Prevalence and etiological agents for chronic suppurative otitis media in a tertiary hospital in Tanzania

Objective

Chronic suppurative otitis media is among the most common otological condition reported in otorhinolaryngology practice commonly attributing to preventable hearing loss. The aim of this study was to determine the prevalence and etiological agents for chronic suppurative otitis media in our department.

Results

A total of 5591 patients were recruited in this study and only 79 (1.4%) had chronic suppurative otitis media. A male preponderance 43 (54.4%) was noted in this study and the left ear (58.2%) was more commonly affected compared to the right ear. Central perforation was the commonest pattern of presentation and was reported in 53% of cases though none had attic perforation. Of the 81 processed ear swabs, microbial growth was seen in majority 80 (98.8%) whilst one sample showed no microbial growth whereas 52.5% had polymicrobial growth. Among the isolates, most were gram negative species accounting for 59.7% while gram positive bacteria accounted for 25.6% and fungi accounted for 14.7%. Most of these isolates were facultative anaerobes. Klebsiella pneumoniae (20.2%) was the commonest isolates while Escherichia coli and Pseudomonas aeruginosa were equally least isolated (10.9%). Tested isolates were most sensitive to Ciprofloxacin, Gentamycin, Ceftriaxone and Amikacin and least sensitive to Amoxicillin/clavulanic acid and Ampicillin.

Electronic supplementary material

The online version of this article (10.1186/s13104-019-4483-x) contains supplementary material, which is available to authorized users.

Bacterial profile and antimicrobial susceptibility patterns in chronic suppurative otitis media at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

Objectives

This study aims to determine bacterial profile and antimicrobial susceptibility patterns of chronic suppurative otitis media in the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

Result

Sixty-two ear swabs were collected and 74 bacterial isolates were identified, of which 48 (77.4%) sample with mono-microbial growth, 11 (17.8%) with polymicrobial growth and the remaining 3 (4.8%) show no growth. The most common isolates were Proteus mirabilis 16 (21.6%), followed by S. aureus 12 (16.2%), Klebsiella spp. 10 (13.5%) and Providencia spp. 11 (14.9%). Proteus mirabilis was 100% susceptible to norfloxacin and ciprofloxacin while 87.5% of the isolates were susceptible to cefixime and gentamicin. S. aureus was 83.3% susceptible to gentamicin and clarithromycin, while 75% of the isolates were susceptible to amoxicillin–clavulanic acid and chloramphenicol, however, 66.7% the isolates were susceptible to ciprofloxacin, norfloxacin and erythromycin. The overall prevalence of multidrug resistance in the current study was 35 (47.3%). In this study P. mirabilis, S. aureus, Providencia spp., and Klebsiella spp. were the most common bacterial isolate and all Gram negative isolates were susceptible to ciprofloxacin and norfloxacin. Amoxicillin–clavulanic acid, gentamicin, chloramphenicol, clarithromycin and tobramycin were relatively effective against Gram positive bacteria.

Electronic supplementary material

The online version of this article (10.1186/s13104-019-4452-4) contains supplementary material, which is available to authorized users.

Surveillance of antibiotic sensitivity pattern in chronic suppurative otitis media of an Indian teaching hospital

Introduction

Chronic suppurative otitis media (CSOM) is a common problem in worldwide and untreated CSOM leads to fatal complications like facial nerve paralysis, lateral sinus thrombosis, labyrinthitis, meningitis and brain abscess in developing country like India.

Objective

To isolate causative bacteria and antibiotic sensitivity pattern for CSOM and to know the prevalence of extended spectrum beta lactamases (ESBL) and Metallobetalactamases (MBL) in CSOM patients.

Methods

A total of 500 ear swabs of clinical suspected CSOM patients were cultured on specific cultured medium and identified the bacteria with conventional methods. Then all the identified bacteria were subjected with specific antibiotics by the Kirby–Bauer's method to know the resistance pattern of antibiotics. ESBL and MBL strains were detected by double disc diffusion test.

Results

A total of 384 bacteria were isolated from 500 CSOM patients, among them 86 P. aeruginosa (22.40%), 112 Staphylococcus aureus (29.17%), 53 A. baumannii (13.80%), 32 E. aerogenes (18%), 26 C. freundii (6.77%), 24 K. oxytoca (6.25%), 23 P. vulgaris (5.99%), 18 K. pneumoniae (4.69%) and 10 P. mirabilis (2.60%) identified with conventional methods. From antibiotic disc diffusion methods 74.22% ESBL strains and 9.90% MBL strains were documented. Multidrug resistant strains of P. aeruginosa (86/384,22.40%) were more prevalent than those of S. aureus (112/384,29.17%) and other bacteria in ear discharges. Imipenem and vancomicin could control to gram negative bacteria and gram positive bacteria respectively.

Conclusion

Continuous and periodic evaluation of microbiological profile and antimicrobial sensitivity pattern of bacterial is essential for optimum management of CSOM patients.

Antimicrobial susceptibility patterns of bacteria isolated from patients with ear discharge in Jimma Town, Southwest, Ethiopia

Background

Otitis media is among the leading causes of childhood illnesses although it can also affect the adults resulting in frequent physician visits, drug prescription and a key contributor to antibiotic resistance. The aim of this study was to determine the risk factors, bacterial profile, and the antimicrobial susceptibility pattern of the isolates from patients with discharging ears which clinically equates to draining otitis media in developing countries with limited medical resources such as otoscope.

Methods

A prospective cross-sectional study was conducted on 173 patients with draining otitis media. The ear discharge specimens were collected and analyzed by standard microbial techniques. The antibiotic susceptibility profiles were determined for 19 different antibiotics by the standard disk diffusion method. Data was analyzed by SPSS version 22 and the P value of less than 0.05 was considered as statistically significant.

Results

Among 173 otitis media patients participated in the study; majority, 102(63%) were pediatrics, out of which 72 (41.61%) were in the age group of less than 4 years. Ear infection was bilateral in 39 (22.54%) and chronic in 100 (57.8%) of the patients. Pathogens were isolated from 160 (92.5%) of the patients with a total of 179 isolates. The predominant isolate was Staphylococcus aureus (30.72%) followed by Proteus spp. (17.89%). The result of this study showed that adult age (p = 0.031), rural residence (p = 0.005), previous history of health care visit and treatment (p = 0.000), upper respiratory tract infection (p = 0.018) and presence of cigarette smoker in the house (p = 0.022) had statistically significant association with chronic otitis media. Most of the isolated bacteria showed high level of resistance to ampicillin/amoxicillin (88.3%), penicillin G (79.5%) followed by trimethoprim /sulfamethoxazole (73.8%). Conversely, the majority of bacterial isolates showed moderate susceptibility to ciprofloxacin (72.9%), gentamicin (70.4%), and amikacin (69.3%). Bacterial isolates identified in this study showed trend of multiple drug resistance, majority (67%) being resistant to three or more antimicrobials.

Conclusions

Majority of the bacterial isolates were multidrug resistant, hence, efforts to isolate microorganisms and determine the susceptibility pattern should be strengthened to improve the treatment outcome of otitis media instead of the usual trend of empirical treatment.

Resistance of Staphylococcus aureus to antimicrobial agents in Ethiopia: a meta-analysis

Background

Emergence of antimicrobial resistance by Staphylococcus aureus has limited treatment options against its infections. The purpose of this study was to determine the pooled prevalence of resistance to different antimicrobial agents by S. aureus in Ethiopia.

Methods

Web-based search was conducted in the databases of PubMed, Google Scholar, Hinari, Scopus and the Directory of Open Access Journals (DOAJ) to identify potentially eligible published studies. Required data were extracted and entered into Excel spread sheet. Statistical analyses were performed using Stata version 13.0. The metaprop Stata command was used to pool prevalence values. Twenty-one separate meta-analysis were done to estimate the pooled prevalence of the resistance of S. aureus to twenty-one different antimicrobial agents. Heterogeneity among the studies was assessed using the I² statistic and chi-square test. Publication bias was assessed using Egger’s test. Because of significant heterogeneity amongst the studies, the random effects model was used to pool prevalence values.

Results

The electronic database search yielded 1317 studies among which 45 studies met our inclusion criteria. Our analyses demonstrated very high level of resistance to amoxicillin (77% [95% confidence interval (CI): 68%, 0.85%]), penicillin (76% [95% CI: 67%, 84%]), ampicillin (75% [95% CI: 65%, 85%]), tetracycline (62% [95% CI: 55%, 68%]), methicillin (47% [95% CI: 33%, 61%]), cotrimoxaziole (47% [95% CI: 40%, 55%]), doxycycline (43% [95% CI: 26%, 60%]), and erythromycin (41% [95% CI: 29%, 54%]). Relatively low prevalence of resistance was observed with kanamycin (14% [95% CI: 5%, 25%]) and ciprofloxacin (19% [95% CI: 13%, 26%]). The resistance level to vancomycin is 11% 995% CI: (4%, 20%). High heterogeneity was observed for each of the meta-analysis performed (I² ranging from 79.36% to 95.93%; all p-values ≤0.01). Eggers’ test did not show a significant publication bias for all antimicrobial agents except for erythromycin and ampicillin.

Conclusions

S. aureus in Ethiopia has gotten notoriously resistant to almost to all of antimicrobial agents in use including, penicillin, cephalosporins, tetracyclines, chloramphenicol, methicillin, vancomycin and sulphonamides. The resistance level to vancomycin is bothersome and requires a due attention. Continued and multidimensional efforts of antimicrobial stewardship program promoting rational use of antibiotics, infection prevention and containment of AMR are urgently needed.

Electronic supplementary material

The online version of this article (doi:10.1186/s13756-017-0243-7) contains supplementary material, which is available to authorized users.

Epidemiology of otitis media in children from developing countries: A systematic review

OBJECTIVE

This systematic review examined the epidemiology of otitis media (OM) in children <6 years within 90 developing and newly industrialised countries.

METHODS

Literature searches (1992-2011), based on MEDLINE, EMBASE, WHO, Index Medicus, country-specific websites, conferences, and the reference lists of included studies, yielded 11,413 records; 59 of 344 studies analysed were included in this review.

RESULTS

The majority of the identified studies provided only a single timepoint for OM. In children <6 years of age, OM prevalence was found to be 9.2% in Nigeria, 10% in Egypt, 6.7% in China, 9.2% in India, 9.1% in Iran and 5.1-7.8% in Russia. Few studies examined the etiology of OM and the antibacterial resistance. The most common bacterial pathogens were S. pneumoniae, H. influenzae and S. aureus. A high resistance to penicillin was reported in Nigeria and Turkey.

CONCLUSIONS

Despite the variability between the identified studies, this review indicates that OM and its various sub-types remain a significant burden in different settings. However, the heterogeneity of studies and a general lack of reliable data made generalisation very difficult.

Pathogenic bacteria profile and antimicrobial susceptibility patterns of ear infection at Bahir Dar Regional Health Research Laboratory Center, Ethiopia

Ear infection linked with frequent antibiotic prescription, hearing impairment, severe disability and death is a public health threat in developing countries. However, there is scarcity of documented data in the study area. Therefore, this study aimed at determining bacterial etiologic agents and their antimicrobial susceptibility patterns among patients of all age groups referred to Bahir Dar Regional Health Research Laboratory Center. Retrospective data recorded on culture and antimicrobial susceptibility profile were retrieved for analysis. Pus swabs from discharging ears collected and processed for aerobic bacteria culture and susceptibility testing. Of the total 368 pus swab samples processed, 296 (80.4 %) were culture positive. Of which, 289 (97.6 %) were bacteria and 7 (2.4 %) were yeast cells. The proportion of ear infection was higher in males (92.7 %) than females (65 %) (P = 0.014). The frequency of ear infection below 21 years of age was 65.2 %. The predominant isolate was Pseudomonas aeruginosa (29.7 %) followed by Staphylococcus aureus (26.3 %) and Proteus spp. (21.9 %). High level of antimicrobial resistance rates were observed for amoxicillin/clavulanic acid, ampicillin and penicillin whereas ciprofloxacin, ceftriaxone, chloramphenicol, cotrimoxazole, gentamicin and amikacin were found effective against the isolated bacteria. Aerobic bacterial otitis media linked with high levels of resistance against amoxicillin/clavulanic acid and ampicillin is major health problem in the study area. Moreover, considerable level of oxacillin resistant S. aureus suggests the diffusion of methicillin resistant S. aureus in the community. Therefore, treatment of otitis media in the study area needs to be guided by antibiotic susceptibility testing of isolates.

Antibiotic-Resistant Bacteria Are Major Threats of Otitis Media in Wollo Area, Northeastern Ethiopia: A Ten-Year Retrospective Analysis

Antibiotic resistance is an increasingly serious threat to human health that needs an urgent action. The aim of this study was to determine the prevalence and antibiotic susceptibility profiles of bacteria isolated from patient ear discharges suspected of otitis media. A retrospective analysis was performed using culture and antibiotic susceptibility test results of 1225 patients who visited Dessie Regional Health Research Laboratory from 2001 to 2011. Results showed a strong association (P < 0.001) between age and the risk of acquiring middle ear infection. The predominant bacterial isolates were Proteus spp. (28.8%), Staphylococcus aureus (23.7%), and Pseudomonas spp. (17.2%). Most of the isolated bacteria showed high resistance to ampicillin (88.5%), ceftriaxone (84.5%), amoxicillin (81.9%), and tetracycline (74.5%). About 72.5% of Proteus spp. and 62.2% of Pseudomonas spp. have developed resistance to one and more antibiotics used to treat them. This retrospective study also revealed the overall antibiotic resistance rate of bacterial isolates was increased nearly twofold (P = 0.001) over the last decade. Relatively, ciprofloxacin and gentamicin were the most effective antibiotics against all the isolates. In conclusion, antibiotic-resistant bacteria are alarmingly increasing in Wollo area, northeastern Ethiopia, and becoming a major public health problem in the management of patients with middle ear infection.

Bacterial profile and antimicrobial susceptibility patterns of otitis media in Ayder Teaching and Referral Hospital, Mekelle University, Northern Ethiopia

Middle Ear infection is a common problem for both children and adults particularly in resource limited countries. Nevertheless, in Ethiopia and particularly in the study area, there is scarcity of recent data that indicate the magnitude of the problem. Thus this study aimed to identify bacterial isolates and determine their drug susceptibility patterns from patients who had ear infection. Cross sectional study was carried out on patients with ear infection and who visited the Ear, Nose and Throat clinic of Ayder referral and teaching hospital from November 2014 to June 2015. Middle ear discharges were collected and processed for bacterial culture and antimicrobial susceptibility testing using standard bacteriological techniques. Clinical and demographic data were collected using standard questionnaire. Data were entered and analyzed using SPSS version 20 software and p value of < 0.05 was considered statistically significant. Of the total of 162 patients with ear discharges, 68.5 % were from rural areas, 71 % with chronic infection, 54.9 % referred cases and 67.3 % of them had decreased hearing status. Pathogens were isolated from 157 (98.2 %) of the patients with a total of 216 isolates. Staphylococcus aureus 46 (28.4 %), Proteus mirabilis 39 (24.1 %), Pseudomonas aeruginosa 27 (16.7 %), Klebsiella spp. and Haemophilus influenzae 18 (11.1 % each) were the dominant bacteria. Out of the individuals with ear infection, single and mixed bacterial infection was seen among 185 (90.7 %) and 59 (39.5 %) respectively. Age group of 0–5 years (p = 0.02), chronic patients (p = 0.042) and referred cases (p = 0.045) showed high bacterial isolates. High resistance was seen to most antibiotics. Ciprofloxacin, Gentamicin Norfloxacin and Erythromycin were effective against isolated bacteria. The overall multi drug resistance rate of bacteria in this study was 74.5 %. Prevalence of bacteria associated with otitis media and multidrug resistance was very high in the study area. Ciprofloxacin, gentamicin, norfloxacin and erythromycin can be used to treat otitis media. Treatment of patients should be based on antimicrobial susceptibility test to prevent complications, development of further antibiotic resistance and extra treatment costs.

Bacterial isolates and drug susceptibility patterns of ear discharge from patients with ear infection at Gondar University Hospital, Northwest Ethiopia

Background

Ear infection is a common problem for both children and adults especially in developing countries. However in Ethiopia particularly in the study area, there is no recent data that shows the magnitude of the problem. The aim of this study was to determine the bacterial isolates and their drug susceptibility patterns from patients who had ear infection.

Method

A retrospective study was conducted from September, 2009 to August, 2012 at Gondar University Hospital, Northwest Ethiopia. Ear discharge samples were cultured on MacConkey agar, blood agar and chocolate agar plates. A standard biochemical procedure was used for full identification of bacterial isolates. Antimicrobial susceptibility tests were done on Mueller-Hinton agar by using disk diffusion method. Data were entered and analyzed by using SPSS version 20 software and P-value of < 0.05 was considered statistically significant.

Result

A total of 228 ear discharge samples were tested for bacterial isolation and 204 (89.5%) cases were found to have bacterial isolates. From the total bacterial isolates, 115 (56.4%) were gram negative bacteria and the predominant isolate was proteus species (27.5%). Of individuals who had ear infection, 185 (90.7%) had single bacterial infection while 19 (9.3%) had mixed infections. Under five children were more affected by ear infection. The prevalence of ear infection was significantly high in males (63.7 vs 36.3%) (P = 0.017). Of all bacterial isolates, 192 (94.1%) had multiple antibiotic resistant pattern. Non Lactose Fermenter Gram Negative Rods (46.0%), Klebsella species (47.7%) and Pseudomonas species (48.5%) were resistant against the commonly used antibiotics.

Conclusion

The prevalence of ear infection was very high in the study area. Majority of the bacterial isolates were resistant to multiple antibiotics. Hence antibiotics susceptibility test is mandatory before prescribing any antibiotics.