分泌性中耳炎培养细菌学的全球与时间变化：系统综述与荟萃分析

文献信息

中文摘要

目的： 本研究系统综合了分泌性中耳炎（OME）培养细菌学的地理差异和日历时期差异，以探讨其对儿童听力健康、病原体监测和抗菌药物管理的意义。
方法： 检索PubMed、Embase和Cochrane Library中1980年1月至2025年12月发表、报告OME患者细菌培养结果的研究。纳入标准为包含人类OME受试者并报告细菌患病率的研究。排除标准为与综述目的或纳入标准无关、重复记录、非原始报告、非人类研究、缺乏基本人口学信息、数据不足或不符合定量合成条件的研究。三名评价者筛选文章并提取数据。最终纳入22项研究（北美：n=4，欧洲：n=9，亚洲：n=7，大洋洲：n=1，中东：n=1）。培养阳性率以培养阳性标本为分子、所有培养标本为分母进行荟萃分析。病原体特异性比例以培养阳性标本为分母进行荟萃分析。原始细菌分离株计数单独汇总，未用作荟萃分析的分母。
结果： 随机效应合并培养阳性率为43.4%（95% CI，35.4-51.8%）。在培养阳性标本中，合并病原体特异性比例为：流感嗜血杆菌26.4%，凝固酶阴性葡萄球菌（CoNS）26.1%，甲氧西林敏感金黄色葡萄球菌（MSSA）16.0%，肺炎链球菌14.2%，耐甲氧西林金黄色葡萄球菌（MRSA）13.1%。在北美研究中，CoNS和流感嗜血杆菌的合并比例相当；在欧洲研究中流感嗜血杆菌占优势，而在亚洲研究中CoNS占优势。2000年及以后开展的研究显示，与早期研究相比，CoNS和MSSA的合并比例更高，而流感嗜血杆菌和肺炎链球菌的合并比例更低。
结论： OME的细菌学特征随地区和时期存在有意义的差异。这些发现支持在儿童听力健康背景下加强病原体监测和抗菌药物管理，而非采用单一通用的经验性管理方法。
系统综述注册： 方案已在国际前瞻性系统综述注册平台注册，https://www.crd.york.ac.uk/PROSPERO/home，PROSPERO，CRD420261291723。

英文摘要

OBJECTIVE: This study systematically synthesized geographic variation and calendar-period differences in culture-based bacteriology of OME to examine their implications for child hearing health, pathogen surveillance, and antimicrobial stewardship.
METHODS: PubMed, Embase, and Cochrane Library were searched for studies published from Jan 1980 to Dec 2025 that reported the results of bacterial culture from patients with OME. Studies were eligible if they included human subjects with otitis media with effusion (OME) and reported the prevalence of bacteria. Studies were excluded if they were unrelated to the review objective or eligibility criteria, duplicate records, non-original reports, non-human studies, studies lacking basic demographic information, studies with insufficient data, or studies not eligible for quantitative synthesis. Three reviewers screened the articles and extracted data. Finally, 22 studies were included (North America: n = 4, Europe: n = 9, Asia: n = 7, Oceania: n = 1, Middle East: n = 1). Culture positivity was meta-analyzed using culture-positive specimens as the numerator and all cultured specimens as the denominator. Organism-specific proportions were meta-analyzed using culture-positive specimens as the denominator. Raw bacterial isolate counts were summarized separately and were not used as denominators for the meta-analysis.
RESULTS: The random-effects pooled culture-positivity proportion was 43.4% (95% CI, 35.4-51.8%). Among culture-positive specimens, the pooled organism-specific proportions were 26.4% for H. influenzae, 26.1% for CoNS, 16.0% for MSSA, 14.2% for S. pneumoniae, and 13.1% for MRSA. In North American studies, CoNS and H. influenzae showed comparable pooled proportions, whereas H. influenzae predominated in European studies and CoNS predominated in Asian studies. Studies conducted from 2000 onward showed higher pooled proportions of CoNS and MSSA and lower pooled proportions of H. influenzae and S. pneumoniae than earlier studies.
CONCLUSION: The bacteriological profile of OME varied meaningfully by region and period. These findings support strengthened pathogen surveillance and antimicrobial stewardship in the context of childhood hearing health, rather than a single universal empirical management approach.
SYSTEMATIC REVIEW REGISTRATION: The protocol was registered in the International Prospective Register of Systematic Reviews, https://www.crd.york.ac.uk/PROSPERO/home, PROSPERO, CRD420261291723.