Gehanno P, Lenoir G, Barry B, Bons J, Boucot I, Berche P
ENT Department, Hôpital Bichat-Claude Bernard, Paris, France.
Pediatr Infect Dis J. 1996 Apr;15(4):329-32. doi: 10.1097/00006454-199604000-00009.
The recent emergence of penicillin-resistant Streptococcus pneumoniae, particularly in acute otitis media (AOM), has increased interest in the development of noninvasive procedures that might help to predict the bacterial etiology of this condition. We conducted an open multicenter study to evaluate the predictive value of the nasopharyngeal (NP) sampling in children with AOM by comparing the bacteriologic results of NP cultures with those of pus collected by myringotomy in the same patients.
The NP secretions and the pus obtained by myringotomy were collected concomitantly in 354 children younger than 6 years of age with clinical signs of AOM. The clinical usefulness of NP culture was determined by calculating its sensitivity and specificity, and especially its positive and negative predictive values for the three main pathogens responsible for AOM, Haemophilus influenzae, S. pneumoniae and Moraxella catarrhalis.
A positive NP culture was found to have little predictive value for H. influenzae (52%), S. pneumoniae (43%) and M. catarrhalis (19%). In contrast the negative predictive value of NP cultures was much greater and was accompanied by negative middle ear fluid cultures in more than 95% of children, especially for S. pneumoniae. Furthermore the incidence of beta-lactamase-producing strains of H. influenzae at both sampling sites was similar (30 and 35%, respectively), as was the incidence of penicillin-resistant S. pneumoniae (50 and 54%).
It appears that the correlation between results of NP and middle ear fluid cultures in children with AOM is too weak to allow NP culture to be recommended for the bacteriologic documentation of this disease. However, these results should not overshadow the considerable epidemiologic value of NP cultures, particularly with reference to the monitoring of pneumonococcal susceptibility in children. The collection of NP cultures should therefore be promoted for their collective epidemiologic value.
耐青霉素肺炎链球菌近来出现，尤其是在急性中耳炎（AOM）中，这使得人们对开发有助于预测该病细菌病因的非侵入性检查方法的兴趣增加。我们开展了一项开放性多中心研究，通过比较同一患者鼻咽（NP）培养的细菌学结果与鼓膜切开术采集的脓液的细菌学结果，来评估NP采样对AOM患儿的预测价值。
在354名6岁以下有AOM临床症状的儿童中，同时采集NP分泌物和鼓膜切开术获取的脓液。通过计算NP培养的敏感性和特异性，尤其是其对导致AOM的三种主要病原体，即流感嗜血杆菌、肺炎链球菌和卡他莫拉菌的阳性和阴性预测值，来确定NP培养的临床实用性。
发现NP培养阳性对流感嗜血杆菌（52%）、肺炎链球菌（43%）和卡他莫拉菌（19%）的预测价值不大。相比之下，NP培养的阴性预测价值要大得多，并且在超过95%的儿童中，尤其是肺炎链球菌感染的儿童中，中耳液培养结果也为阴性。此外，两个采样部位产β-内酰胺酶流感嗜血杆菌菌株的发生率相似（分别为30%和35%），耐青霉素肺炎链球菌的发生率也相似（50%和54%）。
看来AOM患儿NP培养结果与中耳液培养结果之间的相关性太弱，以至于不推荐将NP培养用于该病的细菌学诊断。然而，这些结果不应掩盖NP培养相当大的流行病学价值，尤其是在监测儿童肺炎球菌易感性方面。因此，应推广采集NP培养样本，以发挥其总体流行病学价值。
