Related Experiment Videos
Prevalence of antimicrobial-resistant pathogens in middle ear fluid: multinational study of 917 children with acute
M R Jacobs1, R Dagan, P C Appelbaum
1Department of Pathology (Clinical Microbiology), Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Ohio 44106, USA.
Abstract:
The management of acute otitis media is complicated by the emergence of resistance to beta-lactam and other antibiotics among common pathogens. We conducted a large, international study of infants and children with acute otitis media to identify pathogens and susceptibility patterns. During the winter of 1994 to 1995, middle ear fluid samples were collected from 917 patients with acute otitis media in Bulgaria, the Czech Republic, Hungary, Romania, Slovakia, Israel, and the United States. A single reference laboratory performed in vitro susceptibility testing. Pathogens were isolated from 62% of the patients. For Streptococcus pneumoniae (30% of the patients), untypeable Haemophilus influenzae (17%), and Moraxella catarrhalis (4%), there was significant variation among geographic regions (P < 0.001). The composite susceptibilities of these three organisms to amoxicillin ranged from 62% in the United States to 89% in Eastern and Central Europe; the corresponding susceptibilities to amoxicillin-clavulanate ranged from 90% in Israel to 95% in Eastern and Central Europe. beta-Lactamase was produced by 31 and 100% of the isolates of H. influenzae and M. catarrhalis, respectively. More isolates of S. pneumoniae were susceptible to amoxicillin (90%) or amoxicillin-clavulanate (90%) than to penicillin (70%; P = 0.002). The prevalence of resistant S. pneumoniae was highest in patients less than 12 months of age. S. pneumoniae, H. influenzae, and M. catarrhalis remain the most important bacterial pathogens in patients with acute otitis media; however, their prevalence is variable and resistance patterns are changing.
Insights
Antibiotic resistance in acute otitis media pathogens like Streptococcus pneumoniae varies globally. Susceptibility to amoxicillin and amoxicillin-clavulanate differs by region, impacting treatment effectiveness in children.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Antimicrobial Resistance
Background:
- Management of acute otitis media (AOM) is challenged by increasing antibiotic resistance.
- Common bacterial pathogens show evolving resistance to beta-lactam and other antibiotics.
Purpose of the Study:
- To identify pathogens causing AOM in infants and children.
- To determine antimicrobial susceptibility patterns of these pathogens across different geographic regions.
Main Methods:
- International study conducted during winter 1994-1995.
- Middle ear fluid samples collected from 917 AOM patients across Europe, Israel, and the US.
- In vitro susceptibility testing performed by a central reference laboratory.
Main Results:
- Pathogens isolated from 62% of patients; key organisms were Streptococcus pneumoniae (30%), untypeable Haemophilus influenzae (17%), and Moraxella catarrhalis (4%).
- Significant geographic variation (P < 0.001) in pathogen prevalence and susceptibility.
- Amoxicillin susceptibility ranged from 62% (US) to 89% (Eastern/Central Europe); amoxicillin-clavulanate ranged from 90% (Israel) to 95% (Eastern/Central Europe).
- Beta-lactamase production was high in H. influenzae (31%) and M. catarrhalis (100%).
- S. pneumoniae showed higher susceptibility to amoxicillin (90%) and amoxicillin-clavulanate (90%) than penicillin (70%; P = 0.002).
- Highest prevalence of resistant S. pneumoniae observed in infants < 12 months old.
Conclusions:
- S. pneumoniae, H. influenzae, and M. catarrhalis remain primary bacterial AOM pathogens.
- Pathogen prevalence and antimicrobial resistance patterns exhibit significant geographic variability.
- These changing resistance patterns necessitate ongoing surveillance for effective AOM management.