Bacteriological study of discharging ear in patients attending a tertiary care hospital

Ear infections occur in all age groups. Chronic Suppurative Otitis Media (CSOM) is the most common illness in ENT practice. It may even cause hearing impairment especially sensory – neural deafness if not treated properly and with caution. The study was undertaken to know the aerobic microbiological/bacteriological profile of ear discharge and variations in sensitivity pattern to treat the patients efficiently. A total of 71 patients who had discharging ear infection were included in this study. The most common microorganisms isolated were Pseudomonas aeruginosa and Staphylococcus aureus followed by Coagulase-Negative Staphylococci (CoNS), Klebsiella spp, Proteus spp and Escherichia coli. Among the commonly used topical antibiotics, Ciprofloxacin appear to be first line antibiotic (91.52% sensitive) to treat CSOM followed by Gentamycin (89.6% sensitive). However, the action of Chloramphenicol was low (59.53% sensitive). Ofloxacin can be used to treat CSOM due to Staphylococcus aureus other than Ciprofloxacin and Gentamycin

Aerobic bacteriology of chronic suppurative otitis media: a hospital based study

Background: Chronic suppurative otitis media (CSOM) remains one of the most common childhood chronic infectious diseases worldwide, affecting diverse racial and cultural groups both in developing and industrialized countries. It involves considerable morbidity and can cause extra- and intra-cranial complications. The aim of this study was to determine the microbial diversity and the antibiogram of aerobic bacterial isolates among patients suffering from CSOM who attended the ENT Department of SMHS hospital, a tertiary care centre located in the heart of the Kashmir valley.Methods: A total of 154 patients clinically diagnosed with CSOM were enrolled in the study and the samples were obtained from each patient using sterile cotton swabs and cultured for microbial flora. Drug susceptibility testing for aerobic isolates was conducted using Kirby-Bauer disc diffusion method.Results: Out of total 154 ear swabs processed, microbial growth was seen in 138 (89.61%) while 16 (10.38%) samples showed no growth. In 102 (66.23%) samples mono-microbial growth was seen whereas 26 (16.88%) samples showed poly-microbial growth. The most frequent organism isolated was Pseudomonas aeroginsa followed by Staphylococcus aureus and Proteus sp. The most effective antibiotic against Pseudomonas aeroginsa was amikacin followed by imipenem and piperacillin plus tazobactam, while as Staphylococcus aureus showed maximum sensitivity to vancomycin.Conclusion: Otitis media linked with high levels of multiple antibiotic resistant bacteria is a major health concern in all age groups of the study population. An appropriate knowledge of the etiology and antibacterial susceptibility of microorganisms would contribute to a rational antibiotic use and the success of treatment for chronic supportive otitis media.

Chronic suppurative otitis media: bacteriology, susceptibility and clinical presentation among ENT patients at Mulago Hospital, Uganda

Background: Chronic Suppurative Otitis Media (CSOM) is a major health concern in developing countries due to its association with hearing impairment, particularly among children as it may affect their communication skills. Serious complications like meningitis and brain abscess have been reported as a cause of death.Objective: The study aimed to determine the bacteriology, susceptibility and clinical presentation of chronic suppurative otitis media among ENT patients at Mulago, Uganda.Methodology: We performed a cross sectional study and enrolled 89 patients. Pus was collected from the middle ear for microbial laboratory examination. Our primary outcome was microbial isolates, sensitivity patterns and common clinical features.Results: The commonest isolates identified were Pseudomonas aeruginosa (17.32%), Klebsiella pneumoniae (17.32%), Proteus mirabilis (13.39%), Escherichia coli (9.5%) and Staphylococcus aureus (9.5%). Pseudomonas aeruginosa was found to be 64.7% sensitive to ciprofloxacin, 57.1% to chloramphenicol, and 41.2% to gentamicin. More than 60% of patients had a hearing impairment; 78% had a central perforation.Conclusion: Susceptibility patterns to antimicrobial agent greatly varied but most demonstrated sensitivity to ciprofloxacin followed by choramphenicol and gentamicin.Keywords: chronic suppurative otitis media, bacterial isolates, susceptibility profile

Microbiology of chronic suppurative otitis media at Queen Elizabeth Central Hospital, Blantyre, Malawi: A cross-sectional descriptive study

Background Chronic suppurative otitis media (CSOM) is still a significant health problem in developing countries. Therefore, it was pertinent to determine the local Malawian microbiology in order to guide adequate treatment, avoid complications, and provide records for future reference.Aim The study sought to determine the CSOM-causing microorganisms at Queen Elizabeth Central Hospital in Blantyre, Malawi, and establish their relationship signs and symptoms, and with the demographic pattern of the study.Methods This was a hospital-based cross-sectional descriptive study carried out at the ENT outpatient clinic and the Microbiology Department of Queen Elizabeth Central Hospital.The sample comprised 104 patients with unilateral or bilateral active CSOM, who met the inclusion criteria. All patients were evaluated through a detailed history and clinical examination. Pus samples from draining ears were collected by aspiration with a sterile pipette. The specimens were immediately sent for microbiological analysis. Data were analyzed using SPSS.version 20.Results The study found that Proteus mirabilis, Pseudomonas aeruginosa, and Staphylococcus aureus were the most prevalent aerobic bacteria, while Bacteroides spp. and Peptostreptococcus spp. were the commonest anaerobic bacteria causing CSOM. These CSOM-causing microorganisms were predominant among males aged 18 years and below. Some CSOMcausing microorganisms were—significantly more so than the others—characteristically associated with each of the following clinical features: quantity of pus drainage, mode of onset, otalgia, hearing loss, location of tympanic membrane perforation, and mucosal appearance

Prevalence of Pathogenic Bacterial Isolates from Ear, Nose and Throat: in a Clinical Setup

Objective: To determine the Prevalence of pathogenic bacterial isolates in swabs obtained from patients with Ear, Nose and Throat Infections. Methodology: This Cross sectional hospital based study was conducted at Otolaryngology outpatients department of Capital Hospital, Islamabad, Pakistan from August, 2014 to July, 2016. Swabs for microbial culture from representative infected area were obtained i.e. ear, nose or throat. These included patients of either gender or age, who presented in the Otolaryngology outpatients with suspected bacterial ear, nose or throat infections on the basis of history and clinical examination. Patients on steroids, those with co-morbidities, immune deficient cases and those who took antibiotics in last one week were excluded. Samples (swabs) were taken throat swabs, processed by routine microbiological culture techniques for microbiological isolation. Data collected included gender, age, area of infection (ear, nose or throat) and pathogenic bacteria isolated. Data was recorded, cross tabulated and analyzed using Microsoft Excel Worksheet. Results: Of the study sample of 1439, 737(51.22%) were males and 702(48.78%) females with mean age of 29.12+19.24 years. These included 811(56.36%) cases of aural, 221(15.35%) cases of nasal and 407 (28.29%) cases of throat infections. 800(55.59%) were culture negative for pathogenic bacteria, while pathogens were isolated in 639(44.41%) cases. Staphylococcus aureus was isolated in majority i e., 434(30.16%), followed by pseudomonas in 167(11.61%) swabs. Conclusion: Staph aureus was the commonest isolate from aural and nasal swabs while majority of throat swabs were negative and in a few streptococcus pneumoniae was isolated, indirectly indicating prevalence of viral infections in the cases with throat infections. This indicates importance of culture and sensitivity in these cases before starting antibiotics

Clinical and Microbiological Profile of Active Tubo Tympanic Disease

INTRODUCTION: Chronic suppurative otitis media and its complications are among one of the most common conditions seen by otorhinolaryngologist, pediatrician and general practitioner. It is disease of multiple etiology and is well known for its persistence and recurrence inspite of treatment. Chronic suppurative otitis media is a long standing inflammation of the middle ear cleft. From early days of otology, it is divided into two clinical types. Tubotympanic and atticoantral disease. Tubotympanic disease is characterised by perforation in pars tensa. As it follows a more benign clinical course, term `safe' is applied to it, though it is not always true. It is called active when in addition to tympanic membrane defect, middle ear mucosa is inflammed and edematous with production of excess of mucus or mucopus. Even with newer antibiotics being licenced for use almost every year, chronic suppurative otitis media largely remains unconquered and continues to be one of the major causes of otologic morbidity. Its clinical significance is particularly related to its propensity to cause infectious complications as acute and chronic mastoiditis, petrositis, intracranial infections, and non-infectious sequel as chronic perforation of tympanic membrane, ossicular erosion, labyrinthine erosion, tympanosclerosis, which are the major causes of hearing loss through out the world. Management of CSOM begins with accurate documentation of tympanic membrane defect, preferably with operating microscope. Assessment of hearing loss by tuning fork test and pure tone audiometry is necessary as most of patients have associated conductive hearing loss. Appropriate therapy for otorrhea involves identification of offending organism by means of culture and sensitivity of middle ear discharge. Almost all aspects of disease have been well studied over past few decades, but exhaustive review of available literature shows many authors focussed their attention primarily on bacterial flora, with comparatively fewer reports on mycological aspects, importance of which has been increasing in recent years because of excessive use of broad spectrum antibiotics, corticosteriods, and immune deficiency states. Number of Indian reports on this aspect have been meagre. Causative bacterial flora and their sensitivity patterns are also subjected to change from time to time with emergence of multiple drug resistant strains. As for selection of first line therapy, it must be made by individual physician based on regional susceptibility data of bacterial pathogens. By this study an attempt is made to reevaluate the role of bacterial and fungal pathogens in CSOM, with regional antimicrobial susceptibility data, so as to suggest management guidelines based on these observations. AIMS AND OBJECTIVES: This study was conducted with following objectives: 1. To study clinical profile of active tubotympanic chronic otitis media cases at upgraded Institute of otorhinolaryngology, Chennai. 2. To asses prevalence and distribution of bacterial and fungal organisms in CSOM. 3. To analyze antibiotic sensitivity and resistance pattern of bacterial isolates causing Chronic Suppurative Otitis Media (CSOM). 4. To suggest practical recommendations based on the observations. MATERIALS AND METHODS: Study design: Hospital based clinical observational study. Setting: ENT out patient division of Upgraded Institute of otorhinolaryngology, Madras Medical College and Government General Hospital, Chennai. Duration: Specimen collection and analysis 1st January 2006 to 30th June 2006. Evaluation and data interpretation 1st July 2006 to 30th September 2006. Sample case selection: 100 cases of active Tubotympanic Chronic Suppurative Otitis Media by systemic random sampling method. Inclusion criteria: 1. Adult patients with active tubotympanic type of CSOM i.e. Chronic (more than 3 months) continous or intermittent otorrhea through permanent defect in parstensa, with inflammed and edematous middle ear mucosa producing excess mucus or mucopus. 2. Perforation should be moderate / large sized. 3. History of partial or no response to prior treatment with commonly used ototopical agents like gentamicin, Neomycin, Polymyxin, Ciprofloxacin, before consultation. Exclusion criteria: 1. Pediatric age group – less than 15 yrs. 2. Clinically unsafe ears – i.e. with cholesteatoma granulations or aural polyps. 3. Overt clinical evidence of otitis externa with CSOM i.e external canal congested, inflammed, with otomycotic debries, Tragal tenderness. 4. Discharging ear through a pin hole perforation. 5. Cases undergone previous ear surgeries. 6. Suspected complications of CSOM. 7. Patients with clinical evidence of chronic sinusitis chronic tonsillitis. 8. Known or treated cases of pulmonary tuberculosis. 9. Known immune deficiency states – Diabetes mellitus, AIDS, renal diseases, bronchectasis. All patients evaluated by detailed history and examination. Initially, collected discharge in external canal was cleaned by dry mopping method using sterile cotton wool tipped applicators. Otoscopic examination done, findings were documented. Audiologic evaluation done by Tuning fork tests and pure tone audiometry. Pure tone average and bone conduction at 4 KHZ recorded. SUMMARY AND CONCLUSIONS: 1. Gender distribution of CSOM shows no male : female preponderance. 2. Duration of symptoms in more than 77% patients were more than 2 years. 3. Majority of cases were unilateral (79%). 4. All patients with otorrhea, next common symptom being hard of hearing. 5. Mean pure tone average, was 40, No significant sensory neural hearing loss detected among the 100 cases. 6. Pseudomonas aeruginosa was the most common isolate. Klebsiella and aceineto bacter showed an increased incidence of 13% & 11% in the this study. 7. 30% cases showed positive results with fungal culture. i.e one in 3 patients may have superimposed fungal infections in active chronic suppurative otitis media. 8. Most common fungal isolate was Aspergillus flavus. 9. Antibiotic with maximum sensitivity to all isolates was cefoperazone –sulbactam. Ofloxain and amikacin also showed remarkable sensitivities. (more than 90%) to all isolates. Most of isolate found to be resistant to commonly used antibiotics as cefotaxime, gentamicin

Impact of general practitioner payment scheme on health care system in avoidable hospitalization for ambulatory care sensitive conditions.

This study compares the effectiveness of primary care interventions provided by general practitioners (GP) remunerated under the fee-for-service (FFS) or alternative payment plan (APP), using hospitalization rates for ambulatory care sensitive conditions (ACSC) in select Northern British Columbia (BC) communities. This study used BC Ministry of Health hospital separation data held at Population Data BC. Bivariate statistics were used to compare hospitalization rates for ACSC between both groups. The results indicate overall hospitalization rates of ACSC were higher in APP than FFS communities. Further, several ACSC showed varying hospitalization rates (asthma, pneumonia, COPD, diabetes, angina, gastroenteritis/dehydration and convulsion/epilepsy) and length of hospitalizations (convulsion/epilepsy and dental conditions) between both groups. In summary, this research informs policy on the effectiveness of GP remuneration adopted in Northern BC using hospitalization rates for ACSC. Further research is needed to further validate the findings of this study. --P. ii.The original print copy of this thesis may be available here: http://wizard.unbc.ca/record=b173819

Detection of Extended Spectrum Beta Lactamases (ESBL) and Methicillin Resistant Staphylococcus Aureus (MRSA) in Chronic Suppurative Otitis Media (CSOM) in a Tertiary Care Hospital

INTRODUCTION: Chronic suppurative otitis media (CSOM) is one of the most common infections of the middle ear which can lead to extra cranial complications and intracranial complications, especially in developing countries if not diagnosed early. So, early identification and detection of the etiological agent and its sensitivity pattern helps to prevent the complications. Judicial use of antibiotics helps to prevent the emergence of ESBL and MRSA in CSOM. AIMS AND OBJECTIVES: 1. To isolate and to identify aerobic bacteria from Chronic Suppurative Otitis Media (CSOM) cases. 2. To find out the antibiotic susceptibility pattern of the bacterial isolates. 3. To detect the Extended Spectrum Beta Lactamases (ESBLs) producers from Gram negative bacterial isolates. 4. To find the prevalence of Methicillin Resistant Staphylococcus aureus (MRSA) among Staphylococcus aureus isolates. MATERIALS AND METHODS: Total number of cases included in the study were two hundred and twelve Ear discharge were collected using the sterile cotton wool swabs. Direct gram staining was done & pusculture and bacterial identification was done. Antibiotic susceptibility testing was performed by the Kirby -Bauer disc diffusion method on MHA (Mueller Hinton agar) according to CLSI guidelines. Detection of ESBL producers was done by Phenotypic Confirmation Test Minimum Inhibitory Concentration (MIC) of Bacterial Isolates was performed by agar dilution method. Detection of Metallo beta lactamase (MBL) producers was done by Combined disc test with Ethylene diamine tetra acetic acid ((EDTA).AmpC was detected by AmpC disc test and Ceftazidime- Imipenem Antagonism test (CIAT). MRSA was detected by cefoxitin disc diffusion method. RESULTS: Out of 212 cases of CSOM, 157 cases (74.06%) were culture positive and 55 (25.94%) were culture negative .Among the 157 culture positive isolates,Gram negative organisms constitutes 113 (65.32%) and Gram positive organisms constituted 60 (34.68%) of the cases. The common age group suffering from CSOM were in the age group between 21 to 30 years 55 (25.94%) followed by 49(23.11%) in the age group OF 31 to 40 years. Males 110 (51.88%) were more affected than females 102(48.11%), Observations in this study indicates male preponderance in cases of CSOM. Pseudomonas aeruginosa 80 (46.24%) was found to be the most commonly isolated bacteria among the Gram negative isolates. In our study Staphylococcusaureus 46 (26.59%) was the most common gram positive organism isolated. Pseudomonas aeruginosa 77 (96.25%) was sensitive to amikacin and 76(95%) sensitive to ofloxacin. Klebsiellapneumoniae 20 (80%) were sensitive to amikacin. All the Gram negative bacterial isolates showed 100% sensitivity to imipenem and piperacillin/tazobactum except Pseudomonas aeruginosa78 (97.50%). Extended spectrum beta lactamases (ESBL) producers isolated from Gram negative bacteria causing CSOM was 10 (30.30%). Among the Staphylococcus aureus isolated, 41 (89.13%) and 40 (86.95%) were sensitive to amikacin and ofloxacin respectively. Staphylococcus aureus isolates were 100% sensitive to vancomycin and linezolid. 9 (19.56%) of Staphylococcus aureus isolates were Methicillin resistant Staphylococcus aureus (MRSA). All the 9(19.56%) of MRSA were 100% sensitive to vancomycin and linezolid. All the 10 isolated ESBLs were confirmed by combined disc test and Minimum Inhibitory Concentration (MIC) reduction and also were subjected to PCR. 1(16.66%) was found to be MBL producers by Ceftazidime- EDTA method,but none of them were found to be MBL producing by imipenem–EDTA method. By AmpC disk test and CIAT, 3(2.65/%) were AmpC producers. CONCLUSION: Among the Gram negative organisms, Pseudomonas aeruginosa 80 (46.24%) was found to be the most commonly isolated bacteria followed by Klebsiellapneumoniae 25 (17.09%) in our study. Staphylococcusaureus 46 (26.59%) was the most common gram positive organism isolated. Among the Staphylococcus aureus, 9 (19.56%) were found to be MRSA. Among Enterobacteriaceae isolates 10 were found to be ESBL producers. Thus, it is essential to detect Extended Spectrum etaLactamases(ESBL)and Methicillin Resistant Staphylococcus aureus (MRSA) routinely in laboratories. Administration of antibiotics should be prescribed cautiously to prevent the emergence of bacterial resistance in the hospital and community

Evaluation of Multi Drug Resistant Pseudomonas Aeruginosa Isolates in Chronic Suppurative Otitis Media.

INTRODUCTION : Ear is the most important sensory organ concerned with the perception of hearing. Infections are the leading causes of deafness worldwide. CSOM is a chronic Suppurative inflammation of mucoperiosteal layer of the middle ear cleft (Plate1). Incidence of CSOM higher in developing than developed countries particularly in India. The global burden of illness from CSOM involutes 65-330 million individuals with draining ears, 60% of whom 38-200 million suffer from significant hearing impairment CSOM accounts for 28000 deaths and a disease burden of over 2 million disability adjusted life years. Over 90% of the burden is borne by countries in south East Asia (WHO 2004). It shows the importance of controlling the infections effectively by for preventing the hearing loss all over the world. In developed countries the incidence of CSOM had come down to 0.04% of all cases of suppurative otitis media. In a rural area of India it was found to be 4.26%. Chronic suppurative otitis media is considered to be major problem in developing countries with relatively high mortality and morbidity (Glass cock et al; 1990). Pseudomonas aeruginosa is an opportunist pathogen that can infect almost any body site given the right predisposing conditions. Pseudomonas aeruginosa is a significant pathogen among gramnegative organisms infecting ear (Brobby Gwetal ; 1987, Brook I et al., 1996). Infections caused by pseudomonas aeruginosa are often severe and life threatening and are difficult to treat because of the limited susceptibility to anti microbial agents. (Carmeli; Y; et al ; 1999). The problem of antibiotic resistance in Pseudomonas aeruginosa is on the increase. Accumulation of resistance after exposure to various antibiotics and cross-resistant among agents may result in multidrug resistant Pseudomonas aeruginosa. AIMS AND OBJECTIVES : a) Isolation of aerobic causative organisms from chronic suppurative otitis media. b) Identification of pseudomonas aeruginosa from chronic suppurative otitis meida and their characterization. c) Determination of minimum Inhibitory concentration of selected expanded 3rd and 4th generation, for pseudomonas aeruginosa isolation from CSOM. d) Detection of group I inducible β – Lactamase production by the test isolates and their prevalence. e) Detection of extended spectrum of β –Lactamases (ESBLs) producers among the pseudomonas aeruginosa isolates from CSOM and their prevalence. f) To evaluate synergy effects of selected antibiotics. g) Comparative study of Multidrug resistant between Pseudomonas aeruginosa and other isolates from CSOM. h) To isolate plasmids from CSOM strains of Multidrug resistant pseudomonas aeruginosa. MATERIALS AND METHODS : All the Ear Swab specimens obtained from CSOM patient were processed in the Department of microbiology Government medical college hospital Coimbatore, South India from October 2005 to September 2006 were considered for the study, A total of 43 Pseudomonas aeruginosa isolates from chronic suppurative otitis media patients were cultured and they were stored as suspensions in a 10% (wt/vol) skim milk solution (STGG medium) containing 10% (Vol / Vol) glycerol at 80ºC until additional tests were performed. The other swab was inoculated immediately to blood Agar, chocolate Agar, Macconkey Agar, Potato dextrose Agar, Cetrimide Agar and Brain heart infusion broth for bacteria isolation. "C" shaped streaks in a row were made with spatula while inoculating solid media in order to obtain inoculums in decreasing gradation. Inclusion Criteria: 1) Recurrent or persistent ear discharge over 2-6 wks through a perforation of tympanic membrane who had not received Topical or systemic antibiotic therapy for the previous five days. 2) Patients age ranged from 1 month to 80 years. Their pathogenic potential was confirmed by correlating with clinical findings and repeat isolations. Exclusion Criteria: 1. Acute otitis media, 2. Chronic otitis media with effusion, 3. Cases having purely sanguineous or CSF otorrhoea, 4. Antibiotic therapy (Topical or systemic) with in previous five days. RESULTS : During the study period from October 2005 to September 2006 a total of 110 Ear Swabs were collected from 100 Patients with CSOM attending ENT OP, Coimbatore Medical College hospital and Ear swabs were processed in the laboratory of microbiology department Coimbatore Medical College Hospital Coimbatore. Out of 100 patients with CSOM 10 patients were suffering from bilateral CSOM (Fig.1). About 114 Organisms were isolated from 110 specimens. Among 110 specimens 105 numbers showed positive cultures (95.45%) This study showed that most common isolates obtained from CSOM patients were pseudomonas aeruginosa (37.7%), Staphylococcus aureus (32.4%), Proteus sp (12.2%), Klebsiella sp (7.8%), Coagulate negative staphylococcus aureus (2.6%), Streptococcus pyogens (1.7%), E. Coli (0.8%), Moraxella catarrhalis (0.8%), Candida Sp (2.6%), Aspergillus (0.8%). In total of 105 positive cultures 9 cultures showed mixed growth. SUMMARY : 110 Specimens were collected from 100 CSOM patients attending ENT OP at Government Medical College Hospital, Coimbatore during October 2005 to September 2006. 43 strains of pseudomonas aeruginosa were collected during the study period. Antibiotic susceptibility testing was done for these strains by Kirby -Bauer disc diffusion method. MIC for all 43 strains were detected using Hicomb test (E-TEST). Antibiotic susceptibility of the strains were correlated with their MIC value. Inducibility of beta lactamases were detected for the 20 sensitive trains isolated, by double disc diffusion test and it was observed that all 20 strains were induced to produce betalactamases with disc approximation at 20 mm apart. Only 8 (40%) were induced to produce betalactamases when the discs were 25 mm apart. ESBLs were detected for the resistance strains by double disc diffusion test. Presence of ESBL was detected in 4.3 % strains through 20mm disc approximation, 34.7% of strains through 15mm of disc approximation, 78.2% through 10 mm disc approximation

The role of middle ear risk index on the outcome of tympanoplasty

calculated. The patients were categorised into those with mild, moderate and severe MERI. The hearing benefit was calculated from the pre and post operative air-bone gap. The graft status was assessed. The relation between MERI score and graft status and between MERI score and hearing benefit was assessed by T test and Chi-Square test respectively. RESULTS: The overall graft uptake was 76%. Patients with a high MERI score have lower rate of graft uptake which is statistically significant with a P value of 0.031. Also, patients with mild MERI had greater hearing benefit and those with severe MERI had lesser hearing benefit postoperatively which is statistically significant with a P value of 0.041. The mean hearing benefit was 9.90 dB. CONCLUSION: MERI score is a prognostic tool to predict the outcome of tympanoplasty. It has an inverse relation with graft uptake and hearing benefit. Based on MERI score, the chances for surgical success and hearing benefit should be explained to the patient