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Biofilm-Forming Bacteria Implicated in Complex Otitis Media in Children in the Post-Heptavalent Pneumococcal

Anastasios Ioannidis¹, Stylianos Chatzipanagiotou², Niki Vassilaki³

¹Department of Nursing, Faculty of Health Sciences, University of Peloponnese, 22100 Tripoli, Greece.

|March 29, 2023

Insights

Most pediatric otitis media pathogens form biofilms, hindering antibiotic treatment. This study highlights the prevalence of biofilm formation in otitis-prone children and its impact on treatment outcomes.

Area of Science:

Microbiology
Pediatric Otolaryngology
Infectious Diseases

Background:

Chronic media with effusion (COME) and recurrent acute otitis media (RAOM) are common childhood ear infections.
The post-PCV7 vaccination era has altered the microbiological landscape of these conditions.
Understanding pathogen behavior, particularly biofilm formation, is crucial for effective treatment.

Purpose of the Study:

To determine the microbiological profile of otitis-prone children post-PCV7.
To assess the in vitro biofilm-forming ability of isolated pathogens.
To correlate biofilm formation with clinical history and treatment outcomes over two years.

Main Methods:

Prospective study of patients with COME and RAOM.
Isolation and in vitro testing of otopathogens for biofilm formation.
Comparison of minimum inhibitory concentrations (MIC) for planktonic and sessile bacteria.
Correlation of clinical data with microbiological findings and biofilm status.

Main Results:

*Haemophilus influenzae* (35-40%) and *Streptococcus pneumoniae* (12-24%) were the predominant pathogens.
Polymicrobial infections were observed in 5% of COME and 19% of RAOM cases.
A high prevalence (94%) of biofilm formation was detected among isolated otopathogens.

Conclusions:

This study is the first in Greece to investigate biofilm formation in otitis-prone children post-PCV7.
High rates of polymicrobial infections and biofilm-associated treatment failures may explain antimicrobial resistance.
Targeting biofilm formation could improve treatment efficacy in recurrent and chronic otitis media.

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Abstract:

Background: Chronic media with effusion (COME) and recurrent acute otitis media (RAOM) are closely related clinical entities that affect childhood. The aims of the study were to investigate the microbiological profile of otitis-prone children in the post-PCV7 era and, to examine the biofilm-forming ability in association with clinical history and outcome during a two-year post-operative follow-up. Methods: In this prospective study, pathogens from patients with COME and RAOM were isolated and studied in vitro for their biofilm-forming ability. The minimum inhibitory concentrations (MIC) of both the planktonic and the sessile forms were compared. The outcome of the therapeutic method used in each case and patient history were correlated with the pathogens and their ability to form biofilms. Results: Haemophilus influenzae was the leading pathogen (35% in COME and 40% in RAOM), and Streptococcus pneumoniae ranked second (12% in COME and 24% in RAOM). Polymicrobial infections were identified in 5% of COME and 19% of RAOM cases. Of the isolated otopathogens, 94% were positive for biofilm formation. Conclusions: This is the first Greek research studying biofilm formation in complex otitis media-prone children population in the post-PCV7 era. High rates of polymicrobial infections, along with treatment failure in biofilms, may explain the lack of antimicrobial efficacy in otitis-prone children.

Keywords:

PCV13 PCV7 biofilm children clinical isolates effusion multiplex PCR otitis media re-operation vaccination

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