Chronic suppurative otitis media: a clinico-microbiological menace
Keywords:Chronic suppurative otitis media, Pseudomonas aeruginosa, Resistance
Background: Chronic Suppurative Otitis Media (CSOM) is an important cause of preventable hearing loss. Global emergence of resistant strains is of great concern. The aim of the present study was to determine the etiology and antibiotic sensitivity pattern of bacterial isolates from CSOM cases with special emphasis on ESBL (Extended Spectrum Beta- Lactamases) and AmpC beta lactamases.
Methods: Patients with sign and symptoms suggestive of CSOM, ESBL (Extended Spectrum Beta-Lactamases), AmpC beta lactamases and MBLs (Metallo beta lactamases) were included. Two ear swabs were taken from all the patients and cultured on blood agar and MacConkeyagar. Bacterial identification of isolates was done using standard biochemicals. Antimicrobial susceptibility was performed by Kirby-Bauer's disc diffusion method as per the Clinical Laboratory Standards Institute (CLSI) guidelines using antibiotic discs (HI MEDIA).
Results: Out of 130 patients, 110(84.62%) had bacterial growth. The common pathogenic species were Pseudomonas aeruginosa 36(37.89%), Staphylococcus aureus 31(32.63%), Citrobacter koseri 9(9.47%) and Proteus vulgaris 6(6.32%). P. aeruginosa showed maximum sensitivity to colistin (94.4%), polymixin-B (91.3%) and imipenem (91.3%). Gram positive cocci showed maximum sensitivity to vancomycin (99%).
MRSA (Methicillin Resistant Staphylococcus aureus) and HLAR (High Level Aminoglycoside Resistance) were detected in 9(29%) S. aureus and 1(50%) Enterococcus faecalis respectively. ESBL and AmpC were detected in 11(18.3%) and 12(20%) Gram negative bacteria, respectively and MBL producer was not detected.
Conclusion: P. aeruginosa was found to be the most common isolate in CSOM cases and colistin, polymixin-B and imipenem was found to be most effective antibiotics.
Arvind N, Pavan Chand, Vishrutha KV. Microbiological profile of Chronic Suppurative Otitis Media. Int J Biomed Res. 2014;05(03):204-6.
Shamweel A. Antibiotics in chronic suppurative otitis media: A bacteriologic study. Egyptian Journal of Ear, Nose, Throat and Allied Sciences. 2013;14(3):191–4.
Prakash M, Lakshmi K, Anuradha S, Swathi GN. Bacteriological Profile and their Antibiotic Susceptibility Pattern of Cases of Chronic Suppurative Otitis Media. Asian J Pharm Clin Res. 2013;6(3):210-2.
Jose Acuin, Philippines. Chronic suppurative otitis media Burden of Illness and Management Options. Child and Adolescent Health and Development Prevention of Blindness and Deafness. World Health Organization (WHO), Geneva, Switzerland, 2004.
Collee JG, Fraser AG, Marmion BP, Mackey SA, McCartney .Practical Medical Microbiology. In: Collee JG, Miles RS, Watt B, editors. Tests for the identification of Bacteria. 14th ed. New Delhi India: Elsevier; 2006; 131–149.
Wayne Pa: Clinical and Laboratory Standards Institute: M2-A9. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial disk susceptibility tests, 2006.
Rizvi M, Fatima N, Rashid M, Shukla I, Malik A, Usman A, Siddiqui. Extended Spectrum AmpC and metallo-beta-lactamases in Serratia and Citrobacter spp. in a disc approximation assay. J Infect Developing Countries. 2009;3(3):177-86.
Clinical and laboratory Standards Institute 2003. Performance standards for antimicrobial susceptibility testing: eighteenth informational supplement: Approved standards M100-S18. Clinical and Laboratory Standards Institute, Baltimore, USA. 2008.
Lee KY, Chong HB, Shin YA, Yong KD, Yum JH. Modified Hodge test and EDTA disc synergy tests to screen metallo beta lactamase producing strains of Pseudomonas and Acinetobacter species. Clin Microbiol Infect. 2001;7: 88-91.
Maji PK, Chatterjee TK, Chatterjee S, Chakrabarty J, Mukhopadhyay BB. The investigation of bacteriology of chronic suppurative otitis media in patients attending a tertiary care hospital with special emphasis on seasonal variation. Indian J Otolaryngol Head Neck Surg. 2007;59:128-31.
Kumar R, Srivastava P, Sharma M, Rishi S, Nirwan S, Hemwaniand K, et al. Isolation and antimicrobial sensitivity profile of bacterial agents in chronic suppurative otitis media patients at NIMS Hospital, Jaipur. IJPBS. 2013;3(4):265-9.
Raghu Kumar KG, Navya S, Basavarajappa KG. A Study of Bacterial Profile and Antibiotic Susceptibility Pattern of Chronic Suppurative Otitis Media among Patients attending a Tertiary Care Centre, Davangere. Sch J App Med Sci. 2014;2(5B):1606-12.
Kumar H, Seth S. Bacterial and Fungal Study of Chronic Suppurative Otitis Media. J Clin Diagn Res. 2011;5(6):1224-7.
Nazir A, Kadri SM. Aerobic bacteriology of chronic suppurative otitis media: a hospital based study. Int J Res Med Sci. 2014;2(4):1521-5.
Sanjana RK, Singh YI, Reddy NS. Aerobic bacteriology of Chronic Suppurative Otitis Media (CSOM) in a tertiary care hospital: A retrospective study. Journal of College of Medical Science-Nepal. 2011;7(2):1-8.
Shyamala R, Reddy SP. The study of bacteriological agents of chronic suppurative otitis media - Aerobic culture and evaluation. J Microbiol Biotech Res. 2012;2(1):152-62.
Lakshmi JG, Geeta, Lakshmi S. Chronic suppurative otitis media profile of aerobic pathogens and antibiotic sensitivity. J Evolution of Med and Dent Sci. 2014;3(70):14957-62.
Sharma V, Kaur G. Microbiology and antimicrobial susceptibility pattern of cases of chronic suppurative otitis media in a tertiary care teaching hospital. Int J Bioassays. 2014;3(5):3033-5.
Nia MK, Sepehri G, Khatmi H, Shakibaie MR. Isolation and Antimicrobial Susceptibility of Bacteria from Chronic Suppurative Otitis Media Patients in Kerman, Iran. Iran Red Crescent Med J. 2011;13(12):891–4.
Mariam, Ahmed K, Mir A, Jan M, Imran R, Shah G, et al. Prevalence of Bacteria in Chronic Suppurative Otitis Media Patients and Their Sensitivity Patterns against Various Antibiotics in Human Population of Gilgit. Pakistan J Zool. 2013;45(6):1647-53.