Bacterial aetiology of non-resolving otitis media in South African children

Abstract

Little is known of the aetiology, serotypes or susceptibility of the pathogens causing non-resolving otitis media in children receiving care from specialists in private practice in developed or in developing countries. Increased access to antibiotics in the community amongst children receiving such private care in South Africa may be anticipated to lead to levels of resistance similar to those found in countries with similar models of private practice, such as the United States. This study was conducted to determine the aetiology of non-resolving otitis media in South African children receiving private care and to determine the antimicrobial resistance patterns and serotypes of the bacterial isolates. Middle-ear fluid was cultured from 173 children aged two months to seven years with non-resolving acute otitis media accompanied by persistent pain or fever who were referred to otorhinolaryngologists for drainage of middle-ear fluid within 14 days of the start of symptoms. While 92 per cent of the children had recently received antibiotics and 54 per cent were currently receiving them, bacteria were isolated from 47 children (27 per cent). Streptococcus pneumoniae was the most common pathogen (35), followed by Haemophilus influenzae (nine), Staphylococcus aureus (six), Moraxella catarrhalis (two), Streptococcus pyogenes (two) and Pseudomonas aeruginosa (one). Two isolates were identified in each of eight children. Antimicrobial resistance to one or more antibiotics was found in 33/35 (94 per cent) of the pneumococci isolated, with resistance to penicillin in 86 per cent, resistance to trimethoprim-sulfamethoxazole in 54 per cent and to erythromycin and clindamycin in 69 per cent and 57 per cent, respectively. The pneumococcal serotypes found were 19F (28 per cent), 14 (26 per cent), 23F (23 per cent), 6B (nine per cent), 19A (87 per cent), and four (three per cent). Children with a bacterial pathogen isolated were younger (mean age of 17 months) than children from whom no bacteria were isolated (mean age of 23 months; p = 0.03). Isolation of a pneumococcus was also significantly associated with younger age (mean = 16 months versus 22 months, p = 0.03), the presence of fever (OR = 2.15, p = 0.049), and having one or more prior episodes of otitis media within the six months before tympanocentesis (OR = 7.72, p = 0.03). Almost all pneumococci isolated from non-resolving acute otitis media in this community are antibiotic-resistant and should be considered especially in young children who have failed previous therapy and who have non-resolving pain or fever.

Particularities of bacterial ecology of acute otitis media in an African subtropical country (Cote d’Ivoire)

“…Moreover, it wasn't found on nasopharyngeal swabs. In South Africa and Nigeria, prevalence of this bacterium was less frequent with 5.2% and 7.4%, respectively [12,15].…”

“…In our study, S. pneumoniae come in the second position with 21%. In South Africa, Brazil and France, this bacterium was in first position with a rate of 20.2%, 39.1% and 40%, respectively [12][13][14]. But in Nigeria, the most common agent was Staphylococcus, followed by S. pneumoniae with 8.8% [15].…”

Updated guideline for the management of upper respiratory tract infections in South Africa: 2008

“…5 For S. pneumoniae, the most common pathogen causing otitis media and acute sinusitis, resistance to β-lactam antibiotics can be overcome by increasing dosage. For example, a higher dose of amoxycillin of 90 mg/kg/day is generally recommended for treatment of AOM.…”

Throat Carrier Rate of Streptococcus pneumoniae among Students Living in Hostels in a Higher Institution

“…Streptococcus pneumoniae was responsible for 8.8% cases of otitis media among children in Ile-Ife (Ako-Nai, 2002), 4.6 % conjunctivitis among children in Ibadan (Adeyeba et al, 2010), 7.5% cases of bacterial infections in children in Abuja (Onalo et al, 2011). In South Africa, 74.5% (35 children out of 47) children with otitis media were due to Streptococcus pneumoniae (Huebner et al, 2003). Several studies have examined household transmission of Streptococcus pneumoniae; most of such studies have suggested that children were the source of transmission to adults in the family (Hoshino et al, 2002;Shimada et al, 2002, Leino et al, 2001.…”