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Dynamic changes in otopathogens colonizing the nasopharynx and causing acute otitis media in children after 13-valent
Ravinder Kaur1, Naoko Fuji1, Michael E Pichichero2
1Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, 1425 Portland Avenue, NY, 14621, Rochester, USA.
Insights
Haemophilus influenzae (Hi) is now the leading cause of acute otitis media (AOM) in children, while Streptococcus pneumoniae (Spn) AOM is increasingly resistant to antibiotics. Non-vaccine serotypes of Spn are most common.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Otopathogen dynamics causing acute otitis media (AOM) have shifted post-pneumococcal conjugate vaccine introduction.
- Understanding these changes is crucial for effective AOM management and prevention strategies.
Purpose of the Study:
- To investigate the current prevalence and antibiotic susceptibility of otopathogens causing AOM in children.
- To identify specific Streptococcus pneumoniae (Spn) serotypes and sequence types (STs) associated with AOM.
Main Methods:
- Prospective enrollment of 589 children from 2015-2019.
- Culture and bacterial identification of nasopharyngeal (NP) and middle ear fluid (MEF) samples.
- Serotyping and whole-genome sequencing for Spn isolates, including antibiotic susceptibility testing.
Main Results:
- Haemophilus influenzae (Hi) was the most frequent otopathogen in MEF during AOM (34%), followed by Spn (24%) and Moraxella catarrhalis (Mcat) (15%).
- 48.6% of MEF Hi isolates were beta-lactamase-producing; Spn exhibited high non-susceptibility to penicillin and other antibiotics.
- AOM caused by Spn was predominantly linked to non-PCV13 serotypes (35B, 23B, 15B/C), with ST558 and ST199 being most common.
Conclusions:
- During 2015-2019, Hi emerged as the primary otopathogen in pediatric AOM, with significant beta-lactamase production.
- Pneumococcal AOM is increasingly caused by non-vaccine Spn serotypes, highlighting growing antibiotic resistance.
- Continued surveillance of otopathogen trends and antibiotic resistance is essential for public health.
Abstract:
The otopathogens colonizing the nasopharynx (NP) and causing acute otitis media (AOM) have shown dynamic changes following introduction of pneumococcal conjugate vaccines. Five hundred eighty-nine children were prospectively enrolled, 2015-2019. Two thousand fifty-nine visits (1528 healthy, 393 AOM, and 138 AOM follow-up) were studied. Two thousand forty-two NP and 495 middle ear fluid (MEF) samples by tympanocentesis from 319 AOM cases were cultured for bacterial identification and antibiotic susceptibility. Streptococcus pneumoniae (Spn) isolates were serotyped by Quellung, and multi-locus sequence type (ST) determined by genomic analysis. Haemophilus influenzae (Hi) was the most common otopathogen cultured from MEF during AOM (34% in MEF) followed by Spn (24% in MEF), then Moraxella catarrhalis (Mcat) (15% in MEF). NP isolates during healthy visit were Mcat (39%), Spn (32%), Hi (12%). 48.6% of Hi isolates from MEF were beta-lactamase-producing. Spn non-susceptibility to penicillin and other antibiotics was high. The most common Spn serotypes associated with AOM (and colonizing the NP during healthy visits) were 35B, 23B, and 15B/C. ST558 and ST199 were the most common sequence types. During 2015-2019, Hi was the most common otopathogen cultured from MEF during AOM among young children. Pneumococcal AOM was most commonly caused by non-PCV13 serotypes of Spn, predominantly 35B, 23B, and 15B/C. Resistance to common antibiotics among Spn strains showed an increasing trend.
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