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Assad Z, Cohen R, Varon E, Levy C, Bechet S, Corrard F, Werner A, Ouldali N, Bonacorsi S, Rybak A. Antibiotic Resistance of Haemophilus influenzae in Nasopharyngeal Carriage of Children with Acute Otitis Media and in Middle Ear Fluid from Otorrhea. Antibiotics (Basel) 2023; 12:1605. [PMID: 37998807 PMCID: PMC10668799 DOI: 10.3390/antibiotics12111605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/30/2023] [Accepted: 11/04/2023] [Indexed: 11/25/2023] Open
Abstract
Haemophilus influenzae (Hi) is one of the leading bacteria implicated in childhood acute otitis media (AOM). Recent concerns have been raised about the emergence of Hi-resistant strains. We aimed to analyze the evolution of β-lactam resistance to Hi among strains isolated from nasopharyngeal carriage in children with AOM and in mild ear fluid (MEF) after the spontaneous perforation of the tympanic membrane (SPTM) in France. In this national ambulatory-based cohort study over 16 years, we analyzed the rate of Hi nasopharyngeal carriage and the proportion of β-lactam-resistant Hi strains over time using a segmented linear regression model. Among the 13,865 children (median [IQR] age, 12.7 [9.3-17.3] months; 7400 [53.4%] male) with AOM included from November 2006 to July 2022, Hi was isolated in 7311 (52.7%) children by nasopharyngeal sampling. The proportion of β-lactamase-producing and β-lactamase-negative, ampicillin-resistant (BLNAR) Hi strains in nasopharyngeal carriage remained stable during the study period. Among the 783 children (median [IQR] age, 20 [12.3-37.8] months; 409 [52.2%] male) with SPTM included from October 2015 to July 2022, Hi was isolated in 177 (22.6%) cases by MEF sampling. The proportions of β-lactamase-producing and BLNAR Hi strains did not significantly differ between nasopharyngeal (17.6% and 8.8%, respectively) and MEF (12.6% and 7.4%) samples. Accordingly, amoxicillin remains a valid recommendation as the first-line drug for AOM in France.
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Affiliation(s)
- Zein Assad
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, 75019 Paris, France; (Z.A.); (N.O.)
- Infection, Antimicrobials, Modelling, Evolution (IAME), Inserm UMR 1137, Paris Cité University, 75018 Paris, France;
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), 06200 Nice, France; (R.C.); (A.W.); (A.R.)
| | - Robert Cohen
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), 06200 Nice, France; (R.C.); (A.W.); (A.R.)
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), 94000 Créteil, France; (S.B.); (F.C.)
- Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique Groupe d’Etude des Maladies Infectieuses Néonatales et Infantiles (IMRB-GRC GEMINI), Université Paris Est, 94000 Créteil, France
- Association Française de Pédiatrie Ambulatoire (AFPA), 45000 Orléans, France
| | - Emmanuelle Varon
- National Reference Center for Pneumococci, Centre de Recherche Clinique et Biologique, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France;
| | - Corinne Levy
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), 06200 Nice, France; (R.C.); (A.W.); (A.R.)
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), 94000 Créteil, France; (S.B.); (F.C.)
- Institut Mondor de Recherche Biomédicale-Groupe de Recherche Clinique Groupe d’Etude des Maladies Infectieuses Néonatales et Infantiles (IMRB-GRC GEMINI), Université Paris Est, 94000 Créteil, France
- Association Française de Pédiatrie Ambulatoire (AFPA), 45000 Orléans, France
| | - Stéphane Bechet
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), 94000 Créteil, France; (S.B.); (F.C.)
- Association Française de Pédiatrie Ambulatoire (AFPA), 45000 Orléans, France
| | - François Corrard
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), 94000 Créteil, France; (S.B.); (F.C.)
- Association Française de Pédiatrie Ambulatoire (AFPA), 45000 Orléans, France
| | - Andreas Werner
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), 06200 Nice, France; (R.C.); (A.W.); (A.R.)
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), 94000 Créteil, France; (S.B.); (F.C.)
- Association Française de Pédiatrie Ambulatoire (AFPA), 45000 Orléans, France
| | - Naïm Ouldali
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, 75019 Paris, France; (Z.A.); (N.O.)
- Infection, Antimicrobials, Modelling, Evolution (IAME), Inserm UMR 1137, Paris Cité University, 75018 Paris, France;
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), 06200 Nice, France; (R.C.); (A.W.); (A.R.)
| | - Stéphane Bonacorsi
- Infection, Antimicrobials, Modelling, Evolution (IAME), Inserm UMR 1137, Paris Cité University, 75018 Paris, France;
- Department of Microbiology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, 75019 Paris, France
| | - Alexis Rybak
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), 06200 Nice, France; (R.C.); (A.W.); (A.R.)
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), 94000 Créteil, France; (S.B.); (F.C.)
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Hayashi T, Kitamura K, Hashimoto S, Hotomi M, Kojima H, Kudo F, Maruyama Y, Sawada S, Taiji H, Takahashi G, Takahashi H, Uno Y, Yano H. Clinical practice guidelines for the diagnosis and management of acute otitis media in children-2018 update. Auris Nasus Larynx 2020; 47:493-526. [PMID: 32576390 DOI: 10.1016/j.anl.2020.05.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/07/2020] [Accepted: 05/27/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVE "Clinical Practice Guidelines for the Diagnosis and Management of Acute Otitis Media in Children-2018 update (2018 Guidelines)" aim to provide appropriate recommendations about the diagnosis and management of children with acute otitis media (AOM), including recurrent acute otitis media (recurrent AOM), in children under 15 years of age. These evidence-based recommendations were created with the consensus of the subcommittee members, taking into consideration unique characteristics of bacteriology and antimicrobial susceptibilities of AOM pathogens in Japan, as well as global advances in vaccines. METHODS The subcommittee re-evaluated key clinical issues based on SCOPE (a master plan of the guidelines) and created clinical questions (CQ) about the diagnosis and management of AOM patients. A literature search of the publications from 2013 to 2016 were added to the Guidelines 2013, not only to assess the evidence on the effectiveness of vaccines, but also to provide up to date information of the bacteriology and antimicrobial susceptibilities of AOM causative pathogens in Japan. RESULTS We have proposed guidelines for disease severity-based management of AOM patients, after classifying AOM severity into mild, moderate, and severe, based on age, clinical manifestations, and otoscopic findings. CONCLUSIONS Precise otoscopic findings are essential for judging AOM severity, which can lead to appropriate management of AOM patients.
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Affiliation(s)
- Tatsuya Hayashi
- Department Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa-shi, Hokkaido 078-8510, Japan.
| | - Ken Kitamura
- Shonan University of Medical Sciences, 16-48 Kamishinano, Totsuuka-ku, Yokohama-shi, Kanagawa 244-0806, Japan
| | - Sho Hashimoto
- Department of Otolaryngology Head and Neck Surgery, National Hospital Organization Sendai Medical Center, 2-11-12 Miyagino, Miyagino-ku, Sendai-shi, Miyagi 983-8520, Japan
| | - Muneki Hotomi
- Department of Otolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama 641-8509, Japan
| | - Hiromi Kojima
- Department of Otolaryngology, Tokyo Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Fumiyo Kudo
- Alice ENT Clinic, 2-36-21 Makuharihongo, Hanamigawa-ku, Chiba-shi, Chiba 262-0033, Japan
| | - Yumiko Maruyama
- Department of Otolaryngology, Kurobe City Hospital, 1108-1 Mikkaichi, Kurobe-shi, Toyama 938-8502, Japan
| | - Shoichi Sawada
- Sawada ENT and Eye Clinic, 1734-5 Fukui-cho, Kochi-shi, Kochi 780-0965, Japan
| | - Hidenobu Taiji
- Department of Otolaryngology, Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo 108-0073, Japan
| | - Goro Takahashi
- Yamahoshi ENT Clinic, 1-4-6 Shitoro, Nishi-ku, Hamamatsu-shi, Shizuoka 432-8069, Japan
| | - Haruo Takahashi
- Department of Otolaryngology Head and Neck Surgery, Nagasaki University, 1-12-4 Sakamoto, Nagasaki-shi, Nagasaki 852-8523, Japan
| | - Yoshifumi Uno
- Uno ENT Clinic, 3702-4 Tomihara, Kita-ku, Okayama-shi, Okayama 701-1153, Japan
| | - Hisakazu Yano
- Department of Microbiology and Infectious Diseases, Nara Medical University, 840 Shijo-cho, Kashihara-shi, Nara 634-8521, Japan
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Wald ER, DeMuri GP. Antibiotic Recommendations for Acute Otitis Media and Acute Bacterial Sinusitis: Conundrum No More. Pediatr Infect Dis J 2018; 37:1255-1257. [PMID: 29570583 PMCID: PMC6151174 DOI: 10.1097/inf.0000000000002009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
There has been a substantial change in the prevalence and microbiologic characteristics of cases of acute otitis media secondary to the widespread use of pneumococcal conjugate vaccines. Current trends in nasopharyngeal colonization and the microbiology of acute otitis media support a change in the recommendation for antibiotic management of acute otitis media and acute bacterial sinusitis in children.
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Affiliation(s)
- Ellen R. Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health
| | - Gregory P. DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health
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Cilveti R, Olmo M, Pérez-Jove J, Picazo JJ, Arimany JL, Mora E, Pérez-Porcuna TM, Aguilar I, Alonso A, Molina F, del Amo M, Mendez C, on behalf of the HERMES Study Group. Epidemiology of Otitis Media with Spontaneous Perforation of the Tympanic Membrane in Young Children and Association with Bacterial Nasopharyngeal Carriage, Recurrences and Pneumococcal Vaccination in Catalonia, Spain - The Prospective HERMES Study. PLoS One 2017; 12:e0170316. [PMID: 28146590 PMCID: PMC5287464 DOI: 10.1371/journal.pone.0170316] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/03/2017] [Indexed: 01/26/2023] Open
Abstract
The Epidemiology of otitis media with spontaneous perforation of the tympanic membrane and associated nasopharyngeal carriage of bacterial otopathogens was analysed in a county in Catalonia (Spain) with pneumococcal conjugate vaccines (PCVs) not included in the immunization programme at study time. A prospective, multicentre study was performed in 10 primary care centres and 2 hospitals (June 2011-June 2014), including all otherwise healthy children ≥2 months ≤8 years with otitis media presenting spontaneous tympanic perforation within 48h. Up to 521 otitis episodes in 487 children were included, showing by culture/PCR in middle ear fluid (MEF): Haemophilus influenzae [24.2%], both Streptococcus pneumoniae and H. influenzae [24.0%], S. pneumoniae [15.9%], Streptococcus pyogenes [13.6%], and Staphylococcus aureus [6.7%]. Culture-negative/PCR-positive otitis accounted for 31.3% (S. pneumoniae), 30.2% (H. influenzae) and 89.6% (mixed S. pneumoniae/H. influenzae infections). Overall, incidence decreased over the 3-year study period, with significant decreases in otitis by S. pneumoniae and by H. influenzae, but no decreases for mixed S. pneumoniae/H. influenzae infections. Concordance between species in nasopharynx and MEF was found in 58.3% of cases, with maximal rates for S. pyogenes (71.8%), and with identical pneumococcal serotype in 40.5% of cases. Most patients (66.6%) had past episodes. PCV13 serotypes were significantly more frequent in first episodes, in otitis by S. pneumoniae as single agent, and among MEF than nasopharyngeal isolates. All non-PCV13 serotypes separately accounted for <5% in MEF. Up to 73.9% children had received ≥1 dose of PCV, with lower carriage of PCV13 serotypes than among non-vaccinated children. Pooling pneumococcal isolates from MEF and nasopharynx, 30% were multidrug resistant, primarily belonging to serotypes 19A [29.8%], 24A [14.3%], 19F [8.3%] and 15A [6.0%]. Our results suggest that increasing PCV13 vaccination would further reduce transmission of PCV13 serotypes with special benefits for youngest children (with none or uncompleted vaccine schedules), preventing first otitis episodes and subsequent recurrences.
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Affiliation(s)
- Robert Cilveti
- Department of Paediatrics, H. Universitari Mútua Terrassa, Barcelona, Spain
- * E-mail:
| | - Montserrat Olmo
- Department of Paediatrics, H. Universitari Mútua Terrassa, Barcelona, Spain
| | | | | | | | - Emiliano Mora
- Department of Paediatrics, H. Universitari Mútua Terrassa, Barcelona, Spain
| | | | - Ignacio Aguilar
- CAP Turó de Can Mates, San Cugat del Vallés, Barcelona, Spain
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Angoulvant F, Cohen R, Doit C, Elbez A, Werner A, Béchet S, Bonacorsi S, Varon E, Levy C. Trends in antibiotic resistance of Streptococcus pneumoniae and Haemophilus influenzae isolated from nasopharyngeal flora in children with acute otitis media in France before and after 13 valent pneumococcal conjugate vaccine introduction. BMC Infect Dis 2015; 15:236. [PMID: 26093673 PMCID: PMC4475293 DOI: 10.1186/s12879-015-0978-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 06/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND After the implementation of pneumococcal conjugate vaccines (PCVs), the marked shift in Streptococcus pneumoniae (Pnc) serotype distribution led to a modification in pneumococcal antibiotic susceptibility. In 2011, the pattern of antibiotic prescription in France for acute otitis media in infants was greatly modified, with decreased use of third-generation cephalosporins and amoxicillin-clavulanate replaced by amoxicillin alone. To assess antibiotic strategies, here we measured the antibiotic susceptibility of Pnc and Haemophilus influenzae (Hi) isolated from nasopharyngeal flora in infants with acute otitis media in the 13-valent PCV (PCV13) era in France. METHODS From November 2006 to June 2013, 77 pediatricians obtained nasopharyngeal swabs from infants (6 to 24 months old) with acute otitis media. The swabs were sent for analysis to the national reference centre for pneumococci in France. Demographics, medical history, and physical examination findings were recorded. RESULTS We examined data for 7200 children, 3498 in the pre-PCV13 period (2006-2009) and 3702 in the post-PCV13 period (2010-2013). The Pnc carriage rate decreased from 57.9% to 54.2% between the 2 periods, and the proportion of pneumococcal strains with reduced susceptibility to penicillin or resistant to penicillin decreased from 47.1% to 39% (P < 0.0001). The Hi carriage rate increased from 48.2% to 52.4%, with the proportion of ß-lactamase-producing strains decreasing from 17.1% to 11.9% and the proportion of ß-lactamase-nonproducing, ampicillin-resistant strains remaining stable, from 7.7% to 8.2%. We did not identify any risk factor associated with carriage of ß-lactamase-producing Hi strains (such as daycare center attendance, otitis-prone condition or recent antibiotic use). CONCLUSION In France, the nasopharyngeal carriage rate of reduced-susceptibility pneumococcal strains and ß-lactamase-producing Hi strains decreased in children with acute otitis media after 2010, the year the PCV13 was introduced. Accordingly, amoxicillin as the first-line drug for acute otitis media requiring antibiotics remains a valid choice.
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Affiliation(s)
- François Angoulvant
- Service d'Accueil des Urgences Pédiatriques, AP-HP, Hôpital Necker-Enfants-Malades, Université Paris Descartes Sorbonne Paris Cité, ECEVE - INSERM UMR1123, Paris, France.
| | - Robert Cohen
- ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés, France. .,Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France. .,Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier Intercommunal de Créteil, Créteil, France. .,AFPA, Association Française de Pédiatrie Ambulatoire, Chambéry, France.
| | - Catherine Doit
- Université Paris Diderot Sorbonne Paris Cité, Paris, France. .,Service de Microbiologie, AP-HP, Hôpital Robert-Debré, 75019, Paris, France.
| | - Annie Elbez
- ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés, France.
| | - Andreas Werner
- AFPA, Association Française de Pédiatrie Ambulatoire, Chambéry, France.
| | - Stéphane Béchet
- ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés, France.
| | - Stéphane Bonacorsi
- Université Paris Diderot Sorbonne Paris Cité, Paris, France. .,Service de Microbiologie, AP-HP, Hôpital Robert-Debré, 75019, Paris, France.
| | - Emmanuelle Varon
- National Reference Center for Pneumococci, Laboratoire de Microbiologie, AP-HP, Hopital Européen Georges-Pompidou, Paris, France.
| | - Corinne Levy
- ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés, France. .,Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France. .,AFPA, Association Française de Pédiatrie Ambulatoire, Chambéry, France.
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Kaplan SL, Center KJ, Barson WJ, Ling-Lin P, Romero JR, Bradley JS, Tan TQ, Hoffman JA, Peters TR, Gurtman A, Scott DA, Trammel J, Gruber WC, Hulten KG, Mason EO. Multicenter surveillance of Streptococcus pneumoniae isolates from middle ear and mastoid cultures in the 13-valent pneumococcal conjugate vaccine era. Clin Infect Dis 2015; 60:1339-45. [PMID: 25648240 DOI: 10.1093/cid/civ067] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/26/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Streptococcus pneumoniae is a common cause of otitis media (OM) in children; mastoiditis remains an important complication of OM. Limited data are available on the impact of the 13-valent pneumococcal conjugate vaccine (PCV13) on pneumococcal otitis. METHODS Investigators from 8 children's hospitals in the United States prospectively collected pneumococcal isolates from middle ear or mastoid cultures from children from 2011 to 2013. Serotype and antibiotic susceptibilities were determined and PCV13 doses for children documented. RESULTS Over the 3-year period, the proportion of isolates included in PCV13 (plus a related serotype) decreased significantly (P = .0006) among the middle ear/mastoid isolates (2011, 50% [74/149]; 2012, 40.5% [47/116]; 2013, 29% [34/118]). The number of serotype 19A isolates in 2013 (n = 12, 10.2% of total) decreased 76% compared with the number of 19A isolates in 2011 (n = 50, 33.6% of total). Of the children from whom serotype 19A was isolated (n = 93), 55% had previously received <3 doses of PCV13. The most common non-PCV13 serotypes for the combined years were 35B (n = 37), 21 (n = 20), 23B (n = 20), 15B (n = 18), 11 (n = 17), 23A (n = 14), 15A (n = 14), and 15C (n = 14). The proportion of isolates with a penicillin minimal inhibitory concentration >2 µg/mL decreased significantly over the 3 years (2011, 22% [35/154]; 2012, 20% [24/118]; 2013, 10% [12/120]; P < .02). CONCLUSIONS The number of pneumococcal isolates and the percentage of isolates with high-level penicillin resistance from cultures taken from children with OM or mastoiditis for clinical indications have decreased following PCV13 use, largely related to decreases in serotype 19A isolates.
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Affiliation(s)
- Sheldon L Kaplan
- Pediatric Infectious Diseases Sections, Baylor College of Medicine, Houston, Texas
| | - Kimberly J Center
- Pfizer Vaccine Research, Collegeville, Pennsylvania Pfizer Vaccine Research, Pearl River, New York
| | - William J Barson
- The Ohio State University College of Medicine and Public Health, Columbus
| | - Philana Ling-Lin
- Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pennsylvania
| | - José R Romero
- University of Arkansas for Medical Sciences, Little Rock
| | | | - Tina Q Tan
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jill A Hoffman
- University of Southern California School of Medicine, Los Angeles
| | | | - Alejandra Gurtman
- Pfizer Vaccine Research, Collegeville, Pennsylvania Pfizer Vaccine Research, Pearl River, New York
| | - Daniel A Scott
- Pfizer Vaccine Research, Collegeville, Pennsylvania Pfizer Vaccine Research, Pearl River, New York
| | | | - William C Gruber
- Pfizer Vaccine Research, Collegeville, Pennsylvania Pfizer Vaccine Research, Pearl River, New York
| | - Kristina G Hulten
- Pediatric Infectious Diseases Sections, Baylor College of Medicine, Houston, Texas
| | - Edward O Mason
- Pediatric Infectious Diseases Sections, Baylor College of Medicine, Houston, Texas
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Kaur R, Czup K, Casey JR, Pichichero ME. Correlation of nasopharyngeal cultures prior to and at onset of acute otitis media with middle ear fluid cultures. BMC Infect Dis 2014; 14:640. [PMID: 25475135 PMCID: PMC4264249 DOI: 10.1186/s12879-014-0640-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 11/18/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND We sought to determine if nasopharyngeal (NP) cultures taken at times of healthy visits or at onset of acute otitis media (AOM) could predict the otopathogen mix and antibiotic-susceptibility of middle ear isolates as determined by middle ear fluid (MEF) cultures obtained by tympanocentesis. METHODS During a 7-year-prospective study of 619 children from Jun 2006-Aug 2013, NP cultures were obtained from 6-30 month olds at healthy visits and NP and MEF (by tympanocentesis) at onset of AOM episodes. RESULTS 2601 NP and 530 MEF samples were collected. During healthy visits, S. pneumoniae (Spn) was isolated from 656 (31.7%) NP cultures compared to 253 (12.2%) for Nontypeable Haemophilus influenzae (NTHi) and 723 (34.9%) for Moraxella catarrhalis (Mcat). At onset of AOM 256 (48.3%) of 530 NP samples were culture positive for Spn, 223 (42%) for NTHi and 251 (47.4%) for Mcat, alone or in combinations. At 530 AOM visits, Spn was isolated from 152 (28.7%) of MEF compared to 196 (37.0%) for NTHi and 104 (19.6%) for Mcat. NP cultures collected at onset of AOM but not when children were healthy had predictive value for epidemiologic antibiotic susceptibility pattern assessments. CONCLUSIONS NP cultures at onset of AOM more closely correlate with otopathogen mix than NP cultures at healthy visits using MEF culture as the gold standard, but the correlation was too low to allow NP cultures to be recommended as a substitute for MEF culture. For epidemiology purposes, antibiotic susceptibility of MEF isolates can be predicted by NP culture results when samples are collected at onset of AOM.
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Affiliation(s)
- Ravinder Kaur
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, 1425 Portland Avenue, 14621, Rochester, NY, USA.
| | - Katerina Czup
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, 1425 Portland Avenue, 14621, Rochester, NY, USA.
| | - Janet R Casey
- Otitis Media Research Center, Legacy Pediatrics, Rochester, NY, USA.
| | - Michael E Pichichero
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, 1425 Portland Avenue, 14621, Rochester, NY, USA.
- Otitis Media Research Center, Legacy Pediatrics, Rochester, NY, USA.
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Impact of pneumococcal conjugate vaccines on microbial epidemiology and clinical outcomes of acute otitis media. Paediatr Drugs 2014; 16:1-12. [PMID: 23963858 DOI: 10.1007/s40272-013-0044-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Acute otitis media (AOM) is the leading bacterial infection in childhood and the main reason for antibiotic prescriptions in children. The success of pneumococcal conjugate vaccines (PCVs) in reducing invasive pneumococcal disease has been demonstrated in many studies. Because Streptococcus pneumoniae is one of the two main bacterial species implicated in AOM, the incidence and characteristics of AOM might also be modified by PCVs. Pre-licensure controlled studies showed that the effect was modest. However, after PCV7 implementation, the impact on the AOM burden appeared to be more marked, despite the fact that serotype replacement in the nasopharynx was almost complete. Most data on the impact of PCVs on nasopharyngeal flora have been drawn from studies with PCV7. No difference was observed with PCV10 compared with PCV7 concerning S. pneumoniae and Haemophilus influenza carriage. For PCV13 compared with PCV7, additional reduction of carriage of serotypes 1, 6A, 7F, 6C, 19A, and 19F was observed, but for the other serotypes, the two PCVs seemed to have the same effect.
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