Abstract
BackgroundBecause 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.MethodsMiddle 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.Results119 (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.ConclusionsHaemophilus 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.
Highlights
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
Single bacterial species were identified in the majority of children with acute otitis media (AOM) and a minority of children with otitis media with effusion (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)
Summary
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. The bacterial pathogens most commonly cultured from the middle ear effusions of children with AOM are H. influenzae, S. pneumoniae, and M. catarrhalis [11,12]. A. otitidis, a pathogen first isolated from middle ear effusions of children with OME [18], was more recently identified because its slow growth characteristics are not conducive to identification using conventional bacterial culture methods [13]. We used a multiplex PCR to determine the prevalence of four known otopathogens (H. influenzae, S. pneumoniae, A. otitidis, and M. catarrhalis) in the middle ear effusions of children undergoing routine tympanostomy placement
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