Pichichero M E, Pichichero C L
Department of Pediatrics, University of Rochester Medical Center, NY 14642, USA.
Pediatr Infect Dis J. 1995 Mar;14(3):178-83. doi: 10.1097/00006454-199503000-00002.
In this prospective study tympanocentesis was performed to determine the pathogens isolated from middle ear fluid of 200 ears in 137 children with acute otitis media (AOM) which had not responded after one or two empiric antimicrobial treatment courses (termed persistent AOM). For comparison tympanocentesis from 154 ears in 111 children with AOM not previously treated are described. Patients were enrolled from October, 1989, until September, 1992. In the persistent AOM group amoxicillin and trimethoprim/sulfamethoxazole were the most frequently used antimicrobials before tympanocentesis. Middle ear aspirates produced no pathogenic bacterial growth in 49% of persistent AOM patients, Streptococcus pneumoniae in 24%, Haemophilus influenzae in 7%, Branhamella catarrhalis in 7%, Streptococcus pyogenes in 6%, Staphylococcus aureus in 5% and two pathogens in 3%. Two (18%) of 11 S. pneumoniae isolates tested were penicillin-resistant; 1 was intermediate and 1 was highly resistant. Ten (83%) of 12 H. influenzae and all of 11 B. catarrhalis AOM isolates produced beta-lactamase. In comparison previously untreated AOM patients produced no bacterial growth from tympanocentesis in 30%, S. pneumoniae in 36% (8% penicillin-resistant), H. influenaze in 13% (44% beta-lactamase-producing) and B. catarrhalis in 11% (85% beta-lactamase producing). AOM which is persistent after initial empiric antimicrobial therapy may be caused by middle ear inflammation after bacteria are killed or involve penicillin-resistant S. pneumoniae, beta-lactamase-producing H. influenzae or B. catarrhalis more commonly than occurs in AOM which has not been recently treated.
在这项前瞻性研究中，对137例患有急性中耳炎（AOM）且经过一或两个疗程经验性抗菌治疗后仍无反应（称为持续性AOM）的儿童的200只耳朵进行了鼓膜穿刺术，以确定从中耳液中分离出的病原体。作为对照，描述了对111例未经治疗的AOM儿童的154只耳朵进行的鼓膜穿刺术。患者于1989年10月至1992年9月入组。在持续性AOM组中，鼓膜穿刺术前最常用的抗菌药物是阿莫西林和甲氧苄啶/磺胺甲恶唑。49%的持续性AOM患者中耳抽吸物未培养出致病细菌生长，24%培养出肺炎链球菌，7%培养出流感嗜血杆菌，7%培养出卡他布兰汉菌，6%培养出化脓性链球菌，5%培养出金黄色葡萄球菌，3%培养出两种病原体。在检测的11株肺炎链球菌分离株中，有2株（18%）对青霉素耐药；1株为中介耐药，1株为高度耐药。12株流感嗜血杆菌分离株中的10株（83%）和所有11株卡他布兰汉菌AOM分离株均产生β-内酰胺酶。相比之下，未经治疗的AOM患者鼓膜穿刺术未培养出细菌生长的占30%，培养出肺炎链球菌的占36%（8%对青霉素耐药），培养出流感嗜血杆菌的占13%（44%产生β-内酰胺酶），培养出卡他布兰汉菌的占11%（85%产生β-内酰胺酶）。初始经验性抗菌治疗后仍持续存在的AOM可能是由于细菌被杀灭后中耳炎症所致，或者比近期未治疗的AOM更常见地涉及对青霉素耐药的肺炎链球菌、产生β-内酰胺酶的流感嗜血杆菌或卡他布兰汉菌。
