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Bacteria in middle ear effusions in children treated with tympanostomy; a 10-year series
1Department of Otorhinolaryngology-Head and Neck Surgery, Central Hospital of Central Finland, Jyväkylä.
Insights
This study on pediatric otitis media found Streptococcus pneumoniae most common in infants, while Haemophilus influenzae predominated in older children. Beta-lactamase production increased slightly in Moraxella catarrhalis.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Microbiology
Background:
- Recurrent and chronic otitis media are common childhood conditions requiring medical intervention.
- Tympanostomy tube insertion is a frequent treatment for otitis media in children.
Purpose of the Study:
- To analyze the microbiological findings in middle ear effusion (MEE) from children undergoing tympanostomy.
- To identify common bacterial pathogens and assess beta-lactamase production over a 10-year period.
Main Methods:
- Retrospective analysis of 7,411 tympanostomy procedures in children from 1983-1992.
- Collection and bacterial culture of 4,769 middle ear effusion samples.
- Categorization of patients into three age/treatment groups and comparison of two 5-year periods.
Main Results:
- 69.5% of MEE cultures were sterile; 20.2% yielded pathogenic bacteria.
- Streptococcus pneumoniae was the most common pathogen in infants (Group 1).
- Haemophilus influenzae was more prevalent than S. pneumoniae in older children (Groups 2 & 3).
- Beta-lactamase-producing bacteria (H. influenzae, M. catarrhalis) were found in 3.7% of MEE cultures.
- Moraxella catarrhalis showed an increase in beta-lactamase production over time, unlike H. influenzae.
Conclusions:
- Bacterial pathogens in otitis media vary by age group.
- While overall pathogen prevalence remained stable, a trend towards increased beta-lactamase production in M. catarrhalis was observed.
- These findings are crucial for guiding antibiotic therapy in pediatric otitis media.
Abstract:
During the 10-year period, 1983-92, altogether 7,411 ears of 5,291 children with recurrent or chronic otitis media problems were treated with tympanostomy at our hospital in central Finland, The series was divided into three groups: i) infants aged 6-12 months undergoing primary tube treatment. ii) children aged 1 year or more receiving their first ventilation tube(s) in connection with adenoidectomy, and iii) children who had already had ventilation tubes inserted at least once before the present tympanostomy. Middle ear effusion (MEE) samples were obtained from 4,769 (64.3%) of the affected ears, 69.5% of all MEE cultures were negative for bacteria, whereas 20.2% grew pathogenic bacteria. S. pneumoniae was the most frequent pathogen in group 1, whereas H. influenzae was more frequent than S. pneumoniae in groups 2 and 3. In only 3.7% of MEE cultures were beta-lactamase-producing strains of pathogenic bacteria found, either H. influenzae (0.9%) or M. catarrhalis (2.8%). Comparison of the first and second 5-year periods ( 1983-87 vs. 1988-92) showed no significant changes in the occurrence of the various pathogenic bacteria. An increase was observed in beta-lactamase production for M. catarrhalis but not for H. influenzae strains.