Marom Tal, Shemesh Shay, Habashi Nadeem, Gluck Ofer, Tamir Sharon Ovnat
Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben-Gurion University of the Negev Faculty of Health Sciences, Ashdod, Israel.
Int Arch Otorhinolaryngol. 2020 Apr;24(2):e175-e181. doi: 10.1055/s-0039-1697995. Epub 2020 Jan 28.
is a major pathogen of otogenic meningitis (OgM), the most commonly reported intra-cranial complication of otitis media (OM). To study the changes in adult OgM patients in the pneumococcal conjugated vaccines (PCVs) era. Retrospective cohort of adults presenting with concurrent OM and meningitis in a secondary medical care center between 2005 and 2015. Data collected included demographics, OM-related symptoms, cerebrospinal fluid (CSF) and ear culture results, pre- and during hospitalization antibiotic treatment, imaging findings, and complications. We compared the pre-PCV years (2005-2009) with the post-PCV years (2010-2015). Outcomes were 1) incidence of all-cause adult OgM from the total meningitis cases; 2) impact of PCVs on the clinical presentation of OgM and bacteriology. Otogenic meningitis was diagnosed in 26 out of 45 (58%) cases of all-cause meningitis admissions. Of those, 10 (38%) were male, with a mean age of 62.4 years old. Ear-related signs and symptoms were documented in 70% of the patients, and OgM was diagnosed following imaging studies in 6 out of 26 (23%) patients. All of the patients received intravenous antibiotic therapy, and 7 (27%) patients required surgical interventions: 6 required myringotomy and 1 required mastoidectomy. There were 12 (46%) patients in the pre-PCV years and 14 (56%) in the post-PCV years. The positive pneumococcal CSF and ear culture rates remained high and unchanged (∼ 75%). There were no significant changes in the clinical presentation or mortality rates. Micro-otoscopy should be included in the routine work-up of any suspected adult meningitis, because OgM is underdiagnosed. Unlike their impact on pediatric otitis media, PCVs did not change the epidemiology and bacteriology of OgM.
是耳源性脑膜炎（OgM）的主要病原体，耳源性脑膜炎是中耳炎（OM）最常报告的颅内并发症。 为研究肺炎球菌结合疫苗（PCV）时代成年OgM患者的变化。 对2005年至2015年在二级医疗中心同时患有OM和脑膜炎的成年人进行回顾性队列研究。收集的数据包括人口统计学、与OM相关的症状、脑脊液（CSF）和耳部培养结果、住院前和住院期间的抗生素治疗、影像学检查结果及并发症。我们比较了PCV接种前几年（2005 - 2009年）和PCV接种后几年（2010 - 2015年）的情况。结果为：1）所有脑膜炎病例中成年OgM的全因发病率；2）PCV对OgM临床表现和细菌学的影响。 在45例全因性脑膜炎入院病例中，26例（58%）被诊断为耳源性脑膜炎。其中，10例（38%）为男性，平均年龄62.4岁。70%的患者记录有耳部相关体征和症状，26例患者中有6例（23%）经影像学检查后诊断为OgM。所有患者均接受了静脉抗生素治疗，7例（27%）患者需要手术干预：6例需要鼓膜切开术，1例需要乳突切除术。PCV接种前几年有12例（46%）患者，接种后几年有14例（56%）患者。肺炎球菌脑脊液和耳部培养阳性率仍然很高且未发生变化（约75%）。临床表现或死亡率无显著变化。 对于任何疑似成年脑膜炎患者，应将微型耳镜检查纳入常规检查，因为OgM诊断不足。与PCV对儿童中耳炎的影响不同，PCV并未改变OgM的流行病学和细菌学。
