New patterns in the otopathogens causing acute otitis media six to eight years after introduction of pneumococcal conjugate vaccine.
New patterns in the otopathogens causing acute otitis media six to eight years after introduction of pneumococcal conjugate vaccine.
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DOI：
10.1097/inf.0b013e3181c1bc48
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发表时间：
2010-04
期刊：
影响因子：
--
通讯作者：
Pichichero ME
中科院分区：
文献类型：
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作者：
Casey JR;Adlowitz DG;Pichichero ME
描述 2007-2009 年期间（即美国引入 7 价肺炎球菌结合物 (PCV7) 六至八年后）的 NP 和 AOM 耳病原体，并比较 6 至 36 个月大的第一次和第二次 AOM 发作的儿童与易患中耳炎的儿童的鼻咽 (NP) 定植和急性中耳炎 (AOM) 微生物学。前瞻性地，在 120 名没有或很少发生 AOM 发作的儿童中确定了 NP 定植和 AOM 发作的微生物学。 NP 样本是在 6 至 30 个月龄之间以及 AOM 时进行的 7 次常规访视中收集的。对于第一次和随后的 AOM 发作，通过鼓膜穿刺术获取中耳液 (MEF)。对八十名易患中耳炎的儿童进行了比较研究。所有 200 名儿童均接受了适合年龄的 PCV7 剂量。我们发现两个研究组中几乎不存在 PCV7 血清型：（从 NP 和 MEF 中分离出 0.9%）。然而，非 PCV7 血清型取代了 PCV 血清型，使得肺炎链球菌 (Spn) 的分离频率几乎等于不可分型流感嗜血杆菌 (NTHi) 的分离频率。在两组的 NP 和 MEF 中，卡他莫拉氏菌 (Mcat) 较少见，金黄色葡萄球菌较少见。与易患中耳炎的儿童相比，第一次和第二次 AOM 发作的儿童中 Spn、NTHi 和 Mcat 引起 AOM 的比例相似。然而，从 NP 和 MEF 中分离出的苯唑西林耐药性 Spn 在不存在/不常见的群体中为 19%，在易患中耳炎的群体中为 58%，p<0.0001。产生 β-内酰胺酶的 NTHi 在耳炎易感组中更常见，p=0.04。在广泛使用 PCV7 六到八年后，表达疫苗型血清型的 Spn 菌株实际上已从接种疫苗的儿童的 NP 和 MEF 中消失。 NP 定植和 AOM 已更改为 Spn 的非 PCV7 菌株。 NTHi 仍然是主要的 AOM 病原体。第一和第二 AOM 以及易患中耳炎的儿童中的耳病原体非常相似，尽管 Spn 和 NTHi 在易患中耳炎的儿童中通常更具有抗生素耐药性。
To describe NP and AOM otopathogens during the time frame 2007-2009, six to eight years after the introduction of 7-valent pneumococcal conjugate (PCV7) in the US and to compare nasopharyngeal (NP) colonization and acute otitis media (AOM) microbiology in children 6 to 36 months of age having 1st and 2nd AOM episodes with children who are otitis prone. Prospectively, the microbiology of NP colonization and AOM episodes was determined in 120 children with absent or infrequent AOM episodes. NP samples were collected at 7 routine visits between 6 and 30 months of age and at the time of AOM. For 1st and subsequent AOM episodes, middle ear fluid (MEF) was obtained by tympanocentesis. Eighty otitis prone children were comparatively studied. All 200 children received age-appropriate doses of PCV7. We found PCV7 serotypes were virtually absent: (0.9% isolated from both NP and MEF) in both study groups. However, non-PCV7 serotypes replaced PCV serotypes such that the frequency of isolation of S. pneumoniae (Spn) was nearly equal to that of non-typeable Haemophilus influenzae (NTHi). M. catarrhalis (Mcat) was less common and Staphylococcus aureus infrequent in the NP and MEF from the two groups. The proportion of Spn, NTHi and Mcat causing AOM was similar in children with 1st and 2nd AOM episodes compared to otitis prone children. However, oxacillin-resistant Spn isolated from the NP and MEF was 19% for the absent/infrequent and 58% for the otitis prone groups, p<0.0001. Beta-lactamase producing NTHi occurred more frequently in the otitis prone group, p=0.04. Six to 8 years after widespread use of PCV7, Spn strains expressing vaccine-type serotypes have virtually disappeared from the NP and MEF of vaccinated children. NP colonization and AOM has changed to non-PCV7 strains of Spn. NTHi continues to be a major AOM pathogen. The otopathogens in 1st and 2nd AOM and in otitis prone children are very similar although Spn and NTHi are more often antibiotic resistant in the otitis prone.