DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20211177

Microbiology and antibiotic sensitivity of uncomplicated chronic suppurative otitis media at Dr. George Mukhari Academic Hospital, South Africa

Monica Kotu, Ian Paul Olwoch

Abstract


Background: The study was conducted to assess the type and frequency of isolation of different microorganisms in uncomplicated chronic suppurative otitis media (CSOM) and their antibiotic sensitivity in our institution.

Methods: A total of 88 consecutive patients with unilateral or bilateral active, chronic suppurative otitis media attending outpatient department at DGMAH were included in the study after obtaining an informed consent. There were 55 males (62.5%) and 33 females (37.9%) with age range between 6 months and 76 years. Pus swabs were taken through the perforation site and from the promontory after ear mopping under direct vision.  

Results: Children less than 5 years were more affected (23.9%) than older children 5-10 years (13.6%) and 11-15 years (11.45%). One hundred and six microorganisms were isolated from analysis of cultures obtained from 72 patients. Seven cultures were negative (5.9%), 8 specimens were contaminated (6.7%) and 1 specimen was lost (1.1%). Pseudomonas aeruginosa (24.0%) was the most common isolate, followed by Staphylococcus aureus (17%) and Proteus mirabilis (10%). Drug sensitivity pattern showed that Piperacillin-tazobactam was effective against the majority of Pseudomonas aeruginosa isolates at 72%, followed by both Gentamicin and Ceftazidime at 64% and Ciprofloxacin at 48%. Staphylococcus aureus isolates were sensitive to Erythromycin (77%), Cloxacillin and Clindamycin at 72%. Proteus mirabilis was sensitive to Cefuroxime (91%), Co-amoxiclav (72.8%).

Conclusions: Isolation rate and susceptibility patterns in CSOM, suggest a need for regular surveillance to monitor antimicrobial resistance and to guide antibacterial therapy.

 

 

Keywords


Chronic suppurative otitis media, Microbiological profile, Sensitivity profile

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References


WHO, Geneve. Chronic suppurative otitis media: Burden of illness and management options. World Health Organ. 2004:1-84.

Verhoeff M, Van der Veen EL, Rovers M, Sanders EA, Schilder AG. Chronic suppurative otitis media: A review. Int J Pediatr Otorhinolaryngol. 2006;70:1-12.

Adoga A, Nimkur T, Silas O. Chronic suppurative otitis media: socio-economic implications in a tertiary hospital in northern Nigeria. Pan Afr Med J. 2010;4:1-7.

Schwartz LE, Brown RB. Purulent otitis media in adults. Arch Intern Med. 1992;152:2301-4.

Yorgancilar E, Yildirim M, Gun R. Complications of chronic suppurative otitis media; a retrospective review. Eur Arch Otorhinolaryngol. 2012;12:1924-8

Wariso BA, Ibe S. Bacteriology of chronic discharging ears in Port Harcourt, Nigeria. West Afr J Med. 2006;25:219-22.

Shrestha BL, Amatya R, Shrestha I, Ghosh I. Microbiological profile of chronic suppurative otitis media. Nepalese J Head Neck Surg. 2011;2(2):6-7.

Loy A, Tan A, Lu P. Microbiology of chronic suppurative otitis media in Singapore. Singapore Med J. 2002;43(6):296-9.

Iqbal K, Khan MI, Satti L. Microbiology of chronic suppurative otitis media: Experience at Dera Ismael Khan. Gomal J Med Sci. 2011;9(2):189-93.

Panda NK, Sreedharan S, Mann SBS, Sharma S. Prognostic factors in complicated and uncomplicated chronic otitis media. Am J Otolaryngol. 1996;17(6):391-6.

Bluestone CD. Efficacy of ofloxacin and other ototopical preparations for chronic suppurative otitis media in children. Pediatr Infect Dis J. 2001;20(1):111-5.

Hafidh MA, Keogh I, Walsh RM, Walsh M, Rawluk D. Otogenic intracranial complications. A 7 years retrospective review. Am J Otolaryngol. 2006;27:390-5.

Lee SK, Lee MS, Jung SY. Antimicrobial resistance of Pseudomonas aeruginosa from otorrhea of chronic suppurative otitis media patients. Otolaryngol Head Neck Surg. 2010;143:500-5.

Kong K, Coates HL. Natural history, definitions, risk factors and burden of otitis media. Med J Aust. 2009;191(9):39-43.

Kumar H, Seth S. Bacterial and fungal study of 100 cases of chronic suppurative otitis media. J Clin Diag Res. 2011;5(6):1224-7.

Gul AA, Ali L, Rahim E, Ahmed S. Chronic suppurative otitis media; frequency of Pseudomonas aeruginosa in patients and its sensitivity to various antibiotics. Prof Med J. 2007;14(3):411-5.

Muhaimeid H, Zakzouk S, Bafaqeeh S. Epidemiology of chronic suppurative otitis media in Saudi children. Int J Pediatr Otorhinolaryngol. 1993;26:101-8.

Bello R, Agbo E, Olabode H. Antibiogram of bacterial and fungal isolates associated with otitis media amongst children in Bauchi state, Nigeria. Int J Pharma Bio Sci. 2011;2(3):200-7.

Rao BN, Reddy MS. Chronic suppurative otitis media - a prospective study. Int J Otol Head Neck Surg. 1994;3(2):72-77.

Macfadyen CA, Acuin JM, Gamble CL. Systemic antibiotics versus topical treatments for chronically discharging ears with underlying eardrum perforations (Review). The Cochrane database syst Rev. 2009;(1):1-87.

King JF. Quinolone ear drops for chronic otitis media. BMJ. 2000;321:126-7.

Wai TK, Tong MC. A benefit -risk assessment of ofloxacin otic solution in ear infection. Drug Saf. 2003;26(6):405-20.

Lim DJ, Chun YM, Lee HY. Cell biology of tubo-tympanum in relation to pathogenesis of otitis media - a review. Vaccine. 2001;19:S17-S25.

Yeo SG, Park DC, Hong SM, Cha CIL, Kim MG. Bacteriology of chronic suppurative otitis media - a multicenter study. Acta Otolaryngol. 2007;127:1062-7.

Jang C, Park S. Emergence of ciprofloxacin-resistant pseudomonas in chronic suppurative otitis media. Clin Otolaryngol. 2004;29:321-3.

Sevillano E, Valderrey C, Canduela M. Resistance to antibiotics in clinical isolates of pseudomonas aeruginosa. Pathol biol. 2006;54:493-7.

Ferede D, Geyid A, Lulseged S, Melaku A. Drug susceptibility pattern of bacterial isolates from children with chronic suppurative otitis media. Ethiop J Health Dev. 2001;15:89-86.

Almac A, Elicora SS, Dundar V, Willke A. The relationship between chronic otitis media with effusion and surface and deep flora of hypertrophic adenoids. Int J Pediatr Otorhinolaryngol. 2009;73:1438-40.

Alsaimary IE, Alabbasi AM, Najim JM. Impact of multi drugs resistant bacteria on the pathogenesis of chronic suppurative otitis media. Afr J Microbiol Res. 2010;4(13):1373-82.

Maw RA. Chronic otitis media with effusion (glue ear) and adenotonsillectomy: prospective randomised controlled study. Br Med J. 1983;287:1586-8.

Constable L, Butler I. Microbial flora in chronic otitis media. J Infect. 1982;5:57-60.

Stenfors LE. Non-specific and specific immunity to bacterial invasion of the middle ear cavity. Int J Pediatr Otorhinolaryngol. 1999;49:S223-6.

Stenfors LE, Räisänen S. Immunoglobulin-coated bacteria in effusions from secretory and chronic suppurative otitis media. Am J Otolaryngol. 1991;12:161-4.

Stolp DLC, Swart JG. The significance of Pseudomonas aeruginosa in chronic otitis media. S Afr Med J. 1989;76:543-5.

Van Hasselt P, Van Kregten E. Treatment of chronic suppurative otitis media with ofloxacin in hydroxypropyl methylcellulose ear drops: a clinical/bacteriological study in a rural area of Malawi. Int J Pediatr Otorhinolaryngol. 2002;63:49-56.

Duffy LC, Faden H, Wasielewski R, Wolf J, Krystofik D. Exclusive breastfeeding protects against bacterial colonization and day care exposure to otitis media. Pediatrics. 1997;100(4).

Duncan B, Ey J, Holberg CJ. Exclusive breast-feeding for at least 4 months protects against otitis media. Pediatrics. 1993;91(5):867-72.

Lasisi AO, Olaniyan FA, Muibi SA. Clinical and demographic risk factors associated with chronic suppurative otitis media. Int J Pediatr Otorhinolaryngol. 2007;71:1549-54.

Lodhi M, Munir T, Aziz K, Lodi H. Chronic suppurative otitis media: Empiric quinolones in children. Prof Med J. 2010;17(3):420-4.

Mansoor T, Musani MA, Khalid G, Kamal M. Pseudomonas aeruginosa in chronic suppurative otitis media: sensitivity spectrum against various antibiotics in Karachi. J Ayub Med Coll Abbottabad. 2009;21(2):120-3.