Resistant Bacteria in Middle Ear Fluid at the Time of Tympanotomy Tube Surgery

Abstract

This study was performed to determine the prevalence of resistant Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis isolated from middle ear fluid of children undergoing placement of ventilation tubes. The extent of resistance to commonly prescribed antibiotics and the risk factors associated with this resistance were also examined. Children who had fluid present in their middle ears at the time of ventilation tube placement from May 1996 to May 1997 were included in the study. Middle ear fluid was plated onto culture media in the operating room, and antimicrobial resistance of cultured organisms was ascertained. Risk factors for this resistance were determined from the medical history and analyzed. Cultures of 244 patients (355 ears) were positive for organisms in 29.6%. Penicillin resistance was found in 38.2% of S pneumoniae cultures. β-Lactamase production was found in 65.1% and 100% of H influenzae and M catarrhalis specimens, respectively. Risk factor analysis revealed young age, day care attendance, and number of antibiotic courses to most reliably predict the presence of resistant microorganisms.

Keywords

antibiotic resistance Hemophilus influenzae Moraxella catarrhalis otitis media

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References

Low

Scheld

. Strategies for stemming the tide of antimicrobial resistance. JAMA 1998; 279: 394–5.

Guillemot

Carbon

Balkau

. Low dosage and long treatment duration of β-lactam. Risk factors for carriage of penicillin-resistant Streptococcus pneumoniae. JAMA 1998; 279: 365–70.

Paradise

. Short-course antimicrobial treatment for acute otitis media. Not best for infants and young children. JAMA 1997; 278: 1640–2.

Drug-resistant Streptococcus pneumoniae — Kentucky and Tennessee, 1993. MMWR Morb Mortal Wkly Rep 1994; 43: 23–31.

American Academy of Pediatrics: Committee on Infectious Disease. Therapy for children with invasive pneumococcal infections. Pediatrics 1997; 99: 289–99.

Prevalence of penicillin-resistant Streptococcus pneumoniae — Connecticut, 1992–1993. MMWR Morb Mortal Wkly Rep 1994; 43: 216–23.

Block

Harrison

Hedrick

. Penicillin-resistant Streptococcus pneumoniae in acute otitis media: risk factors, susceptibility patterns and antimicrobial management. Pediatr Infect Dis J 1995; 14: 751–9.

Rodriguez

Schwartz

Akram

Khan

. Streptococcus pneumoniae resistant to penicillin: incidence and potential therapeutic options. Laryngoscope 1995; 105: 300–4.

Baquero

Loza

. Antibiotic resistance of microorganisms involved in ear, nose and throat infections. Pediatr Infect Dis J 1994; 13(Suppl 1): S9–S14.

10.

Muñoz

Coffey

Daniels

. Intercontinental spread of a multiresistant clone of serotype 23F Streptococcus pneumoniae. J Infect Dis 1991; 164: 302–6.

11.

Stahlberg

Ruuskanen

Virolainen

. Risk factors for recurrent otitis media. Pediatr Infect Dis J 1986; 5: 30–2.

12.

Alho

Oja

Koivu

Sorri

. Risk factors for chronic otitis media with effusion in infancy. Arch Otolaryngol Head Neck Surg 1995; 121: 839–43.

13.

Uhari

Mäntysaari

Niemelä

. A meta-analytic review of the risk factors for acute otitis media. Clin Infect Dis 1996; 22: 1079–83.

14.

Daly

Giebink

. Determining risk for chronic otitis media with effusion. Pediatr Infect Dis J 1988; 7: 471–5.

15.

Williamson

Dunleavey

Robinson

. Risk factors in otitis media with effusion. A 1 year case control study in 5–7 year old children. Fam Pract 1994; 11: 271–4.

16.

Blakley

. Smoking and middle ear disease: are they related? A review article. Otolaryngol Head Neck Surg 1995; 112: 441–6.

17.

Etzel

Pattishall

Haley

Fletcher

Henderson

. Passive smoking and middle ear effusion among children in daycare. Pediatrics 1992; 90: 228–32.

18.

Duncan

Holberg

Wright

Martinez

Taussig

. Exclusive breast-feeding for at least 4 months protects against otitis media. Pediatrics 1993; 91: 867–72.

19.

Marx

Osguthorpe

Parsons

. Day care and the incidence of otitis media in young children. Otolaryngol Head Neck Surg 1995; 112: 695–9.

20.

Klugman

. Pneumococcal resistance to antibiotics. Clin Microbiol Rev 1990; 11: 662–6.

21.

Infante-Rivard

Fernandez

. Otitis media in children: frequency, risk factors, and research avenues. Epidemiol Rev 1993; 15: 444–65.

22.

Paradise

Rockette

Colborn

. Otitis media in 2253 Pittsburgh-area infants: prevalence and risk factors during the first two years of life. Pediatrics 1997; 99: 318–33.

23.

Ford

Mason

Jr Kaplan

Lamberth

Tillman

. Factors associated with middle ear isolates of Streptococcus pneumoniae resistant to penicillin in a children's hospital. J Pediatr 1991; 119: 941–4.

24.

Hansman

Bullen

. A resistant pneumococcus. Lancet 1967; 2: 264–5.

25.

Reichler

Allphin

Breiman

. The spread of multiply resistant Streptococcus pneumoniae at a day care center in Ohio. J Infect Dis 1992; 166: 1346–53.

26.

Ståhlberg

. The influence of form of daycare on occurrence of acute respiration tract infections among young children. Acta Paediatr Scand 1980; 282: 1–87.

27.

Bluestone

Stephenson

Martin

. Ten-year review of otitis media pathogens. Pediatr Infect Dis J 1992; 11(suppl): S7–S11.