Bacterial Sensitivity Testing Research Articles

Bacteriological Spectrum of Different Infections and their Antibiogram at NICVD, Dhaka

Background: One of the major causes of death in the current era is the infectious diseases. Aerobic bacteria are one of the most commonly isolated organisms from hospitalised patients. Objectives: The aim of the present study was to observe the infections caused by aerobic bacteria and their antibiotics susceptibility pattern. Methods: This retrospective study was carried out in the National Institute of Cardiovascular Diseases (NICVD) from January 2012 to December 2012 for a period of one year. Patients who were admitted in medical wards and medical ICU suffering from different infections were undertaken for this study. Proper thoroughly clinical examination, routine and specific investigations were done in each case. Microbiological samplings were tried on day 1, after completion of antibiotic therapy or in between as required. Aerobic bacterial culture and sensitivity tests were done according to clinical laboratory standard institute (CLSI) standard. Result: A total of 660 samples were studied of which male (70.0%) were predominant than female (30.0%). The highest number of patients was in the age group of 30-60 years (54.0%) followed by 15-30 years (21.5%) and less than 15 years (13.0%). The mean age with standard deviation was 38.61±19.236 years. The most common isolated bacteria was Escherichia coli (40.1%) followed by Pseudomonas species (30.4%), coagulase negative Staphylococcus (19.0%) and coagulase positive Staphylococcus (5.9%); however, beta-haemolytic Streptococcus (4.2%) was detected. Urine culture has yielded Pseudomonas species (13.3%), E. coli (71.1%) and CNS (15.0%). From pus Pseudomonas species (37.3%) was isolated mostly which was 62 cases followed by E. coli (31.3%), CNS (19.3%) and CPS (7.2%). Pseudomonas species was resistant to penicillin, amoxycillin and vancomycin and ~50% resistant to cotrimoxazole, cefuroxim, ceftriaxone, piperacillin, azythromycin, cephalexin, netelmycin and pfloxacillin. Conclusion: In the conclusion, majority bacteria are resistant to commonly used antibiotics. DOI: http://dx.doi.org/10.3329/cardio.v6i2.18353 Cardiovasc. j. 2014; 6(2): 127-132

A Case of Corneal Ulcer Caused byLeclercia Adecarboxylata

Purpose: To report a case of corneal ulcer caused by Leclercia adecarboxylata in an immunocompetent patient. Case summary: A previously healthy 43-year-old female presented with right ocular pain and was referred to our clinic under the impression of corneal abrasion and secondary infection. The patient was treated at a local clinic for 3 days using artificial tears, therapeutic contact lens, topical antibiotics, and anti-inflammatory eye drops but showed no improvement. Gram staining, bacterial and fungal cultures and antibiotic sensitivity test were performed from a corneal scrape. The cultures revealed growth of Leclercia adecarboxylata. The patient was treated with moxifloxacin and ofloxacin eye drops. After 2 weeks of treatment, the infection resolved without remaining scars. Conclusions: Reportedly, Leclercia adecarboxylata affects humans only as an opportunistic pathogen or part of polymicrobial infections. However, in the present case, Leclercia adecarboxylata was isolated as a single pathogen in an immunocompetent patient which is the first clinical report of this microorganism found in an ocular sample. Therefore, if antibiotic-susceptible gram-negative bacilli are found in opthalmologic samples, the above bacteria should be considerd in the diagnosis. J Korean Ophthalmol Soc 2014;55(6):918-922

Detection and Molecular Characterization of Escherichia coli CTX-M-15 and Klebsiella pneumoniae SHV-12 β-Lactamases from Bovine Mastitis Isolates in the United Kingdom

Recent reports raised concerns about the role that farm stock may play in the dissemination of extended-spectrum β-lactamase (ESBL)-producing bacteria. This study characterized the ESBLs in two Escherichia coli and three Klebsiella pneumoniae subsp. pneumoniae isolates from cases of clinical bovine mastitis in the United Kingdom. Bacterial culture and sensitivity testing of bovine mastitic milk samples identified Gram-negative cefpodoxime-resistant isolates, which were assessed for their ESBL phenotypes. Conjugation experiments and PCR-based replicon typing (PBRT) were used for characterization of transferable plasmids. E. coli isolates belonged to sequence type 88 (ST88; determined by multilocus sequence typing) and carried blaCTX-M-15 and blaTEM-1, while K. pneumoniae subsp. pneumoniae isolates carried blaSHV-12 and blaTEM-1. Conjugation experiments demonstrated that blaCTX-M-15 and blaTEM-1 were carried on a conjugative plasmid in E. coli, and PBRT identified this to be an IncI1 plasmid. The resistance genes were nontransferable in K. pneumoniae subsp. pneumoniae isolates. Moreover, in the E. coli isolates, an association of ISEcp1 and IS26 with blaCTX-M-15 was found where the IS26 element was inserted upstream of both ISEcp1 and the blaCTX-M promoter, a genetic arrangement highly similar to that described in some United Kingdom human isolates. We report the first cases in Europe of bovine mastitis due to E. coli CTX-M-15 and also of bovine mastitis due to K. pneumoniae subsp. pneumoniae SHV-12 β-lactamases in the United Kingdom. We also describe the genetic environment of blaCTX-M-15 and highlight the role that IncI1 plasmids may play in the spread and dissemination of ESBL genes, which have been described in both human and cattle isolates.

Do wheelchairs spread pathogenic bacteria within hospital walls?

Transmission of nosocomial pathogens has been linked to transient colonization of health care workers, medical devices and other constituents of patients' environment. In this paper we present our findings concerning the presence of pathogenic bacteria on wheelchairs, and the possibility that wheelchairs constitute a reservoir of these bacteria and a means of spreading them. In this work we examined four wheelchairs, each from a different location: the internal medicine ward, the emergency department, the general surgery ward and wheelchair stockpile of the transportation unit of the hospital. The samples were collected and cultured on different media. Bacterial identification and antimicrobial sensitivity testing were carried out using accepted practices in the microbiology laboratory. We found that wheelchairs are contaminated with several pathogenic bacteria, among them antibiotic-resistant strains such as MRSA, Pseudomonas aeruginosa, Acinetobacter baumanni etc. Since there is no specific guideline protocol that deals with disinfection and cleaning frequency of wheelchairs in hospitals, we suggest each hospital to write one.

Comparison of the effect of gatifloxacin and levofloxacin for treating acute bacterial infection

Objective To compare the effect of gatifloxacin and levofloxacin for treating acute bacterial infection.Methods According to the digital table,228 patients with respiratory or urinary tract infections were randomly divided into group A and group B,114 cases in each group.Group A was given gatifloxacin 200mg,adding 5％ glucose injection 100ml intravenous drip injection twice daily; Group B was treated with levofloxacin 200mg,by adding 5％ glucose injection 100ml intravenous infusion twice daily.The treatment course lasted 7-14 days.The clincal effect,bacterial clearance rate and adverse reactions of the two groups were observed.Results The cure rate and total effective rate of group A was 68.4％,93.0％,respectively,which of group B was 66.7％,90.3％,respectively,the differences were statistically significant (x2 =0.184,0.213,all P ＞0.05).The bacterial clearance rate and bacterial drug sensitivity test sensitivity was 89.4％,78.8％,respectively,which of group B was 77.2％,70.3 ％,respectively,the differences were all statistically significant (x2 =4.812,4.236,all P ＜ 0.05).The incidence rate of adverse reactions of group A was 7.0％,which of group B was 6.1％,there was no statistically significant difference (x2 =0.672,P ＞0.05).Conclusion Gatifloxacin has better effect and lower adverse reactions in the treatment of acute bacterial respiratory or urinary tract infections,and there is no significant difference compared with levofloxacin treatment,and it is worthy of clinical application. Key words: Gatifloxacin; Levofloxacin; Bacteria; Infection

Drug use evaluation of cefepime in the first affiliated hospital of Bengbu medical college: a retrospective and prospective analysis

BackgroundCefepime is a fourth generation cephalosporin antimicrobial. Its extended antimicrobial activity and infrequent tendency to engender resistance make it popular for the treatment of infections. However, proper use of cefepime has not been studied adequately. In this study, we used a retrospective cohort and a prospective cohort to evaluate the usage pattern, adverse effects and cost-effectiveness of cefepime by conducting a drug use evaluation (DUE) program in the First Affiliated Hospital of Bengbu Medical College, Anhui, China.MethodsThe DUE criteria for cefepime were established by applying literature review and expert consultation, an effective method to promote interventions that will improve patient outcomes and the cost-effectiveness of drug therapy. According to the criteria, we performed a cross-sectional retrospective (cycle A) study on 96 hospitalized patients who received cefepime treatment and a prospective (cycle B) study on 111 hospitalized patients with cefepime treatment intervention. After identifying problems with usage and completing a cefepime use evaluation for cycle A, 2 months of educational intervention among professionals were given and a more effective and rational system of cefepime use was set up. During the 2 months, the lectures were arranged and attendance of prescribers was required.ResultsThe data from cycle A showed that the biggest problem was irrational prescription of cefepime; bacterial culture and drug sensitivity tests for cefepime were also not carried out. Following 2 months of educational intervention among professionals, the results for cycle B showed that the correct indication rate was 94.59%, compared with 84.38% in cycle A. Use of bacterial culture and sensitivity tests also improved, by 88.29% in cycle B compared with 65.22% in cycle A. Compared with cycle A, the significantly improved items (P < 0.05) in cycle B were blood examination, liver function monitoring, renal function monitoring, dose and duration, dosing frequency and correct medication combinations.ConclusionsCefepime can be used appropriately for the right indications and in a cost-effective way for the majority of patients through educational intervention, including the special precautions that must be followed for appropriate dosing frequency and duration. DUE programs will become one model of hospital pharmacy care and part of the plan for continuous improvements to the quality of health care in China.

Suggested guidelines for using systemic antimicrobials in bacterial skin infections: part 1—diagnosis based on clinical presentation, cytology and culture

Systemic antimicrobials are critically important in veterinary healthcare, and resistance is a major concern. Antimicrobial stewardship will be important in maintaining clinical efficacy by reducing the development and spread of...

Community acquired secondary bacterial peritonitis in a tertiary hospital of South India: an audit with special reference to peritoneal fluid culture

This study was conducted to elucidate the spectrum of community acquired acute bacterial peritonitis, the role of microbiological culture in its management and other factors affecting its outcome. This was a prospective study wherein we examined cases of secondary bacterial peritonitis admitted and operated at our institution from January 2005 to May 2006. The peritoneal fluid was sent for bacterial culture and sensitivity testing. Patients were followed up with relevant progress details till discharge or death. We enrolled 352 patients. The mean age of the study population was 42.4 years with a male:female ratio of 7:1. Gastroduodenal perforations formed the major site of perforation (51%), followed by small bowel (29%) and appendicular perforations (17%). Culture positivity rate was 64%. Escherichia coli and Klebsiella species were the predominant isolates from peritoneal fluid. These main isolates were predominantly sensitive to ceftazidime, amikacin and chloramphenicol. Ampicillin with gentamicin and metronidazole was the first line of treatment used preoperatively in 67% of the patients, given its low cost and easier availability. The overall morbidity and mortality rates were 52% and 16.5% respectively. 78% of patients received inadequate antibiotics preoperatively. Only 26% had appropriate change of antibiotics postoperatively. There was no significant benefit of postoperative change of antibiotics based on culture results. Analysis of factors influencing mortality shows dominance of host related factors over the type and source of infection with high risk population identified by age > 60 years, delayed presentations > 3 days and APACHE II score > 15.

Pulse antibiotic therapy: it's time to cut back

The use of antibiotics in small animal practice has become an important and controversial issue. The general public is aware that antibiotic resistance is of increasing concern in medical and...

Antibiotic Sensitivity Pattern of Bacterial Isolates from Different Clinical Specimens: Experience at NICVD, Dhaka

Background: Infectious diseases are among the leading causes of death and sometimes curable. Bacteria are the most common etiology in hospitalized patients. The objective of this study was to evaluate the incidence of bacterial infections and their pattern of susceptibility to antibiotics in moderate and severe infections in patients admitted at NICVD hospital.Methodology: The study was performed in the apical teaching hospital of Bangladesh situated at Dhaka in the first half of 2012. Patients admitted in medical wards and medical ICU, suffering from moderate and severe infections were studied. Clinical evaluation, routine and specific investigations were done in each case. Microbiological samplings were tried on day 1, after completion of antibiotic therapy or in between as required. Aerobic bacterial culture and sensitivity tests were done. Result: A total of 274 cases were studied of which male (67.5%) were predominant than female (32.5%). The highest number of patients were in the age group of 30-60 years (53.6%) followed by 10- 30 years (24.5%) and more than 60 years (12.8%). The mean age with standard deviation was 39.15±19.07 years (range 1-90 years). Most common isolated bacteria was the Pseudomonas species (14.2%) followed by Escherichia coli (13.5%), Staphylococcus saprophyticus (6.9%) and Staphylococcus aureus (2.2%). From these specimens Pseudomonas species (31.5%) was isolated mostly from pus. E. coli was found most commonly in pus (16.3%) and urine (14.1%). Staph saprophyticus (13.0%) and Staphylococcus aureus (4.3%) were both found most commonly in pus. Pseudomonas species was 100% resistant to Penicillin, Amoxycillin and Vancomycin. It was found that Pseudomonas species was still more than 90% sensitive only to Imipenem. Escherichia coli was more than 80% sensitive to only Imipenem and Amikacin. Staphylococcus aureus was sensitive to only Imipenem and Cephalexin. Conclusion: In this study Pseudomonas species and Escherichia coli are the most common isolated bacteria in this Institution. Most of the antibiotics are resistant to these two bacteria. DOI: http://dx.doi.org/10.3329/cardio.v5i1.12276 Cardiovasc. j. 2012; 5(1): 67-72

Clinical analysis of cataract surgery complicated by endophthalmitis.

To assess the efficacy of vitrectomy combined with intravitreal injection in the treatment of endophthalmitis after phacoemulsification and IOL implantation. Five patients (5 eyes), who had undergone conventional phacoemulsification combined with IOL implantation at another treatment facility, presented with endophthalmitis. The subjects ranged in age from 41 to 79 years (65.8 ± 0.5 years on average), and three were male. All five cases received bacterial culture susceptibility testing. On the basis of the treatment of primary disease, 3 cases had anterior chamber irrigation, and posterior vitrectomy followed by intravitreal injection of 1 mg vancomycin plus 2.25 mg ceftazidime. Four out of the five cases of endophthalmitis had a positive bacterial culture testing results (two cases of staphylococcus epidermidis, one case of enterococcus faecalis and one case of head-like staphylococcus), and the remaining case had no bacterial growth. Four cases showed restored visual acuity, clear vitreous cavity, and no retinal detachment or other complications. Management of patients presenting with endophthalmitis subsequent to cataract surgery should include: prompt bacterial culture and drug sensitivity tests, and where appropriate, vitrectomy combined with intravitreal injection of vancomycin.

Accurate Approach in the Treatment of Oral Bisphosphonate–Related Jaw Osteonecrosis

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is not completely understood and difficult to treat. Even though the occurrence of BRONJ is mainly related to the therapy with intravenous bisphosphonates (BPs), this article reports a case of long-term oral BP use and BRONJ occurrence. In addition, a literature review provides some additional information about BPs, BRONJ, and also a guideline for the prevention and treatment of BRONJ stages. A 79-year-old patient presented intense and persistent pain, purulent secretion, and exposed bone at the right side of the lower jaw. Thus, she was submitted to anamnesis, radiologic and tomographic examinations, and bacterial culture and sensitivity tests. These procedures were followed by surgical debridement of the bone and surrounding tissues/cyst and antibiotic prescription and histopathologic analysis of the fragments. Together, the examinations performed showed the occurrence of stage 2 BRONJ. Moreover, the antibiotic prescription, discontinuation of oral BP, and surgical procedures ensure that the patient had no more symptoms. Therefore, considering the presented case, we believe that an accurate approach is promising to diagnose and treat stage 2 BRONJ and other associated pathologic findings.

Analysis of the changes in bacterial types and drug sensitivity profiles of mycobacterial strains in Guangzhou over the last twelve years

To improve evidence-based care in the management of tuberculosis, we retrospectively analyzed the bacterial types and drug sensitivity test results of mycobacteria in Guangzhou over the past twelve years (from July 1998 to March 2010). Over these twelve years, a total of 14 095 mycobacterial strains isolated from different samples were subjected to type identification and drug sensitivity tests according to the Standard Protocols of Laboratory Diagnostics for Tuberculosis by the Chinese Antituberculosis Association. Chi-square test was performed for statistical analyses for comparisons between groups. Of 14 095 strains of mycobacteria isolated, 10 844 strains (76.84%) were MTB, and 3251 strains (23.16%) were non-tuberculosis mycobacteria (NTM). Compared with the result of the fourth national survey of tuberculosis epidemiology, which showed 11.1% of NTM, the one of our study was significantly different (χ(2) = 69.79, P < 0.001). Drug sensitivity tests of MTB showed tolerance rates of 28.99% (2729/9413), 21.75% (2047/9413), 17.45% (1643/9413) and 11.53% (1085/9413) against isoniazid, rifampin, streptomycin and ethambutol, respectively. An increasing trend was observed in MTB drug tolerance against streptomycin, rifampin and isoniazid, whereas more and more NTM strains were isolated in recent years. These findings are worthy of note for clinicians.

An Expedient Bacterial Sensitivity Test for Refractory Ulcers, Particularly Decubitus Ulcers

An Expedient Bacterial Sensitivity Test for Refractory Ulcers, Particularly Decubitus Ulcers

Emergent vitrectomy combined with lensectomy, silicone oil temponade for endogenous endophthalmitis

Objective To observe the effect of emergent vitrectomy combined with lensectomy,silicone oil temponade for endogenous endophthalmitis. Methods The clinical data of 28 patients (30 eyes)with endogenous endophthalmitis were analyzed retrospectively. All patients had no history of ocular trauma and intraocular surgery history. There were 21 patients without systemic symptoms, three patients with fever, two patients with eye pain and headache, and two patients with abdominal pain when presentation.All patients diagnosed by best corrected visual acuity, intraocular pressure, slit-lamp microscopy, direct and indirect ophthalmoscope examination and intraocular B-ultrasound examination. Emergent surgery (vitrectomy, lensectomy, silicone oil temponade) was performed in all 30 patients, those with fever or abdominal pain was also treated by relevant clinical departments. Vitreous purulence was taken in all patients before vitrectomy for bacterial, fungal culture and drug sensitivity test. The follow-up was 18 to 30 months. The preoperative and postoperative visual acuity, intraocular pressure and eye retention situation were observed. Results Endophthalmitis was controlled in 28/30 eyes (93.3%) after surgery, recurrent vitreous empyema occurred in 2/30 eyes (6.7%). Evisceration was performed on those two eyes as uncontrolled intraocular pressure. The visual acuity improved significantly at one month and 18 months after surgery (x2 = 19.87, 32. 44; P ＜ 0.01). Postoperative intraocular pressure was normal in 24 eyes (80.0%), transient elevated and controlled in six eyes (x2 = 7.43; P＜0. 05). 12/28 (42.9%) vitreous samples were positive for pathogen culture, including 7/12 (58. 3%) positive for bacteria, 5/12 (41.7%)positive for fungi. There are 18/28 patients (64.3%) also had hepatobiliary system infections. Conclusion Emergent vitrectomy combined with lensectomy, silicone oil temponade is effective for endogenous endophthalmitis. Key words: Endophthalmitis/surgery; Endophthalmitis/etiology; Vitrectomy; Silicone oils/therapeutic use

Diagnóstico precoz de faringitis estreptocócica en pediatría: validación de una técnica antigénica rápida

Objective To determine the validity of the rapid antigen test for the diagnoses of acute pharyngitis caused by group A beta-haemolytic Streptococcus (GABHS) compared with culture. Design Observational study of a consecutive sample of paediatric patients. Setting Two primary care centres (PCC) from the metropolitan area of Barcelona. Participants Children aged 1–14 years with sore throat of no more than 5 days duration were chosen at PCC. Principal measurements Oropharyngeal samples were collected from tonsillar bed and posterior pharynx. A rapid diagnostic test was performed, as well as a throat culture. Results A total of 211 patients were studied. The overall prevalence of pharyngitis due to Streptococcus was 34.1%. Compared with the throat culture, the sensitivity of the rapid test was 90.3% (95% CI: 81.0–96.0), the specificity was 78.4% (95% CI: 70.6–84.9). The percentage of false negatives was 9.7% and the false positives was 21.6%. Spectrum bias was present, inasmuch as the rapid test sensitivity increased with Centor scores. Conclusions The diagnostic value of a rapid antigen test for the diagnosis of streptococcal pharyngitis in paediatric patients at PCC is high. However, the percentage of false positives and negatives is too high, and also the sensitivity is too low in patients with fewer symptoms to support the use of rapid antigenic test without culture confirmation and bacterial sensitivity test.

In vitro Effect of Chinese Herb Extracts on Caries-Related Bacteria and Glucan

The purpose of this study was to evaluate the inhibitory effects of herb extracts on caries-related bacteria and glucan of dental plaque in vitro. Bacterial sensitivity tests were done using broth dilution, and the phenol sulphate method was used to assess glucan inhibition. The results showed that tannic acid could inhibit bacterial growth more effectively than other herb extracts. Eugenol showed a 46.87 +/- 12.74 and 36.67 +/- 6.30% inhibitory effect on insoluble and soluble glucan synthesis, respectively. Cnidium, barbaloin, caryophyllin, and piperine had > 40.0% inhibitory effect on soluble glucan synthesis. Both insoluble and soluble glucan synthesis of S. sobrinus were inhibited by eugenol and piperine. Eugenol and piperine were efficacious in inhibiting glucan synthesis making them desirable agents for oral care products.

The stethoscope as a vector of infectious diseases in the paediatric division

Nosocomial infections are of great concern in hospital settings, and even more so in the paediatric ward. Health professionals and their medical equipment have long been known to act as vectors of infectious diseases. This study aimed at evaluating the presence of bacterial pathogens on the stethoscopes of medical personnel in the paediatric division. Forty-three stethoscopes belonging to senior physicians, residents, interns and medical students at the paediatric ward were sampled. Bacterial cultures and antibiotic sensitivity testing were carried out. All but six bacterial cultures were positive (85.7%). Staphylococcal species were the most common contaminants (47.5%). One case of methicillin-resistant Staphylococcus aureus was encountered. Gram-negative organisms were isolated in nine different samples (21%) including one case of Acinetobacter baumannii in the neonatal intensive care unit. Most stethoscopes harbour potential pathogens. The isolation of Gram-negative organisms pose a real risk of spreading potentially serious infections, especially in the setting of intensive care departments. Apparently, the current recommendations of regular disinfection of stethoscopes are not carried out by health personnel that participated in the study.

Intraosseous Injection of Clindamycin Phosphate Into the Chronic Apical Lesion of Lower Molar - a Case Report

Periapical disease is the result of bacteria, their product, and the host response to them. Early histological studies of diseased periapical tissue have not been able to demonstrate viable bacteria in the lesions studied. Recent reports indicate that many of periapical lesions are indeed infected before and after endodontic treatment. The validity and applicability of the microbial delivery overcome many disadvantages that we see with systemic drugs. In this case report we presented a novel approach of managing chronic diffuse periapical lesion of lower molar based on specific selection of intracanal medicament in combination with direct periapical injection. We used bacterial culturing and antibiotic sensitivity test to select specific intracanal medicament, in addition we presented an intraosseous injection technique to locally deliver the selected medicament directly into the periapical lesion. Our findings are encouraging and promising. The validity and applicability of the technique needs to be tested in a well controlled clinical trial.

선천성 전이개 누공에서 임상양상과 치료결과

Background and Objectives: The preauricular fistula is the most common congenital anomaly of the ear. Usually it is in an asymptomatic state, but in case of recurrent infection, it must be treated with surgery. The aim of this study was to assess clinical characteristics and treatment outcomes of fistulectomy in the congenital preauricular fistula. Materials and Methods: This study was a retrospective analysis 110 patients (133 ears) of the congenital preauricular fistula who underwent a fistulectomy from January 1995 to July 2004. All the fistulectomy was performed with the same technique which involved an elliptical skin incision around the fistula opening and dissection of the fistula tract using a probe with methylene blue staining after identification of the temporalis fascia. Results: The fistulas were mainly located on the unilateral side of the ear (79 patients, 71.8%). Mostly the opening of the fistula was located on anterior portion at the crus of the helix (120 ears, 90.2%). In bacterial culture and antibiotics sensitivity test of the 23 ears, the most common colonizing species was Staphylococcus epidermidis (9 ears, 39.1%) and methicillin resistant bacteria were 9 ears (39.1%). The majority of length of fistula tract of the 123 ears was 16—20 mm (41 ears, 33.3%). The postoperative recurrence rate was 4.5% (6 ears). Conclusion: The current study indicates that an adequate use of preoperative antibiotics according the result of bacterial culture and antibiotic sensitivity test, and a thorough identification of the fistula tract may be an effective method in the fistulectomy for lowering of the recurrence rate. (J Clinical Otolaryngol 2008;19:46–50)