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Pathogens isolated during treatment failures in otitis
P Gehanno1, L N'Guyen, M Derriennic
1Department of Otolaryngology, Bichat Hospital, Paris, France.
Insights
Penicillin-resistant Streptococcus pneumoniae (S. pneumoniae) is a common cause of treatment failure in infant acute otitis media (AOM). This study highlights the prevalence of resistant S. pneumoniae in the Paris region, emphasizing the need for updated treatment guidelines.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Acute otitis media (AOM) is a common childhood infection, frequently treated with oral antibiotics.
- Therapeutic failures in AOM treatment are increasingly observed, necessitating investigation into causative pathogens and resistance patterns.
Purpose of the Study:
- To evaluate the clinical and bacteriologic epidemiology of AOM in infants experiencing treatment failure with oral antibiotics.
- To identify risk factors associated with infections by penicillin-resistant Streptococcus pneumoniae (PRSP).
Main Methods:
- A prospective study was conducted in the Paris region involving 186 infants with AOM.
- Middle ear fluid or otorrhea fluid samples were collected for bacterial culture.
- Clinical data, including age, daycare attendance, and prior antibiotic use, were recorded.
Main Results:
- 170 bacterial isolates were identified from 141 samples; Streptococcus pneumoniae was the most common (39.4%), followed by Haemophilus influenzae (35.9%).
- 77.6% of S. pneumoniae isolates exhibited reduced susceptibility to penicillin (PRSP).
- Daycare attendance, fever with otalgia, age under 2 years, and prior erythromycin-sulfisoxazole treatment were risk factors for PRSP infection.
Conclusions:
- Penicillin-resistant S. pneumoniae is a significant cause of treatment failure in AOM cases in the Paris region.
- Understanding the epidemiology and risk factors for PRSP is crucial for optimizing AOM management.
Objectives:
A prospective study in the Paris region to evaluate the clinical and bacteriologic epidemiology of acute otitis media in infants in whom oral antibiotic therapy resulted in clinical failure.
Methods:
The study included 186 children with a mean age of 17.5 +/- 13.1 months. Two-thirds of them attended a day-care center and 40.8% had a history of recurrent otitis media. The most frequently prescribed prior antibiotics were amoxicillin-clavulanic acid (43% of cases), an oral third generation cephalosporin (22.6%), erythromycin-sulfisoxazole (11.8%) and a first generation cephalosporin (10.2%). The average duration of antibiotic therapy was 6.9 +/- 2.65 days. Specimens for bacterial cultures included 188 samples of middle ear fluid obtained by tympanocentesis and 37 collected from otorrhea fluid.
Results:
One hundred forty-one samples (62.7%) from 126 children yielded 170 bacterial isolates. In 60 children (32.3%) the culture of the ear pus was sterile. Among the 170 bacterial isolates: 67 (39.4%) were Streptococcus pneumoniae (59 patients), of which 77.6% had reduced susceptibility to penicillin (PRSP with penicillin MIC > or = 0.125 mg/l); 61 (35.9%) were Haemophilus influenzae (56 patients) of which 49.2% were beta-lactamase producers; and 8 were Moraxella catarrhalis (8 patients), of which 87.5% were beta-lactamase producers. Thirty-six patients were infected by S. pneumoniae with penicillin MIC > or =1 mg/l. In our study attending day-care center (P = 0.04), temperature >38 degrees C with signs of otalgia (P = 0.02), age <2 years (P = 0.048) and prior antibiotic treatment with erythromycin-sulfisoxazole (P = 0.006) were independently predictive risk factors for patients infected with penicillin-resistant S. pneumoniae. Pneumococcal serogroups 23, 14 and 19 were predominant (25.4, 25.4 and 23.8%, respectively). Penicillin resistance was mainly associated with serogroups 23 and 14.
Conclusions:
Penicillin-resistant S. pneumoniae isolates are frequently responsible for therapeutic failure in cases of acute otitis media in the Paris region.