IJCRR - 9(21), November, 2017
Pages: 37-39
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Study on Aerobic Bacteria Causing Chronic Suppurative Otitis Media among the Pediatric Age Group
Author: Y. Ajay Kumar, T. Jaya Chandra
Category: Healthcare
Abstract:Objectives: Chronic suppurative otitis media (CSOM) was reported to be the major cause of childhood morbidity. Recurrent ear discharge is the commonest clinical presentation. With these, a study was conducted to find the aerobic bacterial as well as fungal profile among the school going children
Methods: Study was conducted in the department of Microbiology and ENT, GSL Medical College, Rajahmundry from February 2017 to July 2017. Children with ear discharge were selected for the study. An informed written consent was obtained from the parents of all the participants. Study protocol was approved by the Institutional Ethics committee. Aural swabs were collected and send to the Microbiology laboratory for aerobic culture and sensitivity test.
Results: Microorganisms were isolated from 98% (219) samples. Gram negative bacilli (46.6%; 129) were isolated maximum, followed by Gram positive cocci (41%; 114) and fungi (12.3%; 34). Pseudomonas aeruginosa (62; 22.4%) was the leading cause of CSOM.
Conclusion: Decreased sensitivity was detected to Gentamycin and Cotrimoxazole, commonly used antibiotics in the form of ear drops. Hence antibiotic susceptibility testing is always advisable.
Keywords: Antibiotics, Cause, Isolates
Full Text:
Introduction:
Otitis media (OM), inflammation of middle ear and mastoid bone is one of the commonest childhood infections1. Chronic suppurative otitis media (CSOM) was reported to be the major cause of childhood morbidity 2, 3, 4, 5. Recurrent ear discharge is the commonest clinical presentation of CSOM. As per the WHO report, India is the highest CSOM burden countries 6. Factors such as lack of personal hygiene, introducing foreign objects are the important causes CSOM. Due to continuous discharge of pus, CSOM causes social stigma. For school going children this is practical difficulty as they are teased by friends in the class rooms.
Improper usage of antibiotics increases drug resistance as well as CSOM. With these, we conducted a study with an objective to find the aerobic bacterial as well as fungal profile among the school going children with signs and symptoms of CSOM.
Materials and methods:
This is a prospective study conducted in the department of Microbiology and ENT, GSL Medical College, Rajahmundry. Children with ear discharge were selected for the study. An informed written consent was obtained from the parents of all the participants. Study protocol was approved by the Institutional Ethics committee. Study was conducted from February 2017 to July 2017. Aural swabs were collected and send to the Microbiology laboratory for aerobic culture and sensitivity test.
Swabs were inoculated on Blood agar, MacConkey agar. The inoculated plates were incubated at 370C for 24 hours. After incubation, initially growth was classified by grams staining (GS). Battery of biochemical tests were used to identify the pathogens 7, 8, 9. Coagulase test, catalase test, Microdase test, heat test, Bile esculin agar were used for identification of gram positive cocci (GPC). To confirm gram negative bacilli (GNB), tests such as Indole, Methyl Red, Voges Proskauer, Citrate utilization, Urease production and growth on Triple Sugar Iron agar were used. Antibiotic sensitivity test (AST) was done on Muller-Hinton agar (MHA) by kibry bauer disk diffusion method 7, 8, 9, Escherichia coli ATCC 25922 was used as the control. If fungi were suspected, growth was identified by GS, lactophenol cotton blue mount and slide culture techniques.
Results:
During the study period total 223 patients aural swabs were processed. Microorganisms were isolated from 98% (219) samples. GNB (46.6%; 129) were isolated maximum, followed by GPC (41%; 114) and fungi (12.3%; 34). Pseudomonas aeruginosa (62; 22.4%) was the leading cause of CSOM.
Discussion
CSOM is one of the major public health problems. Due to short as well as more horizontal eustachian tube, CSOM is one of the significant problems in the children especially in the school going age 10. This may be the reason for getting more number of CSOM cases to the department of ENT, GSL Medical College.
As per the Hirapure PV and Pote MK report, 60% GNB and 40% GPC were isolated among the CSOM patients 11. Tesfaye G 12. and Iseh KR 13 also mentioned more GNB isolation 75% and 60.5%, respectively. In this study also GNB were isolated more compared to GPC, 46.6%, 41% respectively. In contrast, Rajat et al reported that GPC is the leading cause of CSOM 14.
In the current study, Pseudomoans aeruginosa (22.4%; 62) was isolated maximum, followed by Staphylococcus aureus (17.7%; 49), Klebsiella species (11.5%; 32), Streptococcus pneumoniae (11.2%; 31) Coagulase Negative Staphylococci (7.6%; 21), Proteus (7.6%; 21), Escherichia coli (5%; 14), Enterococci (4.7%; 13). Rajat et al 14 reported, the Staphylococcus aureus (48.69%) is the leading causative agent of CSOM followed by Pseudomonas aeruginosa (19.89%). As per the review report, Staphylococcus aureus estimates were 19 - 25% in acute and CSOM 15, 16, 17. Kumar et al reported that Pseudomoans aeruginosa is the leading causative agent of CSOM 18.
Ding et al. reported that Streptococcus pneumoniae is the leading cause of acute OM and the authors reported 47.2% isolates 19. In the current study, 31 (11.2%) Streptococcus pneumoniae were isolated. In one study, the authors reported 26% Streptococcus pneumoniae 20. Whereas study from outside Asia reported that among the children aged 4 weeks to 18 years, the range of Streptococcus pneumoniae isolates were 23 - 48% 21.
Due to moist environment, fungi are also common causative agent of CSOM 14, Candida and Aspergillus are the common causative agents. In one of the Indian studies 18, the investigators reported 15% fungal etiology among the CSOM cases. In this study also fungal (12.3%; 34) pathogens were isolated. Of the total 34 (100%) fungal isolates, 62% (21) were Candida species and the remaining 38% (13) were Aspergillus species. Among the 21 Candida isolates, 11 isolates were Candida albicans and the remaining 10 were identified as other species of Candida. Whereas, of the 12 Aspergillus isolates, 4 were identified as Aspergillus niger and the remaining 9 isolates were Aspergillus fumigatus.
All the bacterial strains were sensitive to Amikacin, Ciprofloxacin, Ceftraizxone. But the sensitivity was decreased to Gentamicin, Cotrimoxazole. Currently, drug resistance is a burning issue in the medical science. Hence AST is always advisable. AST can control the unnecessary usage of antibiotics as well as drug resistance as our study showed decreased sensitivity to Gentamycin and Cotrimoxazole, commonly used antibiotics in the form of ear drops.
Conclusion: Decreased sensitivity was detected Gentamycin and Cotrimoxazole, commonly used antibiotics in the form of ear drops. Hence antibiotic susceptibility testing is always advisable.
Acknowledgement: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
References:
- P. Auinger, B.P. Lanphear, H.J. Kalkwarf, M.E. Mansour, Trends in otitis media among children in the United States. Pediatrics 2003; 112: 514 - 520.
- A. Bardach, A. Ciapponi, S. Garcia-Marti, D. Glujovsky, A. Mazzoni, A. Fayad, et al., Epidemiology of acute otitis media in children of Latin America and the Caribbean: a systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2011; 75: 1062 - 1070.
- E. Roy, K.Z. Hasan, F. Haque, A.K.M. Siddique, R.B. Sack, Acute otitis media during the first two years of life in a rural community in Bangladesh: a prospective cohort study. J Health Popul Nutr 2007; 25: 414 - 421.
- L Monasta, L. Ronfani, F. Marchetti, M. Montico, L. Vecchi Brumatti, A. Bavcar, et al., Burden of disease caused by otitis media: systematic review and global estimates. PLoS ONE 2012; 7: e36226.
- M. Mahadevan, G. Navarro-Locsin, H.K. Tan, N. Yamanaka, N. Sonsuwan, P.C. Wang, et al., A review of the burden of disease due to otitis media in the Asia- Pacific. Int J Pediatr. Otorhinolaryngol 2012; 76: 623 - 635.
- World Health Organization (WHO), 2004. Chronic suppurative otitis media: burden of illness and management options. WHO Library Cataloguing-in-Publication Data, Geneva, Switzerland, 1.
- Chandra TJ, Lakshmi Prasanna T, A VEnkateswar rao. A study on isolation and identification of bacteria causing nosocomial infections on mobile phones of health care workers. Calicut Medical Journal 2011; 9(1):e2
- Mackie and Mac Cartney Practical medical Microbiology: J.G. Collee, A.G. Fraser, B.P.Marnion, A.Simmons Editors. Tests for the identification of bacteria. 14th edition. Churchill living stone publisher; 1999, P: 131-150.
- Bailey and Scott's Diagnostic Microbiology, Karan Fabiano Editor. Laboratory cultivation and isolation of bacteria, methods for bacterial identification. 11th edition. Andrew Allen Publisher 2002. P: 133-167.
- Healy GB, Rosbe KW. Otitis media and middle ear effusion, in: snow, Ballenger JJ, editors. Ballenger's otorhinolaryngology head neck surgery. BC Decker inc 2003; 16: 249 - 260.
- Hirapure PV and Pote MK. Microbial Profile and Antibiograms of Active Patients of Chronic Suppurative Otitis Media in Latur, Maharashtra, India. International Research Journal of Medical Sciences 2014; 2(5): 6 - 9.
- Tesfaye G., Asrat D., Woldeamanuel Y. and Gizaw M., Microbiology of discharging ears in Ethiopia. Asian Pac J Trop Med 2009; 2(1): 60 - 67.
- Iseh K.R. and Adegbite T., Pattern and bacteriology of acute suppurative otitis media in Sokoto, Nigeria. Ann Afri Med 2004; 3(4): 164 - 166.
- Rajat Prakash, Deepak Juyal, Vikrant Negi, Shekhar Pal, Shamanth Adekhandi, Munesh Sharma, Neelam Sharma. Microbiology of Chronic Suppurative Otitis Media in a Tertiary Care Setup of Uttarakhand State, India. North American Journal of Medical Sciences 2013; 5 (4): 282 - 287.
- AK. Ako-Nai, F.A. Oluga, A.O. Onipede, E.A. Adejuyigbe, Y.B. Amusa, The characterization of bacterial isolates from acute otitis media in Ile-Ife, Southwestern. Nigeria, J. Trop. Pediatr 2002; 48: 15 - 23.
- EA. Al-Faris, H. Abdulghani, G.J. Mukhdomi, A. Kambal, H.S. Al-Muhaimeed, Microbiology and antimicrobials sensitivity of suppurative otitis media. Saudi Med J 1998; 19: 417 - 422.
- M. Guven, Y. Bulut, T. Sezer, I. Aladag, A. Eyibilen, I. Etikan, Bacterial etiology of acute otitis media and clinical efficacy of amoxicillin-clavulanate versus azithromycin. Int. J. Pediatr. Otorhinolaryngol 2006; 70: 915 - 923.
- Kumar H, Seth S. Bacterial and fungal study of 100 cases of chronic suppurative otitis media. J Clin Diagn Res 2011; 5: 1224 - 1227.
- Y. Ding, Q. Geng, Y. Tao, Y. Lin, Y. Wang, S. Black, et al., Etiology and epidemiology of children with acute otitis media and spontaneous otorrhea in Suzhou, China. Pediatr Infect Dis J 2015; 34: e102 - e106.
- KA. Al-Mazrou, A.M. Shibl, W. Kandeil, J.Y. Pircon, C. Marano, A prospective, observational, epidemiological evaluation of the aetiology and antimicrobial susceptibility of acute otitis media in Saudi children younger than 5years of age. J Epidemiol Glob Health 2014; 4: 231 - 238.
- T.R. Coker, L.S. Chan, S.J. Newberry, M.A. Limbos, M.J. Suttorp, P.G. Shekelle, et al., Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children: a systematic review. JAMA 2010; 304: 2161 - 2169.
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