Abstract：
BACKGROUND: Recent studies show an increase in the prevalence of Haemophilus influenzae and a decrease in Streptococcus pneumoniae among the bacteria that cause acute otitis media (AOM). The objective of our study was to analyse the distribution of pathogens identified in children aged less than 14 years presenting to the emergency department with AOM and their patterns of antimicrobial resistance.
METHODS: Single centre retrospective, analytical study in patients aged less than 14 years with a diagnosis of AOM in whom an ear drainage sample was collected for culture in the paediatric emergency department of a tertiary care hospital between 2013 and 2021.
RESULTS: During the study period, there were 14 684 documented care episodes corresponding to children with a diagnosis of AOM. An ear drainage culture was performed in 768 of those episodes. The median age of the patients was 2 years, 57% were male and 70% had a previous history of AOM. The most frequently isolated pathogens were: Haemophilus influenzae (n = 188 [24.5%]; 15.5% of them resistant to ampicillin), Streptococcus pyogenes (n = 86 [11.2%]), Staphylococcus aureus (n = 82 [10.7%]), Streptococcus pneumoniae (n = 54 [6.9%]; 9.4% with intermediate resistance to penicillin), Pseudomonas aeruginosa (n = 42 [5.5%]) and Moraxella catarrhalis (n = 11 [1.4%]). No pathogen was isolated in 34.9% of cases.
CONCLUSIONS: Haemophilus influenzae is the leading cause of AOM in children aged less than 14 years. This, combined with the low frequency of isolation and penicillin resistance of Streptococcus pneumoniae, calls into question the appropriateness of high-dose amoxicillin for empiric treatment of AOM.
METHODS: Single centre retrospective, analytical study in patients aged less than 14 years with a diagnosis of AOM in whom an ear drainage sample was collected for culture in the paediatric emergency department of a tertiary care hospital between 2013 and 2021.
RESULTS: During the study period, there were 14 684 documented care episodes corresponding to children with a diagnosis of AOM. An ear drainage culture was performed in 768 of those episodes. The median age of the patients was 2 years, 57% were male and 70% had a previous history of AOM. The most frequently isolated pathogens were: Haemophilus influenzae (n = 188 [24.5%]; 15.5% of them resistant to ampicillin), Streptococcus pyogenes (n = 86 [11.2%]), Staphylococcus aureus (n = 82 [10.7%]), Streptococcus pneumoniae (n = 54 [6.9%]; 9.4% with intermediate resistance to penicillin), Pseudomonas aeruginosa (n = 42 [5.5%]) and Moraxella catarrhalis (n = 11 [1.4%]). No pathogen was isolated in 34.9% of cases.
CONCLUSIONS: Haemophilus influenzae is the leading cause of AOM in children aged less than 14 years. This, combined with the low frequency of isolation and penicillin resistance of Streptococcus pneumoniae, calls into question the appropriateness of high-dose amoxicillin for empiric treatment of AOM.
摘要：
背景：最近的研究表明，在引起急性中耳炎（AOM）的细菌中，流感嗜血杆菌的患病率增加，肺炎链球菌的减少。我们研究的目的是分析向AOM急诊科就诊的14岁以下儿童中鉴定出的病原体的分布及其耐药性模式。
方法：单中心回顾性研究，在2013年至2021年期间，在三级护理医院儿科急诊科收集耳部引流样本进行培养的年龄小于14岁、诊断为AOM的患者中进行分析研究。
结果：在研究期间，有14684次记录的护理事件与诊断为AOM的儿童相对应.在其中768次发作中进行了耳引流培养。患者的中位年龄为2岁，57％为男性，70％有AOM病史。最常见的病原体是：流感嗜血杆菌（n=188[24.5%]；其中15.5%对氨苄西林耐药），化脓性链球菌（n=86[11.2%]），金黄色葡萄球菌(n=82[10.7%]),肺炎链球菌（n=54[6.9％];9.4％对青霉素具有中等耐药性），铜绿假单胞菌(n=42[5.5%])和粘膜炎莫拉菌(n=11[1.4%])。34.9%的病例没有分离出病原体。
结论：流感嗜血杆菌是14岁以下儿童AOM的主要原因。这个,结合肺炎链球菌的低分离频率和青霉素耐药性,质疑大剂量阿莫西林用于经验性治疗AOM的适当性。
方法：单中心回顾性研究，在2013年至2021年期间，在三级护理医院儿科急诊科收集耳部引流样本进行培养的年龄小于14岁、诊断为AOM的患者中进行分析研究。
结果：在研究期间，有14684次记录的护理事件与诊断为AOM的儿童相对应.在其中768次发作中进行了耳引流培养。患者的中位年龄为2岁，57％为男性，70％有AOM病史。最常见的病原体是：流感嗜血杆菌（n=188[24.5%]；其中15.5%对氨苄西林耐药），化脓性链球菌（n=86[11.2%]），金黄色葡萄球菌(n=82[10.7%]),肺炎链球菌（n=54[6.9％];9.4％对青霉素具有中等耐药性），铜绿假单胞菌(n=42[5.5%])和粘膜炎莫拉菌(n=11[1.4%])。34.9%的病例没有分离出病原体。
结论：流感嗜血杆菌是14岁以下儿童AOM的主要原因。这个,结合肺炎链球菌的低分离频率和青霉素耐药性,质疑大剂量阿莫西林用于经验性治疗AOM的适当性。
