Acute Otitis Media and Other Complications of Viral Respiratory Infection
Acute Otitis Media and Other Complications of Viral Respiratory Infection
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DOI：
10.1542/peds.2015-3555
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发表时间：
2016-04-01
期刊：
影响因子：
8
通讯作者：
McCormick, David P.
中科院分区：
文献类型：
--
作者：
Chonmaitree, Tasnee;Trujillo, Rocio;McCormick, David P.
背景：病毒性上呼吸道和下呼吸道感染(URI、LRI)在婴儿中很常见。我们测定了病毒性URI及其并发症的患病率，包括急性中耳炎(AOM)和急性中耳炎(LRI)，并评估了细菌-病毒相互作用的影响，以及遗传和环境风险对AOM发生的影响。方法：健康婴儿从近出生开始登记，一直跟踪到12个月大的AOM第一次发作。每个月(1-6个月、9个月)和病毒URI发作期间收集鼻咽标本进行细菌培养和病毒聚合酶链式反应研究。结果：共对367名婴儿进行了286岁的随访，记录了887名URI(305名婴儿)和180例AOM发作(143名婴儿)。第一年的URI、LRI和AOM患病率分别为3.2、0.25和0.67个儿童年。3个月、6个月和12个月的AOM累积发生率分别为6%、23%和46%。患有和不患有AOM的婴儿每儿童年分别有4.7次和2.3次URI发作(P<；0.002)。AOM患儿各月病原菌定殖率显著高于对照组(P<；.005)。母乳喂养降低了URI和AOM的风险(P<；0.05)。与卡他莫拉菌和多种呼吸道病毒发生了显著的细菌-病毒相互作用，并改变了URI和AOM的风险。结论：近一半的婴儿在1岁前出现AOM。重要的AOM危险因素包括频繁的病毒URI、病原菌定植和缺乏母乳喂养。细菌与病毒的相互作用可能在AOM的发病机制中起重要作用，值得进一步研究。
BACKGROUND: Viral upper and lower respiratory tract infections (URI, LRI) are common in infants. We determined the prevalence of viral URI and its complications, including acute otitis media (AOM) and LRI, and assessed the effect of bacterial-viral interactions, and genetic and environmental risks on AOM development.METHODS: Healthy infants were enrolled from near birth and followed to the first episode of AOM up to 12 months of age. Nasopharyngeal specimens were collected at monthly intervals (months 1-6, 9) and during viral URI episodes for bacterial culture and viral polymerase chain reaction studies. Subjects were followed closely for AOM development.RESULTS: A total of 367 infants were followed for 286 child-years; 887 URI (305 infants) and 180 AOM episodes (143 infants) were documented. Prevalence of URI, LRI, and AOM in the first year was 3.2, 0.25, and 0.67 per child-year, respectively. Cumulative AOM incidence by ages 3, 6, and 12 months was 6%, 23%, and 46%. Infants with and without AOM had 4.7 and 2.3 URI episodes per child-year, respectively (P < .002). Pathogenic bacterial colonization rates by month were significantly higher in infants with AOM (P < .005). Breastfeeding reduced both URI and AOM risks (P < .05). Significant bacterial-viral interactions occurred with Moraxella catarrhalis and a variety of respiratory viruses and altered URI and AOM risks.CONCLUSIONS: Almost half of infants experienced AOM by age 1. Important AOM risk factors included frequent viral URI, pathogenic bacterial colonization, and lack of breastfeeding. Bacterial-viral interactions may play a significant role in AOM pathogenesis and deserve further investigation.