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Microbiology of bacteria causing recurrent acute otitis media (AOM) and AOM treatment failure in young children in Spain: shifting pathogens in the post-pneumococcal conjugate vaccination era.
Int J Pediatr Otorhinolaryngol 2013; 77(8):1231-6IJ

Abstract

OBJECTIVE

To prospectively identify the bacterial aetiology and antimicrobial susceptibility of problematic (recurrent and treatment failure) acute otitis media in Spanish children several years after the introduction of 7-valent pneumococcal conjugate vaccine.

METHODS

Tympanocentesis or careful sampling of spontaneous otorrhoea was performed on children aged 3 to <36 months with recurrent acute otitis media, acute otitis media treatment failure or unresolved acute otitis media.

RESULTS

105 acute otitis media episodes (77 sampled by tympanocentesis, 28 otorrhoea samples) were evaluated: 46 recurrent, 35 treatment failures, 24 unresolved acute otitis media. 74 episodes (70.4%) had at least one bacterium identified on culture: Streptococcus pneumoniae was identified in 21 episodes, Haemophilus influenzae (all non-typeable) in 44, Streptococcus pyogenes in 2, Moraxella catarrhalis in 2. No statistically significant difference in bacterial aetiology by episode type was detected. Non-typeable H. influenzae was the most commonly isolated pathogen in all acute otitis media types and in all age sub-groups. Forty percent of S. pneumoniae isolates were multi-drug resistant. Pneumococcal serotype 19A was the most frequently identified serotype (7/21 episodes). Multi-drug resistance was found in 56% of 19A isolates. Of non-typeable H. influenzae isolates, 15% were ampicillin resistant and 13% were amoxicillin/clavulanate resistant. S. pneumoniae and non-typeable H. influenzae DNA were each detected in 57% of samples culture negative for these pathogens, including 12 co-infections.

CONCLUSION

Combining culture and polymerase chain reaction results, H. influenzae and S. pneumoniae may be implicated in 70% and 43% of clinically problematic bacterial acute otitis media episodes, respectively. The impact of new vaccines to prevent both S. pneumoniae and non-typeable H. influenzae acute otitis media may be substantial in this population and is worth investigating.

Authors+Show Affiliations

Hospital Infantil Universitario Vall d'Hebrón, Barcelona, Spain. felix.pumarola@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23746414

Citation

Pumarola, Felix, et al. "Microbiology of Bacteria Causing Recurrent Acute Otitis Media (AOM) and AOM Treatment Failure in Young Children in Spain: Shifting Pathogens in the Post-pneumococcal Conjugate Vaccination Era." International Journal of Pediatric Otorhinolaryngology, vol. 77, no. 8, 2013, pp. 1231-6.
Pumarola F, Marès J, Losada I, et al. Microbiology of bacteria causing recurrent acute otitis media (AOM) and AOM treatment failure in young children in Spain: shifting pathogens in the post-pneumococcal conjugate vaccination era. Int J Pediatr Otorhinolaryngol. 2013;77(8):1231-6.
Pumarola, F., Marès, J., Losada, I., Minguella, I., Moraga, F., Tarragó, D., ... Hausdorff, W. P. (2013). Microbiology of bacteria causing recurrent acute otitis media (AOM) and AOM treatment failure in young children in Spain: shifting pathogens in the post-pneumococcal conjugate vaccination era. International Journal of Pediatric Otorhinolaryngology, 77(8), pp. 1231-6. doi:10.1016/j.ijporl.2013.04.002.
Pumarola F, et al. Microbiology of Bacteria Causing Recurrent Acute Otitis Media (AOM) and AOM Treatment Failure in Young Children in Spain: Shifting Pathogens in the Post-pneumococcal Conjugate Vaccination Era. Int J Pediatr Otorhinolaryngol. 2013;77(8):1231-6. PubMed PMID: 23746414.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Microbiology of bacteria causing recurrent acute otitis media (AOM) and AOM treatment failure in young children in Spain: shifting pathogens in the post-pneumococcal conjugate vaccination era. AU - Pumarola,Felix, AU - Marès,Josep, AU - Losada,Isabel, AU - Minguella,Isabel, AU - Moraga,Fernando, AU - Tarragó,David, AU - Aguilera,Ulla, AU - Casanovas,Josep M, AU - Gadea,Gloria, AU - Trías,Elisenda, AU - Cenoz,Santiago, AU - Sistiaga,Alessandra, AU - García-Corbeira,Pilar, AU - Pirçon,Jean-Yves, AU - Marano,Cinzia, AU - Hausdorff,William P, Y1 - 2013/06/06/ PY - 2012/11/01/received PY - 2013/04/02/revised PY - 2013/04/06/accepted PY - 2013/6/11/entrez PY - 2013/6/12/pubmed PY - 2014/3/29/medline KW - Antibiotic resistance KW - Haemophilus influenzae KW - Otitis media KW - Streptococcus pneumoniae KW - Tympanocentesis SP - 1231 EP - 6 JF - International journal of pediatric otorhinolaryngology JO - Int. J. Pediatr. Otorhinolaryngol. VL - 77 IS - 8 N2 - OBJECTIVE: To prospectively identify the bacterial aetiology and antimicrobial susceptibility of problematic (recurrent and treatment failure) acute otitis media in Spanish children several years after the introduction of 7-valent pneumococcal conjugate vaccine. METHODS: Tympanocentesis or careful sampling of spontaneous otorrhoea was performed on children aged 3 to <36 months with recurrent acute otitis media, acute otitis media treatment failure or unresolved acute otitis media. RESULTS: 105 acute otitis media episodes (77 sampled by tympanocentesis, 28 otorrhoea samples) were evaluated: 46 recurrent, 35 treatment failures, 24 unresolved acute otitis media. 74 episodes (70.4%) had at least one bacterium identified on culture: Streptococcus pneumoniae was identified in 21 episodes, Haemophilus influenzae (all non-typeable) in 44, Streptococcus pyogenes in 2, Moraxella catarrhalis in 2. No statistically significant difference in bacterial aetiology by episode type was detected. Non-typeable H. influenzae was the most commonly isolated pathogen in all acute otitis media types and in all age sub-groups. Forty percent of S. pneumoniae isolates were multi-drug resistant. Pneumococcal serotype 19A was the most frequently identified serotype (7/21 episodes). Multi-drug resistance was found in 56% of 19A isolates. Of non-typeable H. influenzae isolates, 15% were ampicillin resistant and 13% were amoxicillin/clavulanate resistant. S. pneumoniae and non-typeable H. influenzae DNA were each detected in 57% of samples culture negative for these pathogens, including 12 co-infections. CONCLUSION: Combining culture and polymerase chain reaction results, H. influenzae and S. pneumoniae may be implicated in 70% and 43% of clinically problematic bacterial acute otitis media episodes, respectively. The impact of new vaccines to prevent both S. pneumoniae and non-typeable H. influenzae acute otitis media may be substantial in this population and is worth investigating. SN - 1872-8464 UR - https://www.unboundmedicine.com/medline/citation/23746414/Microbiology_of_bacteria_causing_recurrent_acute_otitis_media__AOM__and_AOM_treatment_failure_in_young_children_in_Spain:_shifting_pathogens_in_the_post_pneumococcal_conjugate_vaccination_era_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165-5876(13)00157-2 DB - PRIME DP - Unbound Medicine ER -