A prospective study on microbiological profile and antimicrobial resistance pattern in chronic suppurative otitis media at a rural centre
Keywords:Chronic suppurative otitis media, Multi drug resistance, Antibiotic sensitivity
Background: Over and injudicious prescription of antibiotics over the years has resulted in change in microbial flora in chronic suppurative otitis media (CSOM). More over the incidence of multidrug resistance in bacteria is increasing alarmingly. This study was done to know the microbial pattern in CSOM in the current scenario. This study also aims to know the microbial resistance pattern and the drug sensitivity, also how to tackle the growing multidrug resistance in current practice.
Methods: Sterile swab was collected from 100 patients who attended Outpatient Department of our hospital during 1 year period, sent for culture sensitivity. Details like age distribution, sex distribution, microbial pattern, MDR susceptibility pattern were evaluated.
Results: Males were commonly affected. Most common age group was in the 5th decade followed by 4th decade. Staphylococcus aureus was the most common pathogen followed by Pseudomonas. All the multi drug resistant (MDR) strains were Pseudomonas, and were sensitive to only higher antibiotic like Piperaziccilin Tazobactam (PTZ), Imipenem (IMP) with 2 of them only intermediate sensitivity to IMP.
Conclusions: Staph aureus and Pseudomonas are the most common pathogen in CSOM. Incidence of MDR is on the rise even to higher line drugs. Hence pus culture and sensitivity should be made mandatory in every case of CSOM before starting higher antibiotics or putting patient on long term treatment. This will prevent the emergence of multidrug resistant strains.
Quinton G. Pathology and clinical course of the inflammatory diseases of the middle ear. In: Aina JG, eds. Glasscock-Shambaugh’s Surgery of the Ear, (6th edn), USA, People’s Medical Publishing House; 2010: 427-428.
Mirza AI, Ali L, Arshad M. Microbiology of Chronic suppurative otitis media. Pakistan Armed Forces Med J. 2008;12(4):1-6.
Shrestha BL, Amatya RCM, Shrestha I, Ghosh I. Microbiological profile of chronic suppurative otitismedia. Nepalese J ENT Head Neck Surg. 2011;2(2):6-7.
Jakimovska F, Cakarm, Lazareveskia. CSOM – Microbiological findings. Balkan J Otolneuro Otol, 2002: 104-106.
Ghonaim MM, El-Edel RH, Basiony LA. Risk factors and causative organisms of otitis media in children. Ibnosina J Med BS. 2015;3(5):172-81.
Muluye D., Wondimeneh Y., Ferede G., Moges F., Nega T. Bacterial isolates and drug susceptibility patterns of ear discharge from patients with ear infection at Gondar University Hospital, Northwest Ethiopia. BMC Ear Nose Throat Disorders. 2013;13:10.
Singh AH, Basu R, Venkatesh A. Aerobic bacteriology of chronic suppurative otitis media in Rajahmundry. Biol Med. 2012;4:73-9.
Livermore DM. Current epidemiology and growing resistance of Gram-negative pathogens. Korean J Internal Med. 2012;27(2):128-42.
Kollef MH. Broad-spectrum antimicrobials and the treatment of serious bacterial infections: getting it right up front. Clin Infect Dis. 2008;47(suppl 1):S3–S13.
Lakshmipathi G, Bhaskaran CS. Bacteriology of chronic suppurative otitis media. J Ind Med Assoc. 1965;45:436-40.
Mishra A, Shukla G, Nag D, Mishra SC. Bacteriological Study of chronic suppurative otitis media. Indian J Otolaryngol Head Neck Surg. 1999;59(2):87-91.
Bansal S, Ojha T, Kumar S, Singhal A, Vyas P. Changing microbiological trends in cases of Chronic suppurative otitis media patients. Int J Current Res Rev. 2013;5(15):76-80.
Poorey VK, lyer A. Study of bacterial flora in CSOM and its clinical significance. Indian J Otolaryngol Head Neck Surg. 2002;54(2):91-5.
Michael GL, Peter JH, Jeffrey TV, Donald TD. Is chronic suppurative otitis media a neglected tropical disease? PLOS Neglected Tropical Dis. 2015;9(3):1-6.
Shyamla R, Reddy SP. The study of bacteriological agents of chronic suppurative otitis media-aerobic culture and evaluation. J Microbiol Biotechnol Res. 2012; 2:152-62.
Ayyagari A, Pancholi VK, Pandhi SC, Goswami A., Aggarwal K.C.: Anaerobic bacteria in chronic otitis media. Indian J Med Res. 1981;73:860-65.
Prakash R, Juyal D, Negi V, Pal S, Adekhandi S. 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.
Vaishnavi GD. Aerobic Bacteriology of Chronic Suppurative Otitis Media (CSOM)-A Hospital Based Cross Sectional Study. Int J Sci Res. 2015;4(6):607-9.
Patricia N A, Jan Eero GL, Erasmo Gonzalo DV. Chronic suppurative otitis media: Bacteriology and drug sensitivity pattern. Philipp. J Otolaryngol Head Neck Surg. 2006; 21(1,2):20-3.
Arvind N, Chand P, Vishrutha KV. Microbiological profile of Chronic Suppurative Otitis Media. Int J Biomed Res. 2014;05(3):204-6.
Vishwanath S, Mukhopadhyay C, Prakash R, Pillai S, Pujary K, Pujary P. Chronic Suppurative Otitis Media: Optimizing Initial Antibiotic Therapy in a Tertiary Care Setup. Indian J Otolaryngol Head Neck Surg. 2012;64(3):285-9.
Gulati J, Tandon PL, Singh W, Bais AS. Study of Bacterial Flora in Chronic suppurative otitis media. Ind. J. Orolaryngol. 1969;21(4):198.
Rao BN, Reddy MS. Chronic suppurative otitis media-A prospective study. Indian J Otolaryngol Head Neck Surg. 1994;3(2):1-4.
Yildirim A, Erdem H, Kilic S, Yetiser S, Pahsa A. Effect of Climate on the Bacteriology of Chronic Suppurative Otitis Media. Ann Oto Rhino Laryngol. 2005;114(8):652-55.
Kim SH, Kim MG, Kim SS, Cha SH, Yeo SG. Change in detection rate of methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa and their antibiotic sensitivities in patients with chronic suppurative otitis media. J Int Adv Otol. 2015;11:151-6.
Song W, Woo HJ, Kim JS, Lee KM. In vitro activity of beta-lactams in combination with other antimicrobial agents against resistant strains of Pseudomonas aeruginosa. Int J Antimicrob Agents. 2003;21:8-12.
Jang CH, Park SY. Emergence of ciprofloxacin-resistant Pseudomonas in chronic suppurative otitis media. Clin Otolaryngol Allied Sci. 2004;29:321-3.
Ahmed S, Iqbal MA, Hassan Z, Khurshid T, Ali L, Pervez Q. Spectrum and bacterial isolates in chronic suppurative otitis media in Khuzdar. Pak J Otolaryngol. 2006;22:34-6.
Yeo SG, Park DC, Hong SM, Cha CI, Kim MG. Bacteriology of chronic suppurative otitis media – A multicenter study. Acta Otolaryngol. 2007;127:1062-7.
Falagas ME, Kasiakou SK. Colistin: The revival of polymyxins for the management of multidrug-resistant gram-negative bacterial infections. Clin Infect Dis. 2005;40:1333-41.
Falagas ME, Bliziotis IA, Kasiakou SK, Samonis G, Athanassopoulou P, Michalopoulos A. Outcome of infections due to pandrug-resistant (PDR) Gram-negative bacteria. BMC Infect Dis. 2005;5:24.