To determine the distribution of Streptococcus pneumoniae serotypes isolated from patients under 6 years of age with acute suppurative otitis media, to calculate the serotype coverage of 7-valent pneumococcal conjugate vaccine, and to clarify trends in PCG-resistant Streptococcus pneumoniae, we conducted a one-year prospective study from April 2005 to March 2006 at 10 medical institutions in Hokkaido, Miyagi, Chiba, Tokyo, Kanagawa, and Mie, Japan. Specimens collected by tympanotomy or myringotomy numbered 856, and 691 strains were isolated from 599 specimens. Of these, 219 isolates (31.7%) were identified as Streptococcus pneumoniae and 201 met study requirements. The most common serotype was 19F (52 isolates, 25.9%), followed by 6B (30 isolates, 14.9%) and 23F (24 isolates, 11.9%). Seven-valent vaccine serotype coverage was 62.7%. The percentage of PSSP was 40.3%, PISP 42.8%, and PRSP 16.9%, resistant strains (PISP and PRSP) combined accounted for 59.7%. Seven-valent vaccine serotype coverage for PISP was 80.2% and PRSP 82.4%. PBP gene mutation was observed in 175 isolates (87.1%), including 70 of gPISP (34.8%) and 105 of gPRSP (52.2%). Gene mutation induced by macrolides was found in 176 isolates (87.6%).

In the 760 cases of chronic otitis media studied from 1970 to 1976, the detection ratio of anaerobic bacteria and the relation between the nature of anaerobic bacteria and the conditions of focus were investigated. In 8.2% of 760 cases 9 kinds and 81 strains of anaerobic bacteria was detected. Most of the anaerobic bacteria were Peptococcus sp. or Bacteroides sp. and in general non-sporogenic anaerobic bacteria accounted for 97.5%. Anaerobes were frequently detected in cases where the middle ear cavity was filled with cholesteatoma or granulation and in cases of infection recurring after operation.

\s=b\A bacteriologic study was made of 30 patients with peritonsillar abscesses with the use of both aerobic and anaerobic culture procedures. The abscess was punctured and the pus was aspirated by a syringe with an 18-gauge needle. Aerobes and anaerobes were detected in a frequency rate of approximately 1:2. Peptostreptococcus (30.2%), group A streptococci (27.9%), Peptococcus (16.3%), and Fusobacterium (9.3%) were preponderant pathogens. Anaerobic organisms were isolated in 75% of 30 cases. Aside from group A streptococci, anaerobes play a major etiologic role in peritonsillar abscess. Penicillins or cephalosporins will provide maximum chemotherapeutic benefit. (Arch Otolaryngol 1982;108:655-658) Peritonsillar abscess occurs when bacterial infection of the tonsil spreads to the potential peritonsillar space deep behind the tonsil between the tonsillar capsule and the superior constrictor pharyngeal muscle. Treat¬ ment of the condition consists of first confirming the presence of an abscess formation by puncture, and subse¬ quent incision, drainage, and chemo¬ therapy.Most textbooks of otorhinolaryngol¬ ogy describe the causative organisms as aerobes. However, the fact that the site of the infection is in the proximity of the oral mucosa and is kept away from the open air strongly suggests that anaerobic bacteria might also play a causal role. Nevertheless, there are few reports of attempted investi¬ gations into both aerobic and anaero¬ bic organisms as possible causative agents. Under such circumstances, it is not uncommon for us to be at a loss as to the choice of antibiotic in the chemotherapy of peritonsillar ab¬ scess.The present study represents our attempt to reevaluate the bacteriolo¬ gy of peritonsillar abscess with due emphasis placed on both aerobic and anaerobic bacteria as possible invad¬ ers. The purpose of this report is to describe the antibiotic susceptibility of microorganisms detected from peritonsillar abscesses. SUBJECTSThirty patients with peritonsillar ab¬ scess who were seen at the outpatient services of the Ear, Nose, and Throat This group had the following age distribu¬ tion: two people from 10 to 20 years old; ten people in their 20s; nine in their 30s; six in their 40s; two in their 50s; and one in his 60s. METHODS OF BACTERIOLOGIC STUDYAt the time of the first examination, pus was collected from 30 patients with peri¬ tonsillar abscess by puncture of the soft palate at the site of maximum swelling with the use of a syringe with an 18-gauge needle. This eliminated contamination from indigenous flora in the throat, and prevented the death of anaerobic material from exposure to air. The infectious mate¬ rial was aspirated into rubber-stoppered medium-sized test tubes containing 5 mL of tryptosoy broth and stored in a cold place at a temperature below 5°C until submitted for bactériologie study, which was carried out both at

An enzyme-linked immunosorbent assay specific to outer membrane protein P6 (P6-ELISA) was applied for detecting Haemophilus influenzae in middle ear fluids (MEFs) from acute otitis media (AOM) patients and in nasopharyngeal secretions (NPSs) from acute rhinosinusitis patients. P6-ELISA had a sensitivity of 83.3% for MEFs and 71.5% for NPSs and a specificity of 85.6% for MEFs and 92.5% for NPSs, respectively. Real-time PCR exhibited significant differences in the number of ompP1 gene copies among samples determined by P6-ELISA to be positive and negative for H. influenzae. However, because the P6-ELISA test has the reactivity in Haemophilus species include two commensals H. haemolyticus and H. parainfluenzae, it is thus a weak method in order to detect only NTHi correctly. Consequently, diagnosis using the P6-ELISA should be based on an overall evaluation, including the results of other related examinations and clinical symptoms to prevent misleading conclusions in clinical setting.

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