Otitis media crónica supurativa por Mycobacterium tuberculosis. Un reto diagnóstico / Chronic suppurative otitis media by Mycobacterium tuberculosis. A diagnostic challenge

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A study of bacterial pathogens and antibiotic susceptibility patterns in chronic suppurative otitis media.

OBJECTIVE: To assess the frequency of bacterial agents in chronic suppurative otitis media and the antibiotic susceptibility patterns of isolates among patients. METHODS: A total of 185 patients clinically diagnosed with chronic suppurative otitis media were interviewed and middle-ear effusion samples were collected using sterile swabs. All bacterial isolates were identified by conventional microbiological methods. Antibiotic susceptibility patterns of the isolates were determined by Kirby-Bauer disc diffusion. RESULTS: Staphylococci spp. (64.9 per cent) were the most prevalent bacteria isolated, followed by Klebsiella spp. (12.9 per cent) and Pseudomonas aeruginosa (10.3 per cent). The most effective antibiotic for treatment of bacterial chronic suppurative otitis media was ciprofloxacin. Statistical analysis showed no significant difference in bacterial infestations among chronic suppurative otitis media patients and the antimicrobial susceptibility patterns of the bacterial isolates based on gender and age (p > 0.05). CONCLUSION: Our findings highlight the importance of a continuous and periodic evaluation of the bacteriological profile and antibiotic susceptibility patterns in chronic suppurative otitis media patients for efficacious treatment of the infection.

Fluoroquinolone-Resistant Alcaligenes faecalis Related to Chronic Suppurative Otitis Media, Angola.

We found that 20 (10.6%) of 188 patients with chronic suppurative otitis media in Angola were co-colonized with fluoroquinolone-resistant Alcaligenes faecalis, commonly found in birds. A likely explanation for our findings was the use of bird feces by residents as a traditional remedy to prevent ear secretions caused by primary ear infection.

Patho-bacteriological investigation of an outbreak of Mycoplasma bovis infection in calves - Emerging stealth assault.

Mycoplasma bovis (M. bovis) is an important bacterium, causing severe respiratory infection, and arthritis in dairy animals worldwide. This study is based on 50 suckling calves among which 15 showed respiratory distress, lameness and swollen joints and died later. M. bovis was isolated and identified from all dead (n = 15) and live (17.14%; 06 out of 35) calves on the basis of bacteriological examination. In morbid calves, the carpus and stifle joints were severely affected, while necropsy revealed multiple well-circumscribed calcified abscesses and caseous exudates in cranio-ventral and diaphragmatic lobes of lungs. Suppurative polyarthritis, fibrino-suppurative, teno-synovitis and otitis media were the common and striking lesion observed at postmortem examination. Histopathological examination revealed broncho-interstitial pneumonia and necrotic fibrino-purulent broncho-pneumonia in lungs. Similarly, synovial membranes and joints revealed presence of multiple foci of liquefactive necrosis surrounded by lymphocytes, plasma cells, macrophages and peripheral fibroplasia. In the bacteriological investigations, the characteristic fried egg colonies of M. bovis further confirmed this infection in all suspected cases. In conclusion, the current clinico-histo-pathological features are the depictive picture, and is the first report of M. bovis infection in calves in Pakistan.

[Screening for effective antibiotics in chronic suppurative otitis media].

Objective:To explore the method of screening effective antibiotics in active stage of otitis media, in order to lay ground for rational clinical application of antibiotics in this scenario.Method:The clinical data of 198 patients diagnosed as otitis media were analyzed. Based on the results of bacterial culture and drug sensitivity test of middle ear secretion, the clinical availability and the ototoxicity of corresponding drugs, first and second line drugs were screened to control infection. The therapeutic effect of drugs was summarized.Result:In 21 out of 198 cases, there was no growth of common bacteria, while in the remaining 177 cases, there were 36 cases(20.34%) of coagulase negative staphylococcus, which was sensitive to linezolid, vancomycin, cefuroxime, levofloxacin, SMZ-TMP, and rifampin; 30 cases(16.95%) of pseudomonas aeruginosa, which was sensitive to meropenem, imipenem, ceftazidime, amikacin, and piperacillin; and 26 cases(14.69%) of staphylococcus aureus, which was sensitive to linezolid, vancomycin, oxacilin, gentamycin, levofloxacin, ciprofloxacin, moxifloxacin. Drugs that were administrated based on experience including: local use of levofloxacin eardrops, cefuroxime and moxifloxacin as first line oral antibiotics, and ceftazidime as second line oral antibiotics. There were 3 cases of post-operational infection, which recovered after systemic and local use of sensitive drugs and dressing.Conclusion:In otitis media, sensitive antibiotics chosen from results of bacterial culture and drug sensitivity test, are useful in reducing the complication of infection after surgery.

[FEATURES OF OTOGENIC INTRACRANIAL COMPLICATIONS AT THE PRESENT STAGE].

A retrospective analysis of treatment was made in 127 adult patients with acute and chronic otitis media complicated by suppurative-inflammatory pathology of the brain. Purulent meningitis was revealed in 52 (40.9%) of hospitalized patients. Meningoencephalitis was often diagnosed in the cases of acute otitis media (15.4%) and in cases of chronic otitis (22.7%). The otogenic brain abscess was detected in 13.5% of otitis media cases and it was noted to be twice frequent (33.3%) in cases of purulent otitis media. The patients 124 (97.6%) have been operated. An extended mastoidotomy and antromastoidotomy were performed in the acute purulent otitis media. An extended radical operation on the ear was applied in case of chronic otitis media. Performance of craniotomy and complete removal of the abscess using modern systems of neuronavigation showed a higher clinical efficacy as compared with transtemporal approach during sanitizing intervention on the ear including the opening and abscess drainage in surgery of otogenic abscesses of the brain.

Bacteriology of chronic suppurative otitis media (CSOM) in children in Garissa district, Kenya: a point prevalence study.

OBJECTIVES: To identify by type and sensitivity to drugs the bacteria found in ears of school-going children with chronic otitis media in Garissa district. STUDY DESIGN: This was a descriptive prevalence study of CSOM bacterial flora in eligible ears conducted among a cohort of children attending public and private primary as well as Islamic religious schools, screened for chronic ear discharge in Garissa district, Kenya. Procedure and bacteriological techniques: We used sterile swab-sticks to collect a specimen of the discharge from eligible ears of consenting pupils at the induction stage of the zinc supplementation trial for treatment of chronic suppurative otitis media conducted between January and July 2010. All pupils below 18 years present on day of visit were eligible. Both aerobic and anaerobic bacterial cultures were done to identify clinically and epidemiologically important bacteria. Sensitivity tests were based on disc diffusion methods. Results are presented as frequencies and proportions. RESULTS: Of the pupils seen, 61% were still in pre- or lower primary school. Majority were aged 13 and 14 years. Of the 261 ear swab samples processed, 336 isolates - either in mixed or pure flora - were identified, being almost exclusively aerobes. Proteus spp., Enterococcus, Staphylococcus aureus and Pseudomonas spp. were isolated in 32.7%, 28.6%, 12.8% and 11.3% respectively. Proteus was susceptible to majority of the antibiotics tested for, while Enterococcus was poorly susceptible. CONCLUSIONS: Aerobic bacteria were most prevalent in this study. Several of the bacteria identified are known to require iron for their growth. This may be important for CSOM treatment if biofilm formation is involved in pathogenesis. Majority of the isolates were susceptible to basic antibiotics compared to Enterococcus bacteria. This portends an important consideration for clinical management and therapeutic decision-making. Additionally, given the prevalence of Enterococcus bacteria, which is an indicator of faecal contamination of the environment, there is need to consider relevant public health components in managing childhood CSOM besides the clinical ones alone.

Pattern of chronic suppurative otitis media.

This observational study was conducted to know the bacteriological pattern of chronic suppurative otitis media. For this 110 patients of Chronic Suppurative Otitis Media (CSOM) were selected from January 2006 to December 2007 at the out patient department of Otolaryngology and Head Neck surgery, BSMMU and Dhaka Medical College Hospital, Dhaka. Among the 110 patients unilateral involvement was 76.36% and bilateral involvement was 23.64%. Ninety percent patients presented with tubotympanic variety and 10% patients presented with attico-antral variety. Bacteriologically pure growth was found in 79.09% cases, mixed growth in 10.91% cases, no growth in 10% cases. Only aerobic bacteria were isolated in the present series. Pseudomonas aeruginosa was the most common organism (43.68%) isolated in pure culture followed by staphylococcus aureus 27.59%, E. coli 10.35%, Kleibsiella spp. 9.19%, proteus spp. 8.04%. Amikacin was the most effective antibiotic followed by Gentamycin, Ciprofloxacin, Ceftazidime, Cetriaxone. Before giving therapy bacterial growth and sensitivity pattern is to be known where facilities are available.

Bacteriological agents of chronic discharging ears and their antibiotic sensitivity pattern in Ido - Ekiti, Nigeria.

AIMS AND OBJECTIVES: To identify bacterial agents of chronic discharging ear and determine their antibiotic sensitivities pattern in Ido - Ekiti, Nigeria. PATIENTS AND METHODS: Swab specimens of each chronically (>8 weeks) discharging ears of patients with chronic suppurative otitis media (CSOM) presenting to the Ear, Nose and Throat (ENT) clinic of the Federal Medical Centre, Ido Ekiti were bacteriologically cultured aerobically and the antibiotic sensitivity pattern of the recovered organisms determined by the modified Kirby-Bauer disc-diffusion method over a three year period starting from January 2005. RESULTS: Seventy eight patients with CSOM whose age ranged between 3 months and 85 years were seen during the study period with 73.1% of them having unilateral disease and majority were children < 15 years (71.8%). Out of 99 ear swabs that were examined, 87.9% were culture positive with 90.8% yielding a single isolate. Coliforms (34.7%) were the most frequent isolated group of organisms. Other isolates included Staphylococcus aureus (26.3%), Proteus spp (24.2%), Pseudomonas spp (9.5%) and Klebsiella spp (5.3%). Sparfloxacin and ciprofloxacin showed highest activity on all the isolates unlike cefuroxime and ceftiaxone to which all isolates were resistant. CONCLUSION: Chronic discharging ear is caused by bacteria agents most sensitive to quinolones but resistant to cefuroxime and ceftiaxone. Treatment of patients with CSOM in Ido-Ekiti with the quinolones is recommended except where contraindicated.

Current bacteriology of suppurative otitis: resistant patterns and outcomes analysis.

INTRODUCTION: Antibiotic resistance has complicated the management of the draining ear. In this study, we examine the factors predisposing to resistance, as well as the role culture played in the management of these patients. MATERIALS AND METHODS: A retrospective chart review was performed on all patients with a complaint of otorrhea during a 3-year period. Demographic factors, the patients diagnosis, previous antimicrobial use, the organism isolated, the resistance pattern of the organism, the treatment instituted, the treatment changed, and the efficacy of treatment were all examined. RESULTS: Previous antibiotic use resulted in a significantly increased rate of resistance only for the diagnosis of otitis externa (p = 0.01). No other factors were found to be clinically significant. The previous use of ototopical quinolones was shown to be correlated with a significant increase in quinolone resistance (p = 0.01). Methicillin-resistant Staphylococcus aureus isolated was shown to have 60% and 33% resistance rates to clindamycin and trimethoprim/sulfamethoxazole, respectively. The overall treatment failure rate was 36% but rose to 50% for infections involving highly resistant bacteria (p = 0.01). Treatment was changed based on culture results in 21% of cases. CONCLUSION: Previous antibiotic use is correlated with increased bacterial resistance in the case of otitis externa. Highly resistant bacteria were associated with an increased rate of treatment failure. Culture plays an essential role in the management of refractory otorrhea.

Pseudomonas aeruginosa in chronic suppurative otitis media: sensitivity spectrum against various antibiotics in Karachi.

BACKGROUND: Chronic suppurative otitis media (CSOM) is a prevailing and notorious infection in developing countries causing serious local damage and threatening complications. Early and effective treatment based on the knowledge of causing micro organisms and their sensitivity results in good clinical recovery and prevents from damage and complications. Pseudomonas aeruginosa is most common pathogen causing CSOM in Pakistan. The objective of this study is to identify incidence of Pseudomonas aeruginosa involved in CSOM and sensitivity against commonly prescribed antibiotics. METHODS: A total of 263 patients with unilateral or bilateral chronic suppurative otitis media (CSOM) were enrolled in the study at Department of ENT, Karachi Medical and Dental College & Abbasi Shaheed Hospital, Karachi, Pakistan from December 2004 to May 2006. Sterile cotton swabs were used to collect pus from discharging ears and plated on Blood agar and MacConkey agar for 24 to 48 hours. Antibiotics susceptibility was tested by Minimum inhibitory concentrations (MIC) method using Mueller-Hinton agar. RESULTS: Overall microbiology of 267 samples from 263 patients was studied including 4 of bilateral discharge. Polymicrobial growth was present in 8 samples. A total of 275 bacterial isolates were studied. Pseudomonas aeruginosa (40%) and Staphylococcus aureus (30.9%) were the most common bacterial agents found in CSOM. MIC was done for Pseudomonas aeruginosa only as it was the commonest pathogen found in CSOM. Sensitivity pattern of Pseudomonas aeruginosa showed that amikacin was active against 96% of isolates followed by ceftazidime 89%, ciprofloxacin 85%, gentamicin 81%, imipenem 76%, aztreonam 42% and ceftriaxone 21%. CONCLUSIONS: Pseudomonas aeruginosa was the most common bacteria isolated from chronic discharging ears followed by Staphylococcus aureus. Amikacin was found to be the most suitable drug followed by ceftazidime and ciprofloxacin for Pseudomonas aeruginosa. The resistance against ceftriaxone and aztreonam was found to be very high.

[Etiology and rational therapy of severe otitis media purulenta acuta in children].

Etiology and antibiotic susceptibility of the pathogens of otitis media purulenta acuta in children was studied within 2000-2005. A total of 161 children at the age of 1 to 14 years were examined. The middle ear discharge collected during paracentosis (79.5%) or spontaneous perforation of the tympanic membrane (20.5%) was used in the bacteriological tests. The microflora growth in the culture was detected in 80% of the cases. The leading pathogen was Streptococcus pyogenes (47.5%), the part of Streptococcus pneumoniae amounted to 36.6% of all the etiologically significant microflora, the part of Staphylococcus aureus amounted to 6.9% and that of Haemophilus influenzae amounted to 4.0%. The part of the associations of 2 microorganisms equaled 5.0%. The species composion of the pathogens differed from that described in the literature. The isolates of S. pneumoniae and S. pyogenes were characterized by low resistance to macrolides (4.0-6.3%). As for the S. pneumoniae isolates, 97.3% of them was susceptible to penicillin. The results of the etiology study and the pathogen antibiotic susceptibility showed that the drugs of choice for the empirical antibacterial therapy of otitis media purulenta acuta in children should be amoxicillin and 1st generation cepholosporins. When the antibacterial therapy within the first 3 days fails, it is advisable to use protected aminopenicillins or 2nd generation cephalosporins. In case of the drug intolerance, macrolide antibiotics should be used.

Population antibiotic susceptibility for Streptococcus pneumoniae and treatment outcomes in common respiratory tract infections.

PURPOSE: Antibiotic-resistant Streptococcus pneumoniae potentially threatens the successful treatment of common respiratory tract infections (RTIs); however, the relationship between antibiotic resistance and treatment outcomes remains unclear. We aimed to test the hypothesis that higher in vitro penicillin and erythromycin nonsusceptibility levels among clinical isolates of S. pneumoniae are associated with higher risk of treatment failure in suppurative acute otitis media (AOM), acute sinusitis, and acute exacerbation of chronic bronchitis (AECB). METHODS: We conducted a population-level analysis using treatment outcomes data from a national, managed-care claims database, and antibiotic susceptibility data from a national repository of antimicrobial susceptibility results between 1997 and 2000. Treatment outcomes in patients with suppurative AOM, acute sinusitis, or AECB receiving selected macrolides or beta-lactams were assessed. Associations between RTI-specific treatment outcomes and antibiotic nonsusceptibility were determined using Spearman correlation coefficients with condition-specific paired outcome and susceptibility data for each region and each year. RESULTS: There were 649 552 available RTI outcomes and 7252 susceptibility tests performed on S. pneumoniae isolates. There were no statistically significant trends across time for resolution proportions following treatment by either beta-lactams or macrolides among any of the RTIs. Correlation analyses found no statistically significant association between S. pneumoniae susceptibility and RTI treatment outcomes apart from a significant positive association between of erythromycin nonsusceptibility in ear isolates and macrolide treatment resolution for suppurative AOM. CONCLUSION: On the population level, in vitro S. pneumoniae nonsusceptibility to macrolide or beta-lactam antibiotics was not associated with treatment failure in conditions of probable S. pneumoniae etiology.

Topical vancomycin for chronic suppurative otitis media with methicillin-resistant Staphylococcus aureus otorrhoea.

There has been a steady increase in the number of cases of methicillin-resistant Staphylococcus aureus (MRSA) otorrhoea; this is a growing concern. The purpose of this study was to evaluate the efficacy of topical vancomycin treatment in patients with MRSA otorrhoea. Fifty-five patients with MRSA otorrhoea were prospectively enrolled into the study. Thirty-five patients were treated with vancomycin eardrops as outpatients. The concentration of the locally prepared vancomycin solution was 25 mg/ml. The dose of vancomycin was two drops three times daily for 10 days. As a control group, 20 patients were treated with gentamicin 0.3% solution. Data were analysed by the Mann-Whitney U test to compare the efficacy of vancomycin eardrops and gentamicin eardrops. In the vancomycin group, the otorrhoea was significantly reduced in 33 ears (94%); in the gentamicin group, in four ears (20 per cent); this reduction was statistically significant (P < 0.03). The use of topical vancomycin treatment was effective for patients with MRSA otorrhoea refractory to conventional antibiotic treatment.

[Efficacy of topical ciprofloxacin and tobramycin in combination with dexamethasone in the treatment of chronic suppurative otitis media]. / Kronik süpüratif otitis media tedavisinde topikal siprofloksasin ve tobramisinin deksametazon ile kullanimi.

OBJECTIVES: To evaluate the efficacy of topical ciprofloxacin and tobramycin with and without topical dexamethasone in the treatment of chronic suppurative otitis media without cholesteatoma. PATIENTS AND METHODS: The study included 103 ears of 80 patients (49 males, 31 females; mean age 31 years; range 18 to 60 years) with chronic suppurative otitis media without cholesteatoma. The patients were randomly divided into four groups to receive topical applications of either ciprofloxacin and tobramycin alone, or in combination with dexamethasone. Cultures were obtained from the ears preoperatively and 24 hours after treatment. RESULTS: Aerobic bacteria were isolated in 94.1% of patients before the treatment, the most common being Pseudomonas aeruginosa (38.9%). With dexamethasone, the clinical response for ciprofloxacin and tobramycin increased from 80% to 90% and from 70% to 75%, respectively, but this improvement was not significant (p > 0.03). Addition of dexamethasone to ciprofloxacin decreased the recovery period from 14 days to seven days, whereas no change (7 days) was observed with tobramycin. CONCLUSION: The efficacy of ciprofloxacin and tobramycin were similar in the treatment of chronic suppurative otitis media. Addition of dexamethasone to ciprofloxacin decreased the treatment period.

Otitis media supurada por vibrio cólera tipo no-01 / Suppurative otitis media by non-01 Vibrio cholera

El vibrio cholerae tipo no-01 es un microorganismo de distribución mundial con hábitat acuático, que ocasionalmente produce patología en el hombre. Existe relación directa demostrada entre la ingesta de productos de mar y/o la realización de actividades marinas, y la infección por vibrio. La clínica que produce con más frecuencia es la gastrointestinal y en particular la enfermedad diarreica. Por otro lado, la otitis media por vibrio cholerae tipo no01 es extremadamente infrecuente en nuestro medio, aunque si se revisa la bibliografía, su incidencia parece haber aumentado durante los últimos años. Se presenta un caso clínico de otitis media supurada por vibrio cholerae tipo no-01 y se revisa la literatura. (AU)

Topical ciprofloxacin versus topical gentamicin for chronic otitis media.

We compared the therapeutic efficiency of ciprofloxacin hydrochloride and gentamicin sulfate in the treatment of chronic otitis media. A total of 88 patients aged 9-62 years with chronic suppurative media were randomly placed into two groups. In the first group, 48 patients (54.5%) received topical ciprofloxacin hydrochloride, while in the second group 40 patients (45.5%) received local gentamicin sulfate. Of the 48 patients who received ciprofloxacin hydrochloride, 42 (87.5%) were cured, while in 6 patients (12.5%) the treatment failed. In the gentamicin group, 12 (30%) of the patients were cured, while 28 patients showed no clinical or bacteriological improvement. Topical ciprofloxacin is safe and more efficacious and efficient than topical gentamicin in the treatment of acute exacerbation of chronic suppurative otitis media.

Controlled multicenter study on chronic suppurative otitis media treated with topical applications of ciprofloxacin 0.2% solution in single-dose containers or combination of polymyxin B, neomycin, and hydrocortisone suspension.

Otic drops of either ciprofloxacin 0.2% solution (CIP) or a combination of polymyxin B, neomycin, and hydrocortisone suspension (PNH) were administered for 6 to 12 days to patients (14-71 years old) with chronic suppurative otitis media in a randomized, nonblinded, multicenter clinical trial. Two hundred thirty-two enrolled patients were analyzed for efficacy on a "per protocol" basis. The most frequently identified causal agents were Staphylococcus aureus (28% of the patients), Pseudomonas aeruginosa (19%), and Staphylococcus sp (9%). Clinical success was observed in 91% and 87% of the CIP-and PNH-treated patients, respectively. At 1-month follow-up, 4% of CIP and 6% of PNH patients showed a relapse of otorrhea. Bacteriologic eradication was seen in 89% and 85% of patients in the CIP and PNH groups, respectively. At 1-month follow-up, reinfection or recurrence of infection appeared in 3 patients in the PNH group and in 1 patient in the CIP group. Both treatments were well tolerated. The most frequently reported adverse events were pruritus, stinging, and earache. Audiometric tests did not show changes attributable to study drugs in any but 1 patient in the PNH group. This clinical trial shows that topical 0.2% ciprofloxacin solution in single-dose containers is effective and well tolerated in patients with chronic suppurative otitis media.