DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20201288

Study of bacterial pathogens causing chronic suppurative otitis media and the antibiotic susceptibility pattern of the isolates at a tertiary care centre in Kochi

Geetha Nair, Tanya Tonny Mampilly, Bindhu Vasudevan, J. Lancy

Abstract


Background: Chronic suppurative otitis media (CSOM) is defined as chronic inflammation of middle ear and mastoid cavity presenting with recurrent ear discharges through a tympanic membrane perforation. Complications of CSOM were frequent in pre-antibiotic era. Injudicious use of antibiotics led to the emergence of multi-drug resistant strains and complications in return. To isolate the organisms associated with CSOM in a tertiary care centre and to detect their antibiogram.

Methods: In this clinical, prospective, cross sectional study, a total of 100 patients clinically diagnosed with CSOM were enrolled from January to December 2019 (1 year).  

Results: Of the 100 samples collected, predominant bacteria were isolated in 58 patients (58%). The most common isolate was Pseudomonas aeruginosa (29 isolates) followed by Staphylococcus aureus (24), Klebsiella species (3) and 1 isolate each of Pneumococci and Acinetobacter species. Among the 29 isolates of Pseudomonas aeruginosa, 8 (28%) were multidrug resistant. Sensitivity was 100% to imipenem followed by 97% to meropenem,79% to gentamicin, 76% to amikacin, 66% to ciprofloxacin, 41% to piperacillin tazobactam and 17% to ceftazidime. Of the 24 isolates of Staphylococcus aureus, 4 (16%) were methicillin resistant Staphylococcus aureus (MRSA).

Conclusions: Pseudomonas aeruginosa was the most common isolate, of which 28% were multi drug resistant. This calls for the judicious use of antibiotics and alternative measures for treatment of drug resistant strains. Formulating an antibiotic policy based on the local antibiogram can help in preventing the emergence and spread of resistant pathogens.


Keywords


CSOM, Middle ear cleft, Multi drug resistant, MRSA

Full Text:

PDF

References


Gendy GD. The incidence of otitis media with effusion in Menoufiya school children, Faculty of medicine, Menoufiya University. Int J Otorhinolaryng H N Surg. 1998;4(1):2454-5929.

Sauver J, Marss CF, Foxman B, Somsel P, Madira R, Gilsdorf JR. Risk Factors for Otitis Media and carriage of multiple strains of Haemophilus influenzae and Streptococcus Pnuemoniae. Emerg Infect Dis. 2000;6(6):622-30.

Dhingra PL, Dhingra S. Dhingra disease of ENT and Head and Neck Surg. 7th edition. Chapter 11. 74-75.

Tahira M, Mohammed AM, Gulnaz K, Mustafa K. Pseudomonas aeruginosa in chronic suppurative otitis media: Sensitivity spectrum against various antibiotics in Karachi. J of Ayub Medical College, Abbottabad: JAMC. 2008;21(2):120-3.

Brook I. Microbiology and Management of Chronic Suppurative Otitis Media in Children. J of Tropical Pediatrics. 2003;49(4):196-200.

Chronic Otitis Media: Diagnosis and Treatment. Medical Clin North America. 1991;75(6):1277-91.

Hatcher J, Smith A, Mackenzie I. A prevalence study of ear problem in school children in Kiambi district, Kenya. Int J Paediatr Otorhinolaryng. 1995;33:197-201.

Organization WH. Chronic suppurative otitis media: burden of illness and management options. Geneve: World Health Organization; 2004.

Brook I. Microbiology and Management of Chronic Suppurative Otitis Media in Children. J Tropical Pediatrics. 2003;49(4):196-200.

Hatcher J, Smith A, Mackenzie I. A prevalence study of ear problem in school children in Kiambi district, Kenya. Int J Paediatr Otorhinolaryng. 1995;33:197-201.

Kumar H, Seth S. Bacterial and fungal study of 100 cases of chronic suppurative otitis media. J Clin Diagn Res. 2011;5:1224-7.

Ologe FE, Nwawolo. Chronic suppurative otitis media in school pupils in Nigeria. East Afr Med J. 2003;80(3):130-4.

Rout MR, Mohanty D, Vijaylaxmi Y, Kamalesh B, Chakradhar M. Prevalence of cholesteatoma in chronic suppurative otitis media with central perforation. Indian J Otol. 2012;18:7-10.

Mackie, Cartney M. Practical Medical Microbiology. 14th ed. Elsevier; 1996.

Patricia MT. Bailey and Scott’s diagnostic microbiology. 14th ed. Elsevier; 2018.

Clinical and Laboratory standards Institute. M100 Performance standards for antimicrobial susceptibility testing, 29th Edition.

Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug‐resistant, extensively drug‐resistant and pandrug‐resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268-81.

Patel KR, Fefar AD, Khavdu PJ, Mistry SN, Mehta MR. Bacteriological study and antibiotic sensitivity profile in patients with ear discharge visiting ENT OPD at tertiary care center. Int J of Otorhinolaryng and Head and Neck Surg. 2017;4(1):237-41.

Rangaiah ST, Dudda R, Prasad MH, Balaji NK, Gudikote MM. Bacteriological profile of chronic suppurative otitis media in a tertiary care hospital. Int J Otorhinolaryng Head Neck Surg. 2017;3(3):601.

Sharma A, Banerjee M, Mehra M, Khandelwal P, Taneja V. Bacteriology and Antibiotic Sensitivity of Chronic Suppurative Otitis Media in a Government Hospital. Indian J Otology. 2018;24(4):5.

Prakash R, Juyal D, Negi V, Pal S, Adekhandi S, Sharma M, et al. Microbiology of Chronic Suppurative Otitis Media in a Tertiary Care Setup of Uttarakhand State, India. N Am J Med Sci. 2013;5(4):282-7.

Nagraj M, Premalatha DE. Bacteriological and mycological profile of chronic suppurative otitis media. Int J Otorhinolaryng Head Neck Surg. 2018;4(3):754-8.

Kim SH, Kim MG, Kim SS, Cha SH, Yeo SG. Change in detection rate of methicillin‑resistant Staphylococcus aureus and Pseudomonas aeruginosa and their antibiotic sensitivities in patients with chronic suppurative otitis media. J Int Adv Otol. 2015;11:151‑6.

Ikeda K, Misawa S, Kusunoki T. Comparative bactericidal activity of four fluoroquinolones against Pseudomonas aeruginosa isolated from chronic suppurative otitis media. Emerg Infect Dis. 2001;7:337-41.

Juyal D, Negi V, Pal S, Adekhandi S, Sharma M, Sharma N, et al. Microbiology of chronic suppurative otitis media in a tertiary care setup of Uttarakhand state, India. North American J of Medical Sci. 2013;5(4):282.

Prachita S, Ballenger J, Lincoln W. MRSA in Chronic Suppurative Otitis Media. Zenodo. 2017;139(3):395-8.