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Microbiologic characteristics of persistent otitis media
1Department of Pediatrics, Georgetown University School of Medicine, Washington, DC, USA.
Objective:
To identify the pathogens isolated from children with acute otitis media who did not respond to antimicrobial drug therapy.
Methods:
Retrospective analysis of cultures obtained by tympanocentesis from 46 children.
Results:
Organisms were recovered from 34 children (74%), and 43 isolates were recovered from these individuals. The organisms were Streptococcus pneumoniae (16 isolates), Haemophilus influenzae non-type b (12 isolates), Moraxella catarrhalis (5 isolates), Streptococcus pyogenes (5 isolates), Staphylococcus aureus (3 isolates), and Peptostreptococcus species (2 isolates). Resistance to the antimicrobial agent used was found in 27 (63%) of 43 isolates found in 22 patients (48%). Of patients who did not respond to amoxicillin therapy, H influenzae predominated. Streptococcus pneumoniae was recovered from 5 (56%) of 9 of those who did not respond to trimethoprim and sulfamethoxazole therapy, 4 (44%) of 9 patients after azithromycin therapy, 3 (25%) of 12 patients after amoxicillin therapy, and 2 (40%) of 5 patients after cefixime therapy. Streptococcus pyogenes was recovered from 2 (40%) of 5 patients after trimethoprim and sulfamethoxazole therapy and from 2 (40%) of 5 patients after cefixime therapy.
Conclusions:
The data illustrate the relation between resistance to antimicrobial drug therapy and failure of patients with otitis media to improve. They also highlight the importance of diagnostic tympanocentesis in establishing the presence of resistant microorganisms.
Insights
Identifying pathogens in children with acute otitis media unresponsive to antibiotics is crucial. Antimicrobial resistance was common, highlighting the need for diagnostic tympanocentesis to guide treatment.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Antimicrobial Resistance
Background:
- Acute otitis media (AOM) is a common childhood infection.
- Treatment failure in AOM can be linked to pathogen characteristics and antimicrobial resistance.
Purpose of the Study:
- To identify pathogens causing AOM in children who did not respond to antibiotic treatment.
- To investigate the prevalence of antimicrobial resistance in these pathogens.
Main Methods:
- Retrospective analysis of tympanocentesis cultures from 46 children with AOM.
- Identification of bacterial isolates and assessment of antimicrobial susceptibility.
Main Results:
- Pathogens were recovered from 74% of children; Streptococcus pneumoniae and Haemophilus influenzae were most common.
- Antimicrobial resistance was observed in 63% of isolates.
- Haemophilus influenzae predominated in amoxicillin treatment failures; Streptococcus pneumoniae was frequent in failures of other antibiotics.
Conclusions:
- Antimicrobial resistance is associated with treatment failure in pediatric AOM.
- Diagnostic tympanocentesis is essential for identifying resistant pathogens and optimizing therapy.