10.1016/j.ijporl.2018.01.021. Epub 2018 Feb 2.
The objective of this study was to investigate the microbiological cultures and the management of acute ethmoiditis complicated by subperiosteal orbital abscess (SPOA) in a pediatric population.
The medical records of children under 18 years old was performed in a tertiary referral pediatric center from January 2009 to April 2017. Clinical examination, computed tomography scans, medical and surgical treatments were reviewed and compared to other studies in literature.
One hundred and twenty-nine children were hospitalized for acute ethmoiditis. Among them, forty eight were complicated by SPOA. The mean age of these children were 7 years (range 10 months-16 years). Thirtyfour underwent surgical drainage; for the others the medical treatment was sufficient. Microbiological samples were obtained during the surgical intervention and were contributive in 91% of cases. Streptococcus spp was the most frequently encountered bacteria (60% of cases). We also found anaerobic bacteria (12%), and Staphylococcus aureus (12%). 94% of children received two intravenous antibiotics (a third-generation cephalosporin and metronidazole) for a mean duration of four days. Then the oral treatment was based on amoxicillin-clavulanate during about 8.5 days. All children were cured without sequelae.
For five years Streptococcus milleri, Staphylococcus spp and anaerobic bacteria are on the rise in acute ethmoiditis complicated by SPOA. That is why antibiotics must be adapted to these bacteria even in children under ten years old.
本研究的目的是调查儿科人群中急性筛窦炎并发眶骨膜下脓肿（SPOA）的微生物培养情况及治疗方法。
对2009年1月至2017年4月在一家三级转诊儿科中心就诊的18岁以下儿童的病历进行分析。回顾了临床检查、计算机断层扫描、药物和手术治疗情况，并与文献中的其他研究进行比较。
129名儿童因急性筛窦炎住院。其中，48例并发SPOA。这些儿童的平均年龄为7岁（范围为10个月至16岁）。34例行手术引流；其他患儿药物治疗有效。手术干预期间采集了微生物样本，91%的病例样本有参考价值。链球菌属是最常见的细菌（占病例的60%）。我们还发现了厌氧菌（12%）和金黄色葡萄球菌（12%）。94%的儿童接受了两种静脉抗生素（第三代头孢菌素和甲硝唑）治疗，平均疗程为4天。然后口服阿莫西林-克拉维酸治疗约8.5天。所有患儿均治愈，无后遗症。
五年间，米勒链球菌、葡萄球菌属和厌氧菌在急性筛窦炎并发SPOA中的比例呈上升趋势。这就是为什么即使是10岁以下的儿童，抗生素也必须针对这些细菌使用。
