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One third of middle ear effusions from children undergoing tympanostomy tube placement had multiple bacterial pathogens.

Holder RC, Kirse DJ, Evans AK, Peters TR, Poehling KA, Swords WE, Reid SD - BMC Pediatr (2012)

Bottom Line: Haemophilus influenzae was the predominant single organism and caused 58% of all AOM in this study.Overall, we found AOM is predominantly a single organism infection and most commonly from Haemophilus influenzae.In contrast, OME infections had a more equal distribution of single organisms, polymicrobial entities, and non-bacterial agents.

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Affiliation: Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston Salem, NC 27101, USA.

ABSTRACT

Background: Because previous studies have indicated that otitis media may be a polymicrobial disease, we prospectively analyzed middle ear effusions of children undergoing tympanostomy tube placement with multiplex polymerase chain reaction for four otopathogens.

Methods: Middle ear effusions from 207 children undergoing routine tympanostomy tube placement were collected and were classified by the surgeon as acute otitis media (AOM) for purulent effusions and as otitis media with effusion (OME) for non-purulent effusions. DNA was isolated from these samples and analyzed with multiplex polymerase chain reaction for Haemophilus influenzae, Streptococcus pneumoniae, Alloiococcus otitidis, and Moraxella catarrhalis.

Results: 119 (57%) of 207 patients were PCR positive for at least one of these four organisms. 36 (30%) of the positive samples indicated the presence of more than one bacterial species. Patient samples were further separated into 2 groups based on clinical presentation at the time of surgery. Samples were categorized as acute otitis media (AOM) if pus was observed behind the tympanic membrane. If no pus was present, samples were categorized as otitis media with effusion (OME). Bacteria were identified in most of the children with AOM (87%) and half the children with OME (51%, p < 0.001). A single bacterial organism was detected in middle ear effusions from children with AOM more often than those with OME (74% versus 33%, p < 0.001). Haemophilus influenzae was the predominant single organism and caused 58% of all AOM in this study. Alloiococcus otitidis and Moraxella catarrhalis were more frequently identified in middle ear effusions than Streptococcus pneumoniae.

Conclusions: Haemophilus influenzae, Streptococcus pneumoniae, Alloiococcus otitidis, and Moraxella catarrhalis were identified in the middle ear effusions of some patients with otitis media. Overall, we found AOM is predominantly a single organism infection and most commonly from Haemophilus influenzae. In contrast, OME infections had a more equal distribution of single organisms, polymicrobial entities, and non-bacterial agents.

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Flow Chart of PCR Analysis.
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Figure 2: Flow Chart of PCR Analysis.

Mentions: Effusions from 119 (57%) of 207 children were PCR positive for H. influenzae, S. pneumoniae, A. otitidis, and/or M. catarrhalis. Of these 119 PCR positive samples, 36 (30%) had 2–4 bacterial species detected (Figure 2, Table 3, Additional file 1: Table S1). Bacteria were identified in 33 (87%) of 38 children with AOM as compared to 86 (51%) of 169 children with OME (p < 0.001). Single bacterial species were identified in the majority of children with AOM and a minority of children with OME (74% versus 33%, p < 0.001). Identifying multiple bacterial pathogens was similar for children with AOM and OME (13% versus 18%, p = 0.64), whereas not identifying any of the four bacterial pathogens was less common for AOM than OME (13% versus 49%, p < 0.001).


One third of middle ear effusions from children undergoing tympanostomy tube placement had multiple bacterial pathogens.

Holder RC, Kirse DJ, Evans AK, Peters TR, Poehling KA, Swords WE, Reid SD - BMC Pediatr (2012)

Flow Chart of PCR Analysis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475091&req=5

Figure 2: Flow Chart of PCR Analysis.
Mentions: Effusions from 119 (57%) of 207 children were PCR positive for H. influenzae, S. pneumoniae, A. otitidis, and/or M. catarrhalis. Of these 119 PCR positive samples, 36 (30%) had 2–4 bacterial species detected (Figure 2, Table 3, Additional file 1: Table S1). Bacteria were identified in 33 (87%) of 38 children with AOM as compared to 86 (51%) of 169 children with OME (p < 0.001). Single bacterial species were identified in the majority of children with AOM and a minority of children with OME (74% versus 33%, p < 0.001). Identifying multiple bacterial pathogens was similar for children with AOM and OME (13% versus 18%, p = 0.64), whereas not identifying any of the four bacterial pathogens was less common for AOM than OME (13% versus 49%, p < 0.001).

Bottom Line: Haemophilus influenzae was the predominant single organism and caused 58% of all AOM in this study.Overall, we found AOM is predominantly a single organism infection and most commonly from Haemophilus influenzae.In contrast, OME infections had a more equal distribution of single organisms, polymicrobial entities, and non-bacterial agents.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston Salem, NC 27101, USA.

ABSTRACT

Background: Because previous studies have indicated that otitis media may be a polymicrobial disease, we prospectively analyzed middle ear effusions of children undergoing tympanostomy tube placement with multiplex polymerase chain reaction for four otopathogens.

Methods: Middle ear effusions from 207 children undergoing routine tympanostomy tube placement were collected and were classified by the surgeon as acute otitis media (AOM) for purulent effusions and as otitis media with effusion (OME) for non-purulent effusions. DNA was isolated from these samples and analyzed with multiplex polymerase chain reaction for Haemophilus influenzae, Streptococcus pneumoniae, Alloiococcus otitidis, and Moraxella catarrhalis.

Results: 119 (57%) of 207 patients were PCR positive for at least one of these four organisms. 36 (30%) of the positive samples indicated the presence of more than one bacterial species. Patient samples were further separated into 2 groups based on clinical presentation at the time of surgery. Samples were categorized as acute otitis media (AOM) if pus was observed behind the tympanic membrane. If no pus was present, samples were categorized as otitis media with effusion (OME). Bacteria were identified in most of the children with AOM (87%) and half the children with OME (51%, p < 0.001). A single bacterial organism was detected in middle ear effusions from children with AOM more often than those with OME (74% versus 33%, p < 0.001). Haemophilus influenzae was the predominant single organism and caused 58% of all AOM in this study. Alloiococcus otitidis and Moraxella catarrhalis were more frequently identified in middle ear effusions than Streptococcus pneumoniae.

Conclusions: Haemophilus influenzae, Streptococcus pneumoniae, Alloiococcus otitidis, and Moraxella catarrhalis were identified in the middle ear effusions of some patients with otitis media. Overall, we found AOM is predominantly a single organism infection and most commonly from Haemophilus influenzae. In contrast, OME infections had a more equal distribution of single organisms, polymicrobial entities, and non-bacterial agents.

Show MeSH
Related in: MedlinePlus