OBJECTIVE: To determine the frequency of common microorganisms involved in chronic suppurative otitis media (CSOM) and their antibiotic sensitivity.
METHODS: This cross sectional study of 776 patients suffering with CSOM was conducted at Otolaryngology Department, Ayub Teaching Hospital, Abbottabad from 5th May 2017 to 5th November 2018. Patients fulfilling the inclusion criteria were enrolled for otoscopic examination. Sterile cotton swabs were used to collect pus samples and were sent to microbiological analysis and antibiotics sensitivity.
RESULTS: The age ranges of the patients were from 13-73 years, with a mean age of 28.98±13.40 years. The incidence of CSOM was highest in 21-30 years age group (294~37.9%). In a total 776 CSOM patients, only 501 (64.56%) of the samples showed microbial growth. In aerobic isolates, the most common bacterium was Pseudomonas aeruginosa (30.7%) followed by Staphylococcus aureus (11.1%) including 6.7% MRSA. Anaerobes were isolated in 1.2% of the samples in which bacteriodes were being the most common. Samples (1.8%) showed fungal growth and yielded only Candida spp while 0.5% samples were positive for acid fact bacilli. In antimicrobial sensitivity investigation Pseudomonas aeruginosa showed highest sensitivity to piperacillin/tazobactum (84%), to levofloxacin (25.21%), to ciprofloxacin (20.59%). The highest sensitivity of S. aureus was investigated for piperacillin/tazobactum and ceftazidime with 91.18%, and showed no sensitivity to ciprofloxacin and levofloxacin.
CONCLUSION: Pseudomonas aeruginosa and Staphylococcus aureus were the most common bacteria. Both show increasingly high resistance to quinolones and amino glycosides, but both isolates are sensitive to piperacillin/tazobactum, imipenam, cefoperazone/salbactum and ceftazidime.
Afolabi OA, Salaudeen AG, Ologe FE, Nwabuisi C, Nwawolo CC. Pattern of bacterial isolates in the middle ear discharge of patients with chronic suppurative otitis media in a tertiary hospital in north central Nigeria. Afr Health Sci 2012;12(3):362-7. DOI: 10.4314/ahs.v12i3.18.
Fatima G, Shoaib M, Raza MZ, Bilal S. Antimicrobial susceptibility pattern of bacterial and fungal isolates from patients with chronic suppurative otitis media in perspective of emerging resistance. Pak J Otolaryngol 2013;29(2):49-53.
Adoga A, Nimkur T, Silas O. Chronic suppurative otitis media: Socio-economic implications in a tertiary hospital in northern Nigeria. Pan Afr Med J 2010:4:3. DOI: DOI: 10.4314/pamj.v4i1.53613.
Mirza IA, Ali L, Ali L, Arshad M. Microbiology of chronic suppurative otitis media- Experience at Bahawalpur. Pak Armed Forces Med J 2008;58(4):372-6.
Kumar J, Bindu H. Clinical and bacteriological study of chronic suppurative otitis media by anaerobic culture methods in a teaching hospital. Napalese J ENT Head Neck Surg 2012;3(2):12-4.
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. DOI: 10.4103/1947-2714.110436.
Jagdish Kumar SA, Hima BP. Bacteriological study of chronic suppurative otitis media by aerobic methods in a teaching hospital. Napalese J ENT Head Neck Surg 2012;3(2):12-4. DOI: 10.3126/njenthns.v3i2.10155
Jayanthi SR, Venkatesh R, Jeya M. Study of aerobic bacterial and fungal etiology of chronic suppurative otitis media in tertiary care hospital in out skirts of Chennai, India. Int J Res Health Sci 2013;1(3):199-203.
Kumar H, Seth S. Bacterial and fungal study of 100 cases of chronic suppurative otitis media. J Clin Diagn Res 2011;5(6 Suppl 1):S1224-7.
Hiremath SL, Kanta RC, Yeshwanathrao M, Vasantha Kumar CM. Aerobic bacterial isolates of CSOM and their antibiotic sensitivity pattern. Indian Pract 2001;54(7):486-9.
Park MK, Nam DW, Byun JY, Hong SM, Bae CH, Lee HY et al. Differences in antibiotic resistance of MRSA infection in patients with various types of otitis media. J Int Adv Otol 2018;14(3):459-65. DOI:10.5152/iao.2018.5374.
Mokrzan EM, Novotny LA, Brockman KL, Bakaletz LO. Antibodies against the majority subunit (PilA) of the Type IV Pilus of Non typeable Haemophilus influenza Disperse Moraxella catarrhalis from a Dual-Species Biofilm. MBio 2018;9(6):e02423-18. DOI: 10.1128/mBio.02423-18.
Baumann I, Gerendas B, Plinkert PK, Praetorius M. General and disease-specific quality of life in patients with chronic suppurative otitis media-a prospective study. Health Qual Life Outcomes 2011;9(1):48. DOI: 10.1186/1477-7525-9-48.
Meyer E, Whitelaw A, Edkins O, Fagan JJ. Chronic otorrhea: Spectrum of Microorganisms and antibiotic sensitivity in a South African cohort. S Afr Med J 2013;103(7):471-3. DOI: 10.7196/samj.6066.
Nikakhlagh S, Khosravi AD, Fazlipour A, Safarzadeh M, Rashidi N. Microbiologic findings in patients with chronic suppurative otitis media. J Med Sci 2008;8(5):503-6. DOI: 10.3923/jms.2008.503.506.
Arvind N, Chand P, Vishrutha KV. Microbiological profile of chronic suppurative otitis media. Int J Biomed R 2014;5(3):204-6. DOI: 10.7439/ijbr.v5i3.560.
Agrawal A, Kumar D, Goyal A, Goyal S, Singh N, Khandelwal G. Microbiological profile and their antimicrobial sensitivity pattern in patients of otitis media with ear discharge. Indian J Otol 2013;19(1):5-8. DOI: 10.4103/0971-7749.108149.
Rao MV, Jayakar PA. Bacteriological study of chronic suppurative otitis media. J Indian Med Assoc 1980;75(2):30-4.
Coleman A, Wood A, Bialasiewicz S, Ware RS, Marsh RL, Cervin A. the unsolved problem of otitis media in indigenous populations: a systemic review of upper respiratory and middle ear microbiology in indigenous children with otitis media. Micobiome 2018;6(1):199. DOI: 10.1186/s40168-018-0577-2.
Arikan TA, Kelles M. Plasma selenium and cadmium levels in patients with chronic otitis media in a Turkish population and their relation to inflammation markers. Biol Trace Elem Res 2019;189(1):55-63. DOI: 10.1007/s12011-018-1520-x.
Lee SK, Park DC, Kim MG, Boo SH, Choi YJ, Byun JY, et al. Rate of isolation and trends of antimicrobial resistance of multidrug resistant pseudomonas aeruginosa from otorrhea in chronic suppurative otitis media. Clin Exp Otorhinolaryngol 2012;5(1):17-22. DOI: 10.3342/ceo.2012.5.1.17.
Goyal N, KakkarV, Goyal P, Yadav SPS. Myringoplasty for chronic otitis media. Indian J Pediatr 2002;69(2):223-4. DOI: 10.1007/BF02734225.
Rak K, Völker J, Schendzielorz P, Kaulitz S, Steinbach J, Shehata-Dieler W, et al. Cochlear implantation in chronic otitis media: Investigation of long term speech comprehension and rate of complications. Otol Neurotol 2018;39(10):e979-e984. DOI: 10.1097/MAO.0000000000002026.
Iqbal K, Khan MI, Satti L. Microbiology of chronic suppurative otitis media: Experience at Dera Ismail Khan. Gomal J Med Sci 2011;9(2):189-93.
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.
Baron JE, Peterson LR, Finegold SM. Bailey and Scott's Diagnostic Microbiology. 13th ed. United States of America: Mosby-Year Book Inc; 1994. [Cited on: December 12, 2018]. Available from URL: https://www.elsevier.com/books/bailey-and-scotts-diagnostic-microbiology/tille/978-0-323-08330-0.
Vandepitte J, Verhaegen J, Engbaek K, Rohner P, Piot P, Heuck CC. Basic laboratory procedures in clinical bacteriology. 2nd edition. Geneva, Swizerland: World Health Organisation (WHO); 2003. [Cited on: December 12, 2018]. Available from URL: https://apps.who.int/medicinedocs/documents/s16536e/s16536e.pdf.
Ilechukwu GC, Ilechukwu AC, Ubesie AC, Okoroafor I, Ezeanolue BC, Ojinnaka NC. Bacterial agents of the discharging middle ear among children seen at the Umiversity of Nigeria Teaching Hospital, Enugu. Pan Afr Med J 2017;26:87. DOI:10.11604/pamj.2017.26.87.9243.
Nia KM, Sepehri G, Khatmi H, Shakibaie MR. Isolation & antimicrobial susceptibility of bacteria from chronic suppurative otitis media patients in Kerman, Iran. Iran Red Crescent Med J2011;13(12):891-4.
Gorems K, Beyene G, Berhane M, Mekonnen Z. Antimicrobial susceptibility patterns of bacteria isolated from patients with ear discharge in Jimma Town, Southwest, Ethiopia. BMC Ear Nose Throat Disord 2018;18:17. DOI: 10.1186/s12901-018-0065-0.
Altuntas A, Aslam A, Eren A, Unal A, Nalca Y. Susceptibility of microorganisms isolated from chronic suppurative otitis media to ciprofloxacin. Eur Arch Otorhinolaryngol 1996;253(6):364-6. DOI: 10.1007/bf00178293.
Jang CH, Park SY. Emergence of ciprofloxacin resistant pseudomonas in chronic suppurative otitis media. Cli Otolaryngol 2004;29(4):321-3. DOI: 10.1111/j.1365-2273.2004.00835.x.