The Role of Routine Culture in the Treatment of Chronic Suppurative Otitis Media: Implications for the Standard of Care in Rural Areas of South Africa

Julia Toman,J Zachary Porterfield,Melynda Barnes,Anthony Moll,Sheela Shenoi

doi:10.3390/tropicalmed4010010

Abstract

Chronic Suppurative Otitis Media (CSOM) is a widely prevalent disease, which is a leading cause of acquired deafness worldwide, and is associated with complications with significant mortality and morbidity. It often responds poorly to standard of care therapy and places a disproportionate burden on at-risk populations. The microbiology and antibiotic resistance of CSOM varies based on local factors, including health care access, comorbidities, and antibiotic prescribing practices. We evaluated the role and feasibility of using routine culture for the treatment of CSOM in rural areas as a means of improving treatment of CSOM. More than 400 patients were screened in a rural clinic in South Africa over six weeks, and 14 met study criteria and consented for participation. Gram-negative organisms predominated overall, although Staphylococcus aureus was the most commonly isolated single species. A majority of the pathogens were relatively sensitive to commonly prescribed antibiotics, but two cases of methicillin resistant Staphylococcus aureus were cultured, and one patient grew a Scedosporium species. Treatment on follow-up was able to be directed by culture results, suggesting routine culture at the initial point of contact with the health care system may play a pivotal role in addressing this widely prevalent and devastating disease.

Highlights

The World Health Organization estimates that between 65 and 330 million people worldwide are affected by Chronic Suppurative Otitis Media (CSOM), with a prevalence ranging from ~0.9% of children in the developed world to ~20% in the developing world and in certain at-risk populations [1,2,3]
Chronic otorrhea is classically associated with Pseudomonas aeruginosa, Staphylococcus aureus, and Klebsiella spp. infection; the responsible pathogens may vary depending on local prevalence, comorbidities, and patterns of antibiotics use [1,2,3,4,5,6]
Approximately 400 patients from the Msinga municipality of KwaZulu-Natal, South Africa were screened as a part of a needs assessment for ENT services and CSOM in rural South Africa

Summary

Introduction

The World Health Organization estimates that between 65 and 330 million people worldwide are affected by Chronic Suppurative Otitis Media (CSOM), with a prevalence ranging from ~0.9% of children in the developed world to ~20% in the developing world and in certain at-risk populations [1,2,3]. CSOM has been suggested to be responsible for up to 80% of acquired hearing impairment in some communities, with reports showing that between 40 and 91% of children have some degree of permanent hearing loss [6,8]. This can translate into difficulty with speech acquisition, impaired cognitive development, poor school performance, and difficulty in finding future employment in adults, and carries an associated social stigma

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Results

Conclusion