Bacterial causes of otitis media with spontaneous perforation of the tympanic membrane in the era of 13 valent pneumococcal conjugate vaccine

Abstract

After pneumococcal conjugate vaccine (PCV) implementation, the number of acute otitis media (AOM) episodes has decreased, but AOM still remains among the most common diagnoses in childhood. From 2% to 17% of cases of AOM feature spontaneous perforation of the tympanic membrane (SPTM). The aim of this study was to describe the bacteriological causes of SPTM 5 to 8 years years after PCV13 implementation, in 2010. From 2015 to 2018, children with SPTM were prospectively enrolled by 41 pediatricians. Middle ear fluid was obtained by sampling spontaneous discharge. Among the 470 children with SPTM (median age 20.8 months), no otopathogen was isolated for 251 (53.4% [95% CI 48.8%;58.0%]): 47.1% of infants and toddlers, 68.3% older children (p<0.001). Among children with isolated bacterial otopathogens (n = 219), non-typable Haemophilus influenzae (NTHi) was the most frequent otopathogen isolated (n = 106, 48.4% [95% CI 41.6%;55.2%]), followed by Streptoccocus pyogenes (group A streptococcus [GAS]) (n = 76, 34.7% [95% CI 28.4%;41.4%]) and Streptococcus pneumoniae (Sp) (n = 61, 27.9% [95% Ci 22.0%;34.3%]). NTHi was frequently isolated in infants and toddlers (53.1%), whereas the main otopathogen in older children was GAS (52.3%). In cases of co-infection with at least two otopathogens (16.9%, n = 37/219), NTHi was frequently involved (78.4%, n = 29/37). When Sp was isolated, PCV13 serotypes accounted for 32.1% of cases, with serotype 3 the main serotype (16.1%). Among Sp strains, 29.5% were penicillin-intermediate and among NTHi strains, 16.0% were β-lactamase–producers. More than 5 years after PCV13 implementation, the leading bacterial species recovered from AOM with SPTM was NTHi for infants and toddlers and GAS for older children. In both age groups, Sp was the third most frequent pathogen and vaccine serotypes still played an important role. No resistant Sp strains were isolated, and the frequency of β-lactamase–producing NTHi did not exceed 16%.

Bacterial Spectrum of Spontaneously Ruptured Otitis Media in a 7-Year, Longitudinal, Multicenter, Epidemiological Cross-Sectional Study in Germany

“…Almost all cases were singlespecies bacterial infections confirming previous findings (24). S. pyogenes proved the most prevalent of the known pathogens, followed by S. pneumoniae and S. aureus, similar to other studies (25)(26)(27). M. catarrhalis was extremely rare, which contrasts the data from Finland and the US (24).…”

“…M. catarrhalis showed high, although fluctuating, carriage percentages. The fact that M. catarrhalis was frequently carried, but rarely isolated from MEF, indicates the minor role of this pathogen in severe, spontaneously ruptured otitis media (25)(26)(27). The increase of S. pyogenes as pathogen in severe AOM is worrisome and has been reported from several other countries (28,29).…”

Vaccins conjugués contre le pneumocoque chez l’enfant

“…L'implémentation des VPC a changé aussi à la fois le profil des bactéries impliquées (proportionnellement moins de pneumocoque, plus d'H. influenzae ou de SGA) et le profil clinique : otites moins fébriles, moins douloureuses, moins récidivantes, moins d'échecs de traitement (9).…”

Nasopharyngeal carriage rates and serotype distribution of Streptococcus pneumoniae among school children with acute otitis media in Central Java, Indonesia

“…The disease is characterized by purulent tympanic discharge and bulging of the tympanic membrane [3]. Streptococcus pneumoniae and Haemophilus influenzae are the predominant otopathogens associated with otitis media [4,5]. S. pneumoniae causes acute AOM, which accounts for 30-50 % of all cases worldwide [6].…”