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Otitis media with effusion in Lebanese children: prevalence and pathogen susceptibility

Published online by Cambridge University Press:  13 July 2011

S C Nasser ,
N Moukarzel ,
A Nehme ,
H Haidar ,
B Kabbara  and
A Haddad
S C Nasser*
Affiliation:
School of Pharmacy, Lebanese American University, Byblos, Lebanon
N Moukarzel
Affiliation:
Otorhinolaryngology Department, Sacre Coeur Hospital, School of Medicine, Lebanese University, Hazmieh, Lebanon
A Nehme
Affiliation:
Otorhinolaryngology Department, Sacre Coeur Hospital, School of Medicine, Lebanese University, Hazmieh, Lebanon
H Haidar
Affiliation:
Otorhinolaryngology Department, Sacre Coeur Hospital, School of Medicine, Lebanese University, Hazmieh, Lebanon
B Kabbara
Affiliation:
Otorhinolaryngology Department, Sacre Coeur Hospital, School of Medicine, Lebanese University, Hazmieh, Lebanon
A Haddad
Affiliation:
Laboratory Department, Sacre Coeur Hospital, School of Medicine, Lebanese University, Hazmieh, Lebanon
*
Address for correspondence: Dr Soumana C Nasser, School of Pharmacy, Lebanese American University, Byblos Campus, PO Box 36, Byblos 5053, Lebanon Fax: +961 9 547256 E-mail: soumana.nasser@lau.edu.lb
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Abstract

Objective:

To determine the prevalence and resistance profile of bacterial pathogens present in the middle ear of children with otitis media with effusion, and to report beta-lactamase-negative, ampicillin-resistant bacteria for the first time in Lebanese children.

Method:

We included 62 patients younger than 12 year (107 ears), who underwent myringotomy with tympanostomy tube placement for persistent otitis media with effusion. Bacteria were identified by Gram staining and biochemical tests, and antibiotic sensitivities tested by the disc diffusion method and via minimum inhibitory concentration (E-test).

Results:

The commonest pathogen was Haemophilus influenzae (62 per cent), followed by Streptococcus pneumoniae (26 per cent). The H influenzae resistance profile was highest for amoxicillin (81.0 per cent) and lowest for cefotaxime (19.0 per cent). There was a high risk of developing H influenzae antibiotic resistance among children with a history of smoking exposure (p = 0.001), recurrent upper respiratory tract infection (p = 0.001) or previous antibiotic treatment (p = 0.005). Fifty-two per cent of H influenzae colonies were found to be beta-lactamase-negative and ampicillin-resistant.

Conclusion:

In these children with persistent otitis media with effusion, H influenzae was the most prevalent bacteria. It showed a high incidence of resistance to the antibiotics most commonly prescribed to treat acute otitis media.

Keywords

Otitis MediaOtitis Media With EffusionDrug Resistance, MicrobialBeta LactamaseStreptococcus PneumoniaeHaemophilus Influenzae
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 125 , Issue 9 , September 2011 , pp. 928 - 933
Copyright
Copyright © JLO (1984) Limited 2011

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References

1Riding, KH, Bluestone, CD, Michaels, RH, Cantekin, EI, Doyle, WJ, Poziviak, CS. Microbiology of recurrent and chronic otitis media with effusion. J Pediatr 1978;93:739–43CrossRefGoogle ScholarPubMed
2Giebink, GS, Juhn, SK, Weber, ML, Le, CT. The bacteriology and cytology of chronic otitis media with effusion. Pediatr Infect Dis J 1982;1:98–103CrossRefGoogle ScholarPubMed
3Bluestone, CD, Stephenson, JS, Martin, LM. Ten-year review of otitis media pathogens. Pediatr Infect Dis J 1992;11:7–11CrossRefGoogle ScholarPubMed
4Sutton, DV, Darrow, DH, Derkay, CS, Strasnick, B. Resistant bacteria in middle ear fluid at the time of tympanostomy tube surgery. Ann Otol Rhinol Laryngol 2000;109:24–9CrossRefGoogle Scholar
5Pereira, MB, Pereira, MR, Cantarelli, V, Costa, SS. Prevalence of bacteria in children with otitis media with effusion. J Pediatr 2004;80:41–8CrossRefGoogle ScholarPubMed
6Pelton, SI. Acute otitis media in an era of increasing antimicrobial resistance and universal administration of pneumococcal conjugate vaccine. Pediatr Infect Dis J 2002;21:599–604CrossRefGoogle Scholar
7Li, WC, Chiu, NC, Hsu, CH, Lee, KS, Hwang, HK, Huang, FY. Pathogens in the middle ear effusion of children with persistent otitis media: implications of drug resistance and complications. J Microbiol Immunol Infect 2001;34:190–94Google ScholarPubMed
8Martinez, M, Macios, RA, Palau, ME. Bacterial implication in otitis media with effusion in childhood [in Spanish and in English] Acta Otorrinolaringol Esp 2007;58:408–12Google Scholar
9Kilpi, T, Herva, E, Kaijalainen, T, Syrjanem, R, Takala, A. Bacteriology of acute otitis media in a cohort of Finnish children followed for the first two years of life. Pediatr Infect Dis J 2001;20:654–62CrossRefGoogle Scholar
10Ruohola, A, Meurman, O, Nikkari, S, Skottman, T, Heikkinen, T, Ruskanen, O. The dynamics of bacteria in the middle ear during the course of acute otitis media with tympanostomy tube otorrhea. Pediatr Infect Dis J 2007;26:892–6CrossRefGoogle ScholarPubMed
11El-Shamy, HA. Bacteriology of chronic secretory otitis media in children. J Egypt Public Health Assoc 1993;68:495–505Google ScholarPubMed
12Barkai, G, Greenberg, D, Givon-Lavi, N, Dreifuss, E, Vardy, D, Dagan, R. Community prescribing and resistant Streptococcus pneumoniae. Emerg Infect Dis 2005;11:829–37CrossRefGoogle ScholarPubMed
13Leibovitz, E. The challenge of recalcitrant acute otitis media: pathogens, resistance, and treatment strategies. Pediatr Infect Dis J 2007;26(10 suppl):S8–11CrossRefGoogle Scholar
14Senturia, BH, Gessert, CF, Carr, CD, Baumann, ES. Studies concerned with tubotympanitis. Ann Otol Rhinol Laryngol 1958;67:440–67CrossRefGoogle ScholarPubMed
15Hadi, U, Matar, GM. Bacterial etiology of otitis media with effusion in a group of Lebanese children. J Med Liban 2000;48:143–6Google Scholar
16Matar, G, Sidani, N, Fayad, M, Hadi, U. Two-step PCR-based assay for identification of bacterial etiology of otitis media with effusion in infected Lebanese children. J Clin Microbiol 1998;36:1185–8CrossRefGoogle ScholarPubMed
17Mills, RP, Uttley, AH, McIntyre, MF. A bacteriological study of the middle ear and upper respiratory tract in children with chronic secretory otitis media. Clin Otol 1985;10:335–41CrossRefGoogle ScholarPubMed
18Lim, DJ, Lewis, DM, Schram, JL, Birck, HG. Antibiotic-resistant bacteria in otitis media with effusion. Ann Otol Rhinol Laryngol Suppl 1980;89:278–80CrossRefGoogle ScholarPubMed
19Rodriguez, WJ, Schwartz, RH, Thorne, MM. Increasing incidence of penicillin- and ampicillin-resistant middle ear pathogens. Pediatr Infect Dis J 1995;14:1075–8CrossRefGoogle ScholarPubMed
20Rosenblüt, A, Santolaya, ME, Gonzalez, P, Borel, C, Cofré, J. Penicillin resistance is not extrapolable to amoxicillin resistance in Streptococcus pneumoniae isolated from middle ear fluid in children with acute otitis media. Ann Otol Rhinol Laryngol 2006;115:186–90CrossRefGoogle Scholar
21Dagan, R, Abramson, O, Leibovitz, E, Lang, R, Goshen, S, Greenberg, D et al. Impaired bacteriology response to oral cephalosporins in acute otitis media caused by pneumococci with intermediate resistance to penicillin. Pediatr Infect Dis J 1996;15:980–5CrossRefGoogle Scholar
22Hamamoto, Y, Gotoh, Y, Nakajo, Y, Shimoya, S, Kayama, C, Hasegawa, S et al. Impact of antibiotics on pathogens associated with otitis media with effusion. J Laryngol Otol 2005;119:862–5CrossRefGoogle ScholarPubMed
23Hoban, D, Felmingham, D. The PROTEKT surveillance study: antimicrobial susceptibility of Haemophilus influenzae and Moraxella catarrhalis from community-acquired respiratory tract infections. J Antimicrob Chemother 2002;50:49–59CrossRefGoogle ScholarPubMed
24James, PA, Reeves, DS. Bacterial resistance to cephalosporins as a function of outer membrane permeability and access to their target. J Chemother 1996;8:37–47Google ScholarPubMed
25Tristram, S, Jacobs, MR, Appelbaum, PC. Antimicrobial resistance in Haemophilus influenzae. Clin Microbiol Rev 2007;20:368–89CrossRefGoogle ScholarPubMed
26Jacobs, MR. Worldwide trends in antimicrobial resistance among common respiratory tract pathogens in children. Pediatr Infect Dis J 2003;22(8 suppl):S109–19CrossRefGoogle ScholarPubMed
27Matic, V, Bozdogan, B, Jacobs, MR, Ubukata, K, Appelbaum, PC. Contribution of beta-lactamase and PBP amino acid substitutions to amoxicillin/clavulanate resistance in beta-lactamase-positive, amoxicillin/clavulanate-resistant Haemophilus influenzae. J Antimicrob Chemother 2003;52:1018–21CrossRefGoogle ScholarPubMed
28Fluit, AC, Florijn, A, Verhoef, J, Milatovic, D. Susceptibility of European beta-lactamase-positive and -negative Haemophilus influenzae isolates from the periods 1997/1998 and 2002/2003. J Antimicrob Chemother 2005;56:133–8CrossRefGoogle ScholarPubMed
29Toltzis, P, Dul, M, Blumer, J. Change in pneumococcal susceptibility to azithromycin during treatment for acute otitis media. Pediatr Infect Dis J 2007;26:647–9CrossRefGoogle ScholarPubMed
30Hoppe, H, Johnson, C. Otitis media: focus on antimicrobial resistance and new treatment options. Am J Heath Syst Pharm 1998;55:1881–97CrossRefGoogle ScholarPubMed
31Klein, JO. Management of otitis media: 2000 and beyond. Pediatr Infect Dis J 2000;19:383–7CrossRefGoogle ScholarPubMed
32Coker, TR, Chan, LS, Newberry, SJ, Limbos, MA, Suttorp, MJ, Shekelle, PG et al. Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children. JAMA 2010;304:2161–9CrossRefGoogle ScholarPubMed