Abstract
BackgroundThe etiology and epidemiology of acute otitis media (AOM) are poorly understood in China. This study aimed to describe the etiology of AOM and the phenotypic and molecular characteristics of AOM-causing Streptococcus pneumoniae (S.pneumoniae) recovered from Chinese children.MethodsA retrospective study was conducted to enrol patients younger than 18 years diagnosed as AOM. Middle ear fluid specimens were collected then cultured for bacterial pathogens. All S.pneumoniae isolates were tested for antibiotic susceptibility, serotypes, virulence genes, antibiotic resistant determinants and sequence types.ResultsThe dominant otopathogen among AOM children was S.pneumoniae (54.4%). Among S.pneumoniae isolates, there were 97.3, 97.3 and 75.7% isolates resistant to erythromycin, tetracycline and trimethoprim-sulfamethoxazole, respectively. There was 72.8% S.pneumoniae with multidrug resistance. The dominant sequence types (STs) were ST271 and ST320, whereas the prevailing serotypes were 19F and 19A. The 7-valent and 13-valent pneumococcal conjugate vaccine (PCV) coverage among AOM children were 73.0 and 94.6%, respectively. Additionally, we found that CC271 expressed more of mef(A/E) (P < 0.001), pspA (P = 0.022) and sipA (P < 0.001) than non-CC271 isolates.ConclusionThe high prevalence of international multidrug-resistant clone (Taiwan19F-14) in China necessitates continued dedication to expand PCV13 immunization and better control of antibiotic use in China.
Highlights
The etiology and epidemiology of acute otitis media (AOM) are poorly understood in China
All 37 children experiencing pneumococcal AOM were less than 2 years old, whilst 62.2% were male
The proportion of pneumococcal isolates that were resistant to penicillin, was inconsistent with previous reports from China that demonstrated a high prevalence of resistance to penicillin [6, 20]
Summary
The etiology and epidemiology of acute otitis media (AOM) are poorly understood in China. Acute otitis media (AOM) is one of the most frequently encountered bacterial infections and the leading cause of medical visits and antibiotic prescription in children worldwide [1, 2]. Among the pathogens involved in this infection, Streptococcus pneumoniae (S.pneumoniae) and Haemophilus influenzae (H.influenzae) are the principal bacterial otopathogens that account for up to 60–80% of microbiologically confirmed AOM [3, 4]. Concerns have been rising about the major role of S.pneumoniae in AOM etiology, which coincides with growing antibiotic resistance rates among S.pneumoniae isolates. Increasing rates of resistance of S.pneumoniae to commonly used antibiotics highlights the increased urgency for use of vaccines for controlling pneumococcal diseases. The heptavalent pneumococcal polysaccharide conjugate vaccine (PCV7) has had a dramatic effect on reducing the disease burden of pneumococcal diseases
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