DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20164494

Prevalence and antibiotic susceptibility of Pseudomonas aeruginosa isolated from chronic suppurative otitis media

Kiran A. Deshmukh, Deepak Manthale

Abstract


Background: Chronic suppurative otitis media (CSOM) is the most common middle ear infection characterized by recurrent ear discharges or otorrhoea through a tympanic perforation from the middle ear. The organisms isolated from CSOM include both aerobic and anaerobic bacteria. Among  the  bacteria,  Pseudomonas aeruginosa (P. aeruginosa) has been particularly blamed for deep seated and progressive  destruction  of  middle  ear  and mastoid  structures  through  its  toxins  and enzymes. The present study was done to determine the prevalence and antibiotic susceptibility of P. aeruginosa isolated from CSOM.

Methods: This was a retrospective study conducted in a tertiary care hospital in South India in March 2016. Data was obtained from the microbiology records from January 2014 to January 2016. Patients who had active ear discharge for at least three months were included in the study. P. aeruginosa was identified by colony morphology, pigment production, characteristic musty or earthy odor. The identification was confirmed by motility and standard biochemical tests.  

Results: A total of 293 cases of CSOM were included in the study. Microbial growth was seen in 248 (84.6%) cases and remaining 45 cases did not show any growth. Among 248 bacterial growth, 87 (35%) were positive for P. aeruginosa. Most common organism was P. aeruginosa followed by Staphylococcus aureus. Highest resistance was seen with Gentamicin and Ofloxacin and least resistance with Imipenem. The increased resistance to Cephalosporin group is warning sign, as these are potent anti-Psuedomals.

Conclusions: P. aeruginosa and Staphylococcus aureus were found to be the common cause of CSOM in the present study. P. aeruginosa was resistant to commonly used antimicrobials. There was no resistance seen with Imipenem and only two strains were resistant to Piperacillin+tazobactum. Regular evaluation of the microbiological pattern and antibiogram of isolates will help in decreasing the complications of CSOM. 


Keywords


Otitis media, P. aeruginosa, Antibiogram, Resistance

Full Text:

PDF

References


Prayaga N, Srinivas M, Jadi L, Sudhakar K, Anil N. Clinical application of a microbiological study on chronic suppurative otitis media. Indian J Otolaryngol Head Neck Surg. 2013;2:290-4.

Rout MR, Mohanty D, Vijaylaxmi Y, Kamalesh B, Chakradhar M. Prevalence of cholesteatoma in chronic suppurative otitis media with central perforation. Indian J Otol. 2012;18:7‑10.

Morris PS, Leach AJ. Prevention and management of chronic suppurative otitis media in aboriginal children: A practical approach. Community Ear Hear Health. 2007;4:22-5.

Taneja M, Taneja MK. CSOM - A bacteriological study. Indian J Otol. 2009;15:3-7.

Poorey VK, Arati Iyer. Study of bacterial flora in CSOM and its clinical significance. Indian J Otolaryngol Head Neck Surg. 2002;54:91-5.

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;19:5-8.

Shazia Parveen SJ. Aerobic bacteriology of CSOM in a teaching hospital. Microbiol Biotech Res. 2012;2(4):1306-10.

Nikakhlagh S, Khosravi AD, Fazlipour A, Safarzadeh M, Rashidi N. Microbiologic Findings in patients with chronic suppurative otitis media. J Med Sci. 2008;8:503-6.

Malkappa S, Saileela K, Rajendra B, Chakraverti T. Study of aerobic bacterial isolates and their antibiotic susceptibility pattern in chronic suppurative otitis media. Indian J Otol. 2012;18:136-9.

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;5:282-7.

Hayne DS. Preoperative antibiotics in CSOM. Ear Nose Throat J. 2002;81:13-5.

Hassan O, Adeyemi RE. A study of bacterial isolates in cases of otitis media in patients attending Oautch, Ile‑Ife. Afr J Exp Microbiol. 2007;8:130-6.

Collee JG, Miles RS, Watt B. Tests for identification of bacteria. In: Collee JG, Fraser AG, Marmion BP, Simmons A, Eds. Mackie & McCartney Practical Medical Microbiology, 14th edition. New York & London: Churchill Livingstone; 1996: 131-149.

Bailey, Scotts. Non fermentative gram negative Bacilli and coccobacilli. Diagnostic microbiology. 12 th edition. St. Louis, Missouri (US): Mosby Elsevier; 1990: 386-407.

Cockerill FR III. Performance Standards for AST. CLSI 22nd Informational Supplement. 2012;31(1):100-22.

Kumar S, Sharma R, Saxena A, Pandey A, Gautam P, Taneja V. Bacterial flora of infected unsafe CSOM. Indian J Otol. 2012;18:208-11.

Khan JA, Iqbal Z, Rahman SU, Farzana K, Khan A. Prevalence and resistance pattern of Pseudomonas aeruginosa against various antibiotics. Pak J Pharm Sci. 2008;21(3):311-5.

Olayinka AT, Onile BA, Olayinka BO. Prevalence of multidrug resistant P. aeruginosa isolates in surgical units ofAhmadubello University teaching hospital, Zaria, Nigeria: An indication for effective control measures. Ann Afr Med. 2004;3:13-6.

Karlowsky JA, Draghi DC. Jones ME, Thornsherry C, Friedland IR, Saham DF. Surveillance for antimicrobialsusceptibility among clinical isolates of P. aeruginosa and Acinetobacter baumannii from hospitalized patients in the United states, 1998 to 2001. Antimicrob Agents Chemother. 2003;47:1681-8.

Mansoor T, Musani M, 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.

Kumar H, Seth S. Bacterial and Fungal Study of 100 cases of Chronic Suppurative Otitis Media. J Clin Diag Res. 2011;5(6):1224-7.

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.

Suhail Z, Ashrafi AK, Malik Iqbal SS, Khambaty Y, Khan A F, Sajjad Qaiser MS. Microorganism and Anti-Microbial Resistance of Bacterial Agents in Chronic Suppurative Otitis Media Patients at Abbasi Shaheed Hospital. Pakistan J Otolaryngol. 2012;28:92-4.

24) Shrestha BL, Amatya RCM, Shrestha I, Ghosh I. Nepalese Journal of ENT Head and Neck Surgery. Microbiological Profile of Chronic Suppurative Otitis Media. Nepalese J ENT Head Neck Surg. 2011;2(2):6–7.

Iqbal K, Khan M, Satti L. Microbiology of Chronic Suuppurative Otitis Media: Experience at Dera Ismail Khan. Gomal J Med Sci. 2011;9(2):189–93.

Javiya VA, Ghatak SB, Patel KR, Patel JA. Antibiotic susceptibility patterns of Pseudomonas aeruginosa at a tertiary care hospital in Gujarat, India. Indian J Pharmacol. 2008;40(5):230-4.

Tahir M, Jawaid A, Abdullah A, Najam MA. Bacterial culture and sensitivity in active chronic otitis media: 500 cases in combined military hospital Rawalpindi. Pak J Otolaryngol. 2012;28:56 8.

Madana J, Yolmo D, Kalaiarasi R, Gopalakrishnan S, Sujata S. Microbiological profile with antibiotic sensitivity pattern of cholesteatomatous chronic suppurative otitis media among children. Int J Pediatr Otorhinolaryngol. 2011;75:1104-8.

Mirza IA, Ali L, Arshad M. Microbiology of chronic suppurative otitis media experience at Bahawalpur. Pak Armed Forces Med J. 2008;58:372 6.

Orrett FA. Antimicrobial susceptibility survey of Pseudomonas aeruginosa strains isolated from clinical sources. J Natl Med Assoc. 2004;96(8):1065-9.

Chen HY, Yuan M, Livermore DM. Mechanisms of resistance to beta-lactam antibiotics amongst Pseudomonas aeruginosa isolates collected in the United Kingdom in 1993. J Med Microbiol. 1995;43:300-9.

Das RN, Chandrashekhar TS, Joshi HS, Gurung M, Shrestha N, Shivananda PG. Frequency and susceptibility profile of pathogens causing urinary tract infections at a tertiary care hospital in western Nepal. Singapore Med J. 2006;47:281-5.