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Microbiological and their antimicrobial susceptibility pattern in patients with chronic discharging ear disease.

INTRODUCTION: Chronic suppurative otitis media (CSOM) has been an important cause of middle ear disease since prehistoric times. Its incidence appears to depend to some extent on race and socioeconomic factors. It may result in permanently disabling and potentially fatal complications. The organism isolated in CSOM can be aerobes, anaerobes mixed or fungi. [1]

The causative infection may be in the nose, paranasal sinuses or in the oropharynx, and can lead to ascending infection of the Eustachian tube. [2] In a discharging ear both topical and systemic therapy is employed to control infection. [3,4]

Due to irrational use of wide-spectrum antibiotics, problem of resistance become very common. So choice of antibiotics therapy depends on the organism isolated in the culture. [5]

MATERIAL AND METHODS: This is a prospective observational study conducted in tertiary care centre, Ranchi, Jharkhand over 30 patients attended outdoor and indoor with ear discharge with signs and symptoms of chronic otitis media. Detailed history and examination were done. All patients having ear discharge for more than 3 months duration were included.

Commercially available single use cotton swabs were used to collect pus and care was taken to avoid surface contamination and swab was sent to microbiology department for bacteriological pattern and antibiotics susceptibility assessment. All micro-organism isolated were identified using standard microbiological methods, and their antimicrobial sensitivity performed using Kirby-Bauer disc diffusion method.

RESULT: There were total 30 patients of age ranged from 10 years to 60 years were included in the study. Male to female ratio is 21: 9.

Staphylococcus aureus were isolated in 22 cases followed by Pseudomonas aeruginosa in 6 cases, while 2 cases showed coliforms. In total, Staphylococcus aureus were found susceptible to gentamicin and levofloxacin in 86.36% cases, ciprofloxacin in 81.81% cases followed by lomefloxacin in 77.27%, amikacin in 68.18%, ampicillin in 54.55%, erythromycin (18.18%), and cloxacillin (13.63%).

Drug susceptibility of Pseudomonas aeruginosa, of total 6 isolates, 83.33% were found susceptible to amikacin, 66.67% to lomefloxacin, azithromycin to 50%, and 100% isolates were showed resistant to ciprofloxacin and cloxacillin.

Coliforms showed 100% resistance to amoxicillin and ampicillin while 100% susceptibility towards amikacin and gentamicin.

DISCUSSION: Usually the most common pathogen isolated around world in CSOM patient is Pseudomonas species and less commonly Staphylococcus species, [6,7] and coliforms, occasionally fungi and viruses. Some studies revealed to have higher incidence of CSOM among males than female, [8] but others have found female preponderance!9 Early bacteriological evaluation of isolates will assure accurate and effective therapy.

Ear swab microbiological studies of chronic discharging ear revealed that the most frequently isolated bacteria was Pseudomonas aeruginosa (30.96%), Staphylococcus aureus (29.65%), and coliform (14.2%). [10] and Pseudomonas aeruginosa (31.1%), Staphylococcus aureus (19.1%), Proteus species (7.7%), Klebsiella species (1%) and fungi. [11]

In our study, the most common pathogen isolated is Staphylococcus aureus (73.33%) followed by Pseudomonas aeruginosa (20%) and coliforms (6.67%).

Some studies also revealed that the most common micro-organism isolated were Staphylococcus aureus (37.6%) followed by Pseudomonas aeruginosa (32.8%), Klebsiella pneumoniae (4%). E. coli (3.2%), streptococcus pneumoniae (1.6%) and Proteus mirabilis (0.8%). [12]

Staphylococcus aureus susceptibility with ciprofloxacin was 81. 81% in our study. In some of the study, susceptibility with ciprofloxacin was on lower side (55.3%) [12], and were on higher side (83.0%-95.0%). [13,14,15] Staphylococcus aureus were resistant with ampicillin in 45. 45% cases. But, in study at Rawalpindi by Aslam, et al [16] resistance with ampicillin and amoxicillin was found to be 77.2%.

Pseudomonas aeruginosa showed 83.33% sensitivity with amikacin, 66.67% with gentamicin in our study. Mirza, et al, [17] found sensitivity of 45% with gentamicin and 48% with amikacin. Tahir, et al, [14] observed sensitivity of 60% with gentamicin and 70% with amikacin.

In our study, Coliforms showed 100% sensitivity towards amikacin and gentamicin, and 100% resistance to ampicillin.

CONCLUSION: Our study showed, Staphylococcus aureus, most common organism isolated and susceptibility towards gentamicin was 86.36% and towards ciprofloxacin 81.81% and followed by Pseudomonas and Coliforms. The study showed increasing resistance to commonly used ant microbiological agents. Thus, evaluation of microbiological profile and their antimicrobial susceptibility pattern will be helpful in prescribing specific antibiotics and preventing further emergence of resistance.

DOI: 10.14260/Jemds/2015/950

REFERENCES:

[1.] Brook I. Microbiology and management of Chronic Suppurative Otitis Media in children. J Trop Pediatr 2003; 49: 196-9.

[2.] Aroll B. Antibiotics for upper respiratory tract infection. J Resipir Med 2005; 99: 250-5.

[3.] Miro N. Controlled multicenter study on chronic suppurative otitis media treated with topical applications of ciprofloxacin 0.2% solution in single dose containers or contamination of polymyxin B, neomycin, and hydrocortisone suspension. Otolaryngol Head Neck Surg 2000; 123: 617-23.

[4.] Suzuki K, Nishimura T, Baba S, Yanagita N, Ishigami H. T opical ofloxacin for chronic suppurative otitis media and acute exacerbation of chronic otitis media: Optimum duration of treatment. Otol Neurotol 2003; 24: 447-52.

[5.] Kenna MA, Rosane BA, Bluestone CD. Medical management of chronic suppurative otitis media without cholesteatoma in children: Update 1992. Am J Otol 1993; 14: 469-73.

[6.] Indudharan R, Haq JA, Aiyar S. Antibiotics in chronic suppurative otitis media: A bacteriologic study. Am Otol Rhinol Laryngol 1999; 108: 440-5.

[7.] Kenna MA, Bluestone CD, Reilly J. Medical management of chronic suppurative otitis media without cholesteatoma in children. Laryngoscope 1986; 96: 146-51.

[8.] Teele DW, Klein JO, Rosner B; Greater Boston Otitis Media Group. Epidemiology of otitis media during the first seven yeasrs of life in children in greater Boston: A prospective cohort study. J Infect Dis 1989; 160: 83-94.

[9.] Casselbrant ML, Mandel EM, Kurs- Lasky M, Rockette HE, Bluestone CD. Otitis media in a population of black American and white American infants, 0-2 years of age. Int J Pediatr Otorhinolaryngol 1995; 33: 1-16.

[10.] Raghuvendra Singh Gaur, John Mathew, Ajoy Mathew Varghese, George Ani Mathew, Ramanathan Chandrasekharan, Shalini Anandan. Microbiological pattern of ear swabs in chronically discharging ears in a tertiary care hospital in India. Indian J Otol 2013; 19: 51-54.

[11.] Ricciardiello F, Cavaliere M, Mesolella M, Iengo M. Notes on the microbiology of cholesteatoma: Clinical findings and treatment. Acta Otorhinolaryngol Ital 2009; 29: 197-202.

[12.] Arti Agarwal, Dharmendra Kumar, Ankur Goyal, Sapna Goyal, Namrata Singh, Gaurav Khandelwal. Microbiological profile and their antimicrobial sensitivity pattern in patients of otitis media with ear discharge. Indian J Otol 2003; 19: 5-8.

[13.] Nia KM, Sepehri G, Khatmi H, Shakibaie MR. Isolation and antimicrobial susceptibility of bacteria from chronic suppurative otitis media patients in Kerman, Iran. Iran Red Cresent Med J 2011; 13: 891-4.

[14.] Tahir M, Jawaid A, Abdullah A, Najam MA. Bacterial culture and sensitivity in active chronic otitis media: 500 cases in combined military hospital Rawalpindi. Pak J Otolaryngol 2012; 28: 56-8.

[15.] Madana J, Yolmo D, Kalaiarasi R, Gopalkrishnan S, Sujata S. Microbiological profile with antibiotic sensitivity pattern of cholesteatoma chronic suppurative otitis media among children. Int J Pediatr Otorhinolaryngol 2011; 75: 1104-8.

[16.] Van Hasselt P, van Kregten E. Treatment of chronic suppurative otitis media with ofloxacin in hydroxypropyl methylcellulose ear drops. A clinical/ bacteriological study in a rural area of Malawi. Int J Pediatr Otorhinolaryngol 2002; 63: 486-89.

[17.] Mirza IA, Ali L, Arshad M. Microbiology of chronic Suppurative otitis media experience of Bahawalpur. Pak Armed Force Med J 2008; 58: 372-6.

Abhinav Paul Minj (1), Amit Kumar (2), Tarun Gurjar (3), Binod Kumar Sinha (4), Chandra Kant (5)

AUTHORS:

(1.) Abhinav Paul Minj

(2.) Amit Kumar

(3.) Tarun Gurjar

(4.) Binod Kumar Sinha

(5.) Chandra Kant

PARTICULARS OF CONTRIBUTORS:

(1.) Junior Resident-III, Department of ENT, RIMS, Ranchi.

(2.) Senior Resident, Department of ENT, RIMS, Ranchi.

(3.) Junior Resident-II, Department of ENT, RIMS, Ranchi.

FINANCIAL OR OTHER COMPETING INTERESTS: None

(4.) Assistant Professor, Department of ENT, RIMS, Ranchi.

(5.) Professor & Head, Department of ENT, RIMS, Ranchi.

NAME ADDRESS EMAIL ID OF THE CORRESPONDING AUTHOR:

Dr. Amit Kumar, Senior Resident, Department of ENT, RIMS, Ranchi-834009.

E-mail: amit.kumar17031981@gmail.com

Date of Submission: 24/03/2015.

Date of Peer Review: 25/03/2015.

Date of Acceptance: 30/04/2015.

Date of Publishing: 08/05/2015.
TABLE 1: SEX DISTRIBUTION

TYPE OF OTITIS MEDIA      SEX     NO. OF CASES     %
CSOM                     MALE          21         70
CSOM                    FEMALE          9         30

TABLE 2: STAPHYLOCOCCUS AUREUS

        ANTIBIOTIC     SUSCEPTIBLE %     RESISTANT %

1.    GENTAMICIN           86.36            13.63
2.    LEVOFLOXACIN         86.36            13.63
3.    CIPROFLOXACIN        81.81            18.182
4.    LOMEFLOXACIN         77.27            22.73
5.    AMIKACIN             68.18            31.82
6.    AMPICILLIN           54.55            45.45
7.    ERYTHROMYCIN         18.18            81.82
8.    SPARFLOXACIN         27.27            72.73
9.    CLOXACILLIN          13.63            86.36
10.   AZITHROMYCIN         13.63            86.36

TABLE 3: PSEUDOMONAS AERUGINOSA

      ANTIBIOTIC       SUSCEPTIBLE%    RESISTANT%

1.    AMIKACIN             83.33          16.67
2.    GENTAMICIN           66.67          33.33
3.    LOMEFLOXACIN         66.67          33.33
4.    AZITHROMYCIN          50             50
5.    LEVOFLOXACIN         16.67          83.33
6.    AMPICILLIN           16.67          83.33
7.    CIPROFLOXACIN          0             100
8.    CLOXACILLIN            0             100

TABLE 4: COLIFORMS

      ANTIBIOTIC    SUSCEPTIBLE %    RESISTANT %

1.    AMOX/CLAV           0              100
2.    AMPICILLIN          0              100
3.    AMIKACIN           100              0
4.    GENTAMICIN         100              0
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Title Annotation:ORIGINAL ARTICLE
Author:Minj, Abhinav Paul; Kumar, Amit; Gurjar, Tarun; Sinha, Binod Kumar; Kant, Chandra
Publication:Journal of Evolution of Medical and Dental Sciences
Article Type:Clinical report
Date:May 11, 2015
Words:1524
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