Andrade M A, Hoberman A, Glustein J, Paradise J L, Wald E R
Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Pediatrics. 1998 Apr;101(4 Pt 1):617-9. doi: 10.1542/peds.101.4.617.
We investigated the prevalence and the etiology of acute otitis media (AOM) in children with bronchiolitis to determine whether AOM in such children is due entirely or mainly to respiratory syncytial virus (RSV), in which case routine antimicrobial treatment would not be appropriate.
The study group consisted of children aged 2 to 24 months with bronchiolitis. In patients with AOM at entry, nasal washings for RSV enzyme-linked immunosorbent assay were obtained, and Gram-stained smear, bacterial culture, and reverse transcriptase polymerase chain reaction to detect the presence of RSV were performed on middle-ear aspirates. Patients without AOM were reevaluated at 48 to 72 hours, 8 to 10 days, and 18 to 22 days.
Forty-two children with bronchiolitis were enrolled. Sixty-two percent had AOM at entry or developed AOM within 10 days. An additional 24% had or eventually developed otitis media with effusion. Only 14% remained free of both AOM and otitis media with effusion throughout the 3-week observation period. All patients with AOM had 1 or more bacterial pathogens isolated from one or both middle-ear aspirates. Of 33 middle-ear aspirates, Streptococcus pneumoniae was isolated in 15, Haemophilus influenzae in 8, Moraxella catarrhalis in 8, and Staphylococcus aureus in 2. Two middle-ear aspirates yielded 2 pathogens each; 2 aspirates had no growth. RSV was identified in 17 (71%) of 24 patients with AOM.
Bacterial AOM is a complication in most children with bronchiolitis. Accordingly, in patients with bronchiolitis and associated AOM, antimicrobial treatment is indicated.
我们对细支气管炎患儿急性中耳炎（AOM）的患病率及病因进行了调查，以确定此类患儿的AOM是否完全或主要由呼吸道合胞病毒（RSV）引起，若如此，则常规抗菌治疗可能并不适宜。
研究组包括年龄在2至24个月的细支气管炎患儿。对于入院时患有AOM的患者，采集鼻洗液进行RSV酶联免疫吸附测定，并对中耳吸出物进行革兰氏染色涂片、细菌培养及逆转录聚合酶链反应以检测RSV的存在。未患AOM的患者在48至72小时、8至10天及18至22天进行重新评估。
共纳入42例细支气管炎患儿。62%的患儿入院时患有AOM或在10天内发展为AOM。另外24%的患儿患有或最终发展为渗出性中耳炎。在为期3周的观察期内，只有14%的患儿未患AOM及渗出性中耳炎。所有患有AOM的患者，其一侧或双侧中耳吸出物中均分离出1种或更多种细菌病原体。在33份中耳吸出物中，分离出肺炎链球菌15份、流感嗜血杆菌8份、卡他莫拉菌8份、金黄色葡萄球菌2份。2份中耳吸出物各分离出2种病原体；2份吸出物无细菌生长。在24例患有AOM的患者中，17例（71%）检测出RSV。
细菌性AOM是大多数细支气管炎患儿的一种并发症。因此，对于患有细支气管炎及相关AOM的患者，应进行抗菌治疗。
