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Beyond Traditional Pathogens: Clinical and Microbiologic Insights Into Atypical Pediatric Otitis Media

Din Haim Ben Hayoun1,2, Danielle Keidar-Friedman3,4, Ori Cohen Michael2

  • 1From the Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital.

The Pediatric Infectious Disease Journal
|March 18, 2026
PubMed
Abstract

Insights

Atypical pathogens in otitis media (OM) affect older children and are linked to chronic suppurative OM (CSOM), but outcomes are similar to typical pathogens. Quinolone resistance is high in atypical cases.

Area of Science:

  • Pediatric Infectious Diseases
  • Microbiology
  • Otolaryngology

Background:

  • Advanced diagnostics identify more bacterial species in otitis media (OM).
  • The clinical significance of atypical otopathogens in OM is not well understood.
  • This study compares pediatric OM caused by atypical versus typical pathogens.

Purpose of the Study:

  • To compare the characteristics and clinical outcomes of pediatric otitis media (OM) caused by atypical versus typical bacterial pathogens.
  • To investigate the association between specific pathogen types and OM phenotypes, such as acute OM versus chronic suppurative OM (CSOM).
  • To assess antimicrobial resistance patterns, particularly quinolone resistance, in atypical otopathogens.

Main Methods:

  • Retrospective cross-sectional study of children (0-18 years) with culture-positive monomicrobial OM.
  • Pathogens were classified as typical (e.g., Streptococcus pneumoniae, Haemophilus influenzae) or atypical (all others).
  • 1:1 matched cohorts and propensity score analysis were used to compare clinical outcomes and characteristics.

Main Results:

  • Atypical otopathogens, predominantly Turicella otitidis, were associated with older age and prior otologic surgery.
  • Acute OM was more common with typical pathogens, while CSOM was linked to atypical pathogens.
  • No significant differences in clinical outcomes or complications were found, but atypical pathogens showed high quinolone resistance (53%).

Conclusions:

  • Atypical otopathogens in pediatric OM are associated with older children and distinct disease phenotypes like CSOM.
  • Clinical outcomes for OM caused by atypical pathogens are comparable to those caused by typical pathogens.
  • Elevated quinolone resistance among atypical otopathogens necessitates careful consideration for empirical treatment selection.
Keywords:
atypical bacteriaotitis mediaquinolone resistance

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