Abstract
BackgroundNon-typeable Haemophilus influenzae (NTHi) and Streptococcus pneumoniae are major causes of bacterial acute otitis media (AOM). Data regarding AOM are limited in Latin America. This is the first active surveillance in a private setting in Venezuela to characterize the bacterial etiology of AOM in children < 5 years of age.MethodsBetween December 2008 and December 2009, 91 AOM episodes (including sporadic, recurrent and treatment failures) were studied in 87 children enrolled into a medical center in Caracas, Venezuela. Middle ear fluid samples were collected either by tympanocentesis or spontaneous otorrhea swab sampling method. Standard laboratory and microbiological techniques were used to identify bacteria and test for antimicrobial resistance. The results were interpreted according to Clinical Laboratory Standards Institute (CLSI) 2009 for non-meningitis isolates. All statistical analyses were performed using SAS 9.1 and Microsoft Excel (for graphical purposes).ResultsOverall, bacteria were cultured from 69.2% (63 of the 91 episodes); at least one pathogen (S. pneumoniae, H. influenzae, S. pyogenes or M. catarrhalis) was cultured from 65.9% (60/91) of episodes. H. influenzae (55.5%; 35/63 episodes) and S. pneumoniae (34.9%; 22/63 episodes) were the most frequently reported bacteria. Among H. influenzae isolates, 62.9% (22/35 episodes) were non-capsulated (NTHi) and 31.4% (11/35 episodes) were capsulated including types d, a, c and f, across all age groups. Low antibiotic resistance for H. influenzae was observed to amoxicillin/ampicillin (5.7%; 2/35 samples). NTHi was isolated in four of the six H. influenzae positive samples (66.7%) from recurrent episodes.ConclusionsWe found H. influenzae and S. pneumoniae to be the main pathogens causing AOM in Venezuela. Pneumococcal conjugate vaccines with efficacy against these bacterial pathogens may have the potential to maximize protection against AOM.
Highlights
Non-typeable Haemophilus influenzae (NTHi) and Streptococcus pneumoniae are major causes of bacterial acute otitis media (AOM)
Exclusion criteria included: children hospitalized at the time of the diagnosis or treatment of AOM, presenting with a new episode of AOM but having received antibiotic treatment in the previous 72 h for a different illness, those who had received antibiotic by the physician/ear, nose and throat (ENT) specialist prior to tympanocentesis and those with otorrhea for > 24 h or with otitis media with effusion
Bacteria were cultured from 69.2% (63) of the 91 episodes; one treatment failure episode of AOM did not show any bacterial growth
Summary
Non-typeable Haemophilus influenzae (NTHi) and Streptococcus pneumoniae are major causes of bacterial acute otitis media (AOM). Acute otitis media (AOM) is one of the most frequently diagnosed bacterial infections in children following nasopharyngeal colonization [1]. It results in frequent pediatric visits both in the developed [2] and developing world [3]. In Venezuela, approximately 100,000-130,000 AOM cases per year (2004-2007) are reported in children < 5 years of age Streptococcus pneumoniae (S. pneumoniae) and non-typeable Haemophilus influenzae (NTHi) have consistently been reported as the two major bacterial pathogens responsible for AOM, [9,10,11] identified in up to 80% of cases. 65-330 million people may suffer from CSOM [17]
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