Prevalence of common bacterial etiology and antimicrobial susceptibility pattern in patients with otitis media in Duhok Province –Iraq

Abstract

     Otitis media is the most frequent type of ear infection. It is a major health problem for both children and adults but the proportion is different in different countries. The current study was designed to determine the frequency of bacterial isolates causing otitis media and their antimicrobial resistance profile to assess the incidence of multidrug-resistant (MDR), extensively drug-resistant (XDR), and pan drug resistance (PDR) among the isolated pathogens. Also, to determine the various risk factors (age, gender, type, and site of infection) associated with ear infection. A total of 200 ear discharge samples were collected from patients aged 1-77 years attending the Ear, Nose, and Throat (ENT) unit in Azadi Teaching Hospital in Duhok city from November 2018 to September 2019. The clinical samples were cultured and bacterial isolates were identified by standard microbiological methods then confirmed by VITEK® 2 Compact automated system. All gram-negative bacterial isolates were studied phenotypically for Extended Spectrum Beta Lactamase production. Out of 200 ear swabs, 95% confirmed positive culture; 85.8% were bacterial isolates. From the total bacterial isolates, 57% were gram-positive bacteria, while gram-negative bacteria were 43%; with predominant of Pseudomonas aeruginosa, (22%) followed by Staphylococcus aureus (19%) and Coagulase negative Staphylococci (18%). The prevalence of otitis media was not significantly affected by gender. The majority of patients belonged to the age group (1-10) years old. 64.1% of the isolates were characterized as MDR, 31.7% were XDR, with one (0.7%) as PDR. Among these, 60.7% isolates were ESBL producers, Pseudomonas aeruginosa was the most frequent ESBL- producing isolates (45.9%), followed by Proteus spp (18.9%). The in-vitro sensitivity results indicated that Gentamycin and Ciprofloxacin were effective antibiotics in the treatment of otitis media. Additionally, Meropenem, Imipenem, Cefepime, and Azetronam were also the most effective drug against Pseudomonas aeruginosa. We concluded that the drug resistant isolates were common, worryingly high, leaving only limited drugs as a treatment choice.