Mansour Tamer, Yehudai Noam, Tobia Amjad, Shihada Rabia, Brodsky Alex, Khnifies Riad, Barzilai Roni, Srugo Isaac, Luntz Michal
Department of Otolaryngology-Head and Neck Surgery, Bnai-Zion Medical Center, Haifa, Israel; The Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel.
The Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel.
Int J Pediatr Otorhinolaryngol. 2019 Oct;125:187-191. doi: 10.1016/j.ijporl.2019.07.014. Epub 2019 Jul 16.
To characterize the clinical presentation of pediatric patients who, upon AM diagnosis, also had imaging-diagnosed ICCs (ID-ICCs); to define the group of AM patients at risk of developing ID-ICCs; and to update knowledge about organisms causing AM.
Analysis of all AM patients admitted between 1997 and 2018 and treated according to an obligatory protocol including both brain imaging and sampling for bacterial culture upon clinical diagnosis of AM.
Of 166 admitted patients (0.5-19 years old) 22 (13%) already had ID-ICCs. In patients who, on admission, had already received antibiotics for acute otitis media (AOM) and also had CRP (C-reactive protein) levels above 93.5 mg/L, the risk of ID-CC was increased by 22.5-fold (P < 0.0001). Bacterial culture results were available for all patients and were positive in 115 (69%). Organisms most commonly found in patients without prior antibiotic treatment were group A Streptococcus pyogenes (53%), Streptococcus pneumoniae (23%), and Haemophylus influenzae (11%), while with prior antibiotic treatment they were Fusobacterium necrophorum (21%), Streptococcus pyogenes (18%) and Pseudomonas aeruginosa (18%).
Since the risk of ID-ICC in patients with the abovementioned CRP and prior antibiotic treatment was significantly higher than in the others, these high-risk patients should undergo diagnostic imaging on admission. Antibiotic treatment prior to AM development may promote growth of non-AOM pathogen.
描述在急性中耳炎（AM）诊断时同时患有影像学诊断的颅内并发症（ID-ICCs）的儿科患者的临床表现；确定有发生ID-ICCs风险的AM患者群体；并更新关于引起AM的病原体的知识。
分析1997年至2018年间收治的所有AM患者，并根据一项强制性方案进行治疗，该方案包括在AM临床诊断时进行脑部成像和细菌培养采样。
166例入院患者（年龄0.5 - 19岁）中，22例（13%）已患有ID-ICCs。入院时已因急性中耳炎（AOM）接受过抗生素治疗且C反应蛋白（CRP）水平高于93.5mg/L的患者，发生ID-CC的风险增加了22.5倍（P<0.0001）。所有患者均有细菌培养结果，115例（69%）为阳性。在未接受过抗生素治疗的患者中最常见的病原体是A组化脓性链球菌（53%）、肺炎链球菌（23%）和流感嗜血杆菌（11%），而在接受过抗生素治疗的患者中则是坏死梭杆菌（21%）、化脓性链球菌（18%）和铜绿假单胞菌（18%）。
由于上述CRP水平且接受过抗生素治疗的患者发生ID-ICC的风险显著高于其他患者，这些高危患者入院时应接受诊断性影像学检查。AM发生前的抗生素治疗可能会促进非AOM病原体的生长。
