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Category: Volume 07 Issue 01 January 2019
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Title: Bacteriological Profile and Antibiotic Susceptibility Pattern in Cases of Chronic Otitis Media – Active Mucosal Disease in a Tertiary Care Setting

Authors: Dr Jincy JP, Dr Susan James, Dr Jyothi R, Dr Satheesh S, Dr Shaiju A

 DOI: https://dx.doi.org/10.18535/jmscr/v7i1.155

Abstract

Background: Chronic otitis media is defined by otorrhoea of at least six weeks duration in the presence of a chronic tympanic membrane perforation1. It can cause many complications if not treated properly and is well known for its recurrence and persistent infection. Its incidence is increasing in the developing countries because of poor hygienic practices and lack of health education. The complications of chronic otitis media have been reduced to a greater extent because of the invention of antibiotics. But irrational use of antibiotic has led to the emergence of resistant organisms to the commonly used drugs. Knowledge of local microbiological flora is essential for initiating empirical therapy pending culture results, making it mandatory for periodic surveillance of microbiological profile & sensitivity pattern.

Materials and Method: This study is conducted over a period of 24 months (March 2016 to February 2018 ). A total of 166 cases of chronic otitis media active mucosal disease who were not  on any antibiotic (systemic and topical treatment) for a minimum of 48hrs prior to sample collection were taken and pus sent for culture and sensitivity. The factors affecting the development of multidrug resistant organisms were also evaluated.

Results: Out of the 166 cases of chronic otitis media active mucosal disease, 76.5% cases were culture positive. Pseudomonas aeruginosa (31.9%) was the most common organism isolated followed by Staphylococcus aureus (24.1%) of which Methicillin Sensitive Staphylococcus aureus was 19.3% and Methicillin Resistant Staphylococcus aureus was 4.8% followed by mixed growth (9%), fungus (6.6%) [Candida species – 4.2% & Aspergillus species – 2.4%], Streptococci (1.8%), Acinetobacter & Enterococci (1.2%), Klebsiella (0.6%). Culture was sterile for 23.5% cases.  The first line antibiotic (Ciprofloxacin and Gentamycin) sensitivity for Pseudomonas is only 35.8%, second line antibiotic (Amikacin) sensitivity is 47.2%. 54.7% of cases were sensitive to Ceftazidime, 86.8% of cases were sensitive to Piperacillin+ Tazobactum and 75.5% were sensitive to Cefoperazone + Sulbactum. Pseudomonas showed sensitivity to the higher antibiotic Imipenem in 52% cases. Among the first line antibiotics Staphylococcus aureus showed maximum sensitivity to Cloxacillin (80%), followed by Gentamycin (70%). Sensitivity for second line agents such as Amikacin is 88.9% and Trimethoprim – Sulfamethoxazole is 77.8%. 90.3% showed sensitivity to third line antibiotic (Vancomycin). According to our study, there is a significant association between multidrug resistant Pseudomonas aeruginosa and previous history of minor ear procedures that patients underwent (p value -0.000).

Keywords: Chronic otitis media, culture, Pseudomonas, Staphylococcus, Antibiotic, Sensitivity.

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Corresponding Author

Dr Susan James

Department of ENT, Assistant Professor, Government Medical College, Thiruvananthapuram