兒童慢性積液性中耳炎之細菌學

背景：細菌感染在兒童慢性積液性中耳炎病理發生學上扮演了重要的角色，然而在抗生素的使用下，造成菌種改變與抗藥性菌株的出現；本研究希望能比較慢性積液性中耳炎在抗生素使用後是否出現細菌學的差異，同時觀察慢性中耳積液的細菌學與增殖體炎及慢性鼻竇炎間的相關性。方法：本前瞻性研究收集接受過藥物治療的兒童慢性積液性中耳炎息者，中耳積液治療後仍存在3個月以上，且有嚴重的聽力喪失合併氣骨導閥值差(air-bono gap) 15dB以上。所有患者皆以拋棄式無菌中耳積液收集器(JUHN TYM-TAP(上標 ®) sterile disposable middle ear fluid aspirator/collector)收集積液並置放通氣導管；同時採取中鼻道分泌物及增殖體組織檢體做細菌培養。結果：自2000年3月至2001年3月共收集30例患者，單耳積液者有3例，其餘皆為雙耳積液。中耳積液共57耳，其中16耳耳朵的中耳積液細菌培養為陽性(28.1%)，有一耳培養出兩種細菌(1.7%)。最常見的菌種為葡萄球菌屬(Staphylococcus sp)及流行感冒嗜血桿菌(Hemophilus influenzae)。只有4耳積液培養陽性的患者，其菌種與鼻咽腔或中鼻道的細菌一致(25%)，以流行感冒嗜血桿菌最為常見。結論：兒童慢性積液性中耳炎經抗生素治療後細菌學發現以葡萄球菌屬及流行感冒嗜血桿菌最常見。本研究顯示慢性中耳積液與增殖體炎及慢性鼻竇炎間的細菌學相關性並不顯著。

關鍵字

積液性中耳炎；細菌學

並列摘要

BACKGROUND: Bacterial infection plays an important role in the pathogenesis of chronic otitis media with effusion (COME) in children. Various bacterial strains have emerged, with the administration of antibiotics, including antibiotic resistant strains. This study was designed to determine if any differences existed in the bacteriology of COME after antibiotic therapy and also to evaluate any relationships between bacterial strains isolated from COME, adenoiditis and chronic sinusitis. METHODS: This prospective study recruited patients with COME and persistent effusion after three months of treatment. The patients also had a serious associated hearing loss with an air-bone gap greater than 15 dBHL. Effusions in the middle ear were sampled with a sterile disposable middle ear fluid aspirator/collector (JUHN TYM-TAP(superscript ®)) at the same time a ventilation tube was implanted. Secretions from the middle meatus and tissue from the adenoid were also collected for bacterial culture. RESULTS: Thirty patients were enrolled between March 2000 and March 2001. Among the cases, unilateral ear effusion was diagnosed in only three cases, making a total of 57 ears with effusion. From the results of bacterial cultures, 16 ears (28.1%) were found to be infected by a bacterial strain while one ear (1.7%) was infected with two different strains of bacteria. The predominant bacteria strains isolated from effusions were Staphylococcus species and Hemophilus influenzae. There were only four patients with the same bacterial strain isolated from their effusion and middle meatus or nasopharynx (25%), with Hemophilus influenzae being the most prevalent. CONCLUSION: Staphylococcus species and Hemophilus influenzae were the most commonly found strains in COME effusions after antibiotic therapy. No significant relationship between the bacterial strains isolated from COME, adenoiditis and chronic sinusitis was identified.

並列關鍵字

otitis media with effusion ； bacteriology

國際替代計量

兒童慢性積液性中耳炎之細菌學

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