Demographics and Microbiology of Otorrhea through Patent Tubes Failing Ototopical and/or Oral Antibiotic Therapy
Demographics and Microbiology of Otorrhea through Patent Tubes Failing Ototopical and/or Oral Antibiotic Therapy
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DOI：
10.1177/0194599811419098
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发表时间：
2011-12-01
影响因子：
3.4
通讯作者：
Wei, Julie L.
中科院分区：
文献类型：
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作者：
Fishman, Inessa;Sykes, Kevin J.;Wei, Julie L.
目标.鼓膜造孔术后置管耳鼻喉科（PTTO）会导致显著的医疗保健成本和护理满意度下降。作者回顾了PTTO失败的初始耳局部和/或口服抗生素治疗和微生物学/敏感性数据的文化。病例系列与图表审查。设置。一所社区大学附属门诊部和一所儿童医院门诊部。方法.回顾性分析2004年1月至2009年1月202例228次耳源性中耳炎患者的临床资料。PTTO平均发生在置管后13个月。中位耳鼻喉持续时间为21天（平均42天）。PTTO解决需要平均1.6次（范围，1-6）到儿科耳鼻喉科办公室就诊。据报告，在儿科耳鼻喉科访视前，228例耳鼻喉科发作中有198例（87%）使用了耳局部治疗。近50%的患者接受了至少1个或多个疗程的全身性抗生素治疗。金黄色葡萄球菌占培养微生物的52%，耐甲氧西林金黄色葡萄球菌（MRSA）占57%。金黄色葡萄球菌对克林霉素的耐药率较高（49%），对左氧氟沙星的耐药率较低（1.8%）。MRSA对克林霉素的耐药率为68%，明显高于本院及儿童医院其他部位MRSA对克林霉素的耐药率。表现为耳局部和/或口服抗生素治疗失败的PTTO最常见的是金黄色葡萄球菌、肺炎链球菌和铜绿假单胞菌。MRSA在这一人群中非常普遍。由于对左氧氟沙星的耐药率仅为1.8%，因此没有必要对耳鼻喉科门诊就诊的PTTO进行培养。目前尚不清楚为什么最初失败的氟喹诺酮类耳局部治疗在耳鼻喉科医生就诊后通常能成功治疗PTTO。
Objectives. Posttympanostomy tube otorrhea (PTTO) results in significant health care cost and decreased satisfaction with care. The authors reviewed PTTO failing initial ototopical and/or oral antibiotic therapy and microbiology/susceptibility data from cultures.Study Design. Case series with chart review.Setting. A community university satellite ambulatory clinic and the outpatient clinic of a children's hospital. Methods. Review of 202 patients with 228 discrete episodes of culture-positive otorrhea from January 2004 to January 2009.Results. PTTO occurred an average of 13 months after tube placement. Median otorrhea duration was 21 days (mean, 42 days). A mean of 1.6 visits (range, 1-6) to the pediatric otolaryngology office was required for PTTO resolution. Ototopical therapy was reported used in 198 of 228 (87%) episodes of otorrhea prior to pediatric otolaryngology visit. Nearly 50% of patients were prescribed at least 1 or more courses of systemic antibiotics. Staphylococcus aureus accounted for 52% of the organisms cultured, with 57% methicillin-resistant S aureus (MRSA). S aureus resistance to clindamycin was high (49%) and resistance to levofloxacin was low (1.8%). MRSA was 68% clindamycin resistant, much higher than both ours and the children's hospital's clindamycin resistance rate of MRSA cultured from all other body sites.Conclusions. PTTO that presents as having failed ototopical and/or oral antibiotics most commonly consists of S aureus, Streptococcus pneumoniae, and Pseudomonas aeruginosa. MRSA is highly prevalent in this population. It is not necessary to culture PTTO that presents to an otolaryngology office, as resistance to levofloxacin was only 1.8%. It is unclear why the same fluoroquinolone ototopical therapy that failed initially is often successful in treating PTTO after otolaryngologist visit.