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Epidemiology and antimicrobial susceptibility of non-typeable Haemophilus influenzae in otitis media in Taiwanese children.
J Microbiol Immunol Infect 2019; 52(1):75-80JM

Abstract

BACKGROUND

Concerns about non-typeable Haemophilus influenzae (NTHi) in otitis media (OM) have grown after the introduction of pneumococcal conjugate vaccine (PCV). We aim to better understand the clinical role of NTHi in pediatric OM.

METHODS

Middle ear fluid samples from children <18 years with OM were obtained from 2010 to 2015. For culture-positive episodes (Streptococcus pneumoniae, H. influenzae, Moraxella catarrhalis, and Streptococcus pyogenes), patients' demographic and clinical information were reviewed and analyzed.

RESULTS

A total of 783 episodes were included with 31.8% of isolates as positive. S. pneumoniae was recovered in 69.4%, NTHi in 24.6%, M. catarrhalis in 5.6%, and S. pyogenes in 4.0% of culture-positive episodes. The proportion of pneumococcal OM has declined since 2012 (P for trend <0.005), but NTHi OM rose simultaneously (P for trend = 0.009). Factors associated with increased risk of NTHi infection included less spontaneous otorrhea (OR 0.15, 95% CI 0.06-0.39, P < 0.001), absence of fever (OR 0.30, 95% CI 0.14-0.66, P = 0.003), concurrent sinusitis (OR 2.91, 95% CI 1.36-6.20, P = 0.006), previous ventilation tube insertion (OR 12.02, 95% CI 3.15-45.92, P < 0.001) and recurrent OM (OR 3.43, 95% CI 1.01-11.71, P = 0.049). The susceptibility of NTHi to amoxicillin/clavulanate was 82.0%.

CONCLUSIONS

NTHi OM has trended upward in the post-PCV era. Concurrent sinusitis, previous ventilation tube insertion, and recurrent OM were associated with NTHi OM implicated a correlation between NTHi and complex OM. In consideration of NTHi infection, we suggest amoxicillin/clavulanate as the first-line therapy for OM among Taiwanese children.

Authors+Show Affiliations

Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; Department of Pediatrics, Taiwan Adventist Hospital, Taipei, Taiwan.Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei, Taiwan.Department of Pediatrics, MacKay Memorial Hospital Tamshui, New Taipei, Taiwan.Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.Department of Pediatrics, MacKay Memorial Hospital Tamshui, New Taipei, Taiwan.Department of Otorhinolaryngology, MacKay Memorial Hospital, Taipei, Taiwan.Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan. Electronic address: chi.4531@mmh.org.tw.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28988664

Citation

Cho, Ying-Chun, et al. "Epidemiology and Antimicrobial Susceptibility of Non-typeable Haemophilus Influenzae in Otitis Media in Taiwanese Children." Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi, vol. 52, no. 1, 2019, pp. 75-80.
Cho YC, Chiu NC, Huang FY, et al. Epidemiology and antimicrobial susceptibility of non-typeable Haemophilus influenzae in otitis media in Taiwanese children. J Microbiol Immunol Infect. 2019;52(1):75-80.
Cho, Y. C., Chiu, N. C., Huang, F. Y., Huang, D. T., Chang, L., Huang, C. Y., ... Chi, H. (2019). Epidemiology and antimicrobial susceptibility of non-typeable Haemophilus influenzae in otitis media in Taiwanese children. Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi, 52(1), pp. 75-80. doi:10.1016/j.jmii.2017.08.020.
Cho YC, et al. Epidemiology and Antimicrobial Susceptibility of Non-typeable Haemophilus Influenzae in Otitis Media in Taiwanese Children. J Microbiol Immunol Infect. 2019;52(1):75-80. PubMed PMID: 28988664.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Epidemiology and antimicrobial susceptibility of non-typeable Haemophilus influenzae in otitis media in Taiwanese children. AU - Cho,Ying-Chun, AU - Chiu,Nan-Chang, AU - Huang,Fu-Yuan, AU - Huang,Daniel Tsung-Ning, AU - Chang,Lung, AU - Huang,Ching-Ying, AU - Kung,Yen-Hsin, AU - Lee,Kuo-Sheng, AU - Chi,Hsin, Y1 - 2017/09/18/ PY - 2017/04/24/received PY - 2017/08/18/revised PY - 2017/08/28/accepted PY - 2017/10/11/pubmed PY - 2019/9/13/medline PY - 2017/10/10/entrez KW - Children KW - Non-typeable Haemophilus influenzae KW - Otitis media KW - Recurrent otitis media KW - Ventilation tube SP - 75 EP - 80 JF - Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi JO - J Microbiol Immunol Infect VL - 52 IS - 1 N2 - BACKGROUND: Concerns about non-typeable Haemophilus influenzae (NTHi) in otitis media (OM) have grown after the introduction of pneumococcal conjugate vaccine (PCV). We aim to better understand the clinical role of NTHi in pediatric OM. METHODS: Middle ear fluid samples from children <18 years with OM were obtained from 2010 to 2015. For culture-positive episodes (Streptococcus pneumoniae, H. influenzae, Moraxella catarrhalis, and Streptococcus pyogenes), patients' demographic and clinical information were reviewed and analyzed. RESULTS: A total of 783 episodes were included with 31.8% of isolates as positive. S. pneumoniae was recovered in 69.4%, NTHi in 24.6%, M. catarrhalis in 5.6%, and S. pyogenes in 4.0% of culture-positive episodes. The proportion of pneumococcal OM has declined since 2012 (P for trend <0.005), but NTHi OM rose simultaneously (P for trend = 0.009). Factors associated with increased risk of NTHi infection included less spontaneous otorrhea (OR 0.15, 95% CI 0.06-0.39, P < 0.001), absence of fever (OR 0.30, 95% CI 0.14-0.66, P = 0.003), concurrent sinusitis (OR 2.91, 95% CI 1.36-6.20, P = 0.006), previous ventilation tube insertion (OR 12.02, 95% CI 3.15-45.92, P < 0.001) and recurrent OM (OR 3.43, 95% CI 1.01-11.71, P = 0.049). The susceptibility of NTHi to amoxicillin/clavulanate was 82.0%. CONCLUSIONS: NTHi OM has trended upward in the post-PCV era. Concurrent sinusitis, previous ventilation tube insertion, and recurrent OM were associated with NTHi OM implicated a correlation between NTHi and complex OM. In consideration of NTHi infection, we suggest amoxicillin/clavulanate as the first-line therapy for OM among Taiwanese children. SN - 1995-9133 UR - https://www.unboundmedicine.com/medline/citation/28988664/Epidemiology_and_antimicrobial_susceptibility_of_non_typeable_Haemophilus_influenzae_in_otitis_media_in_Taiwanese_children_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1684-1182(17)30203-7 DB - PRIME DP - Unbound Medicine ER -