Mustafa Koray BALCI, Tuba MUDERRİS, Rahim ÖZDEMİR, Süreyya GÜL YURTSEVER, Selçuk KAYA

Microorganisms isolated from external ear cultures and their antimicrobial susceptibility in patients with chronic suppurative otitis media: A six years experience

Aim: Chronic suppurative otitis media (CSOM) continues to be a major health issue in developing countries. The goal of this studywas to establish the microorganisms causing CSOM and their susceptibility to antimicrobials.Materials and Methods: External ear tract swab that came to our laboratory between 2014-2019 were evaluated retrospectively. Thedata were obtained from the hospital medical records. Data was collected using an electronic database.Results: The analysis included 185 ear swab samples. These patients 55.1% male and 44.9% female, and average age was 44.29± 1.6 (2-86) years. Forty (21.6%) of the patients included in the study were diagnosed with cholesteatoma as having chronicsuppurative otitis media. The first three bacteria species isolated from the samples included in the study; Pseudomonas aeruginosa(31.9%), Staphylococcus aureus (11.9%) and Escherichia coli (9.7%). In addition, in 10.8% of the samples Candida spp. and in 5.4%of the samples Aspergillus spp. were isolated. The first three species isolated from the patients with cholesteatoma; P. aeruginosa(6.5%),S. aureus (4.3%) and Candida spp. (3.2%), the first three species isolated in patients without cholesteatoma; P. aeruginosa(25.4%), E. coli (8.1%), S. aureus and Candida spp. (7.6%) was detected. Ciprofloxacin (68.8%) and gentamicin (46.7%) in P. aureginosaisolates, amoxicillin-clavulonic acid (66.7%) and trimethoprim-sulfamethoxazole (42.9%) in E. coli isolates were found to be the mostresistant antimicrobials.Conclusion: In conclusion, antimicrobial therapy should not be initiated in CSOM patients without waiting for the culture result.However, in cases where empirical antimicrobial therapy is mandatory, the first choice has been determined as amikacin. Goodawareness of microorganisms’ antimicrobial sensitivity can lead to appropriate antibiotic usage and treatment success for CSOM.We think that multicenter prospective studies are needed to organize effective treatments of these infections.

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1. Head K, Chong LY, Bhutta MF, et al. Antibiotics versus topical antiseptics for chronic suppurative otitis media. Cochrane Database Syst Rev 2020;1:CD013056.
2. Gul C, Kurnaz A, Turhan V, et al. Kronik süpüratif otitis medialı hastalarda orta kulak kültürlerinde üreyen mikroorganizmalar ve antibiyotik duyarlılıkları. Kulak Burun Bogaz Ihtis Derg 2006;16:164-8.
3. Orji F. A survey of the burden of management of chronic suppurative otitis media in a developing country. Ann Med Health Sci Res 2013;4:598-601.
4. Dubey SP, Larawin V. Complications of chronic suppurative otitis media and their management. Laryngoscope 2007;117:264-7.
5. Yorgancilar E, Yildirim M, Gun R, et al. Complications of chronic suppurative otitis media: a retrospective review. Eur Arch Otorhinolaryngol 2013;270:69-76.
6. Roland PS. Chronic otitis media: a clinical overview. Ear Nose Throat J 2002; 81:8-10.
7. Verhoeff M, Van der Veen EL, Rovers MM, et al. Chronic otitis media: a review. Int J Pediatr Otorhinolaryngol 2006;70:1-12.
8. Brook I, Burke P. The management of acute, serous and CSOM: the role of anaerobic bacteria. J Hosp Infect 1992;22:75-87.
9. Adoga AS, Malu D, Badung BP, et al. Swab and Aspiration collection methods and antibiograms in chronic otitis media at Jos University Teaching Hospital. Which is superior? Ann Afr Med 2010;9:230- 4.
10. Cockerill FR, Patel JB, Alder J. Performance standards for antimicrobial susceptibility testing, Twenty-third informational supplement. Clinical and Laboratory Standards Institute 2013;23:1-206.
11. The European Committee on Antimicrobial Susceptibility Testing (EUCAST). http://www.eucast. org/clinical_breakpoints/ access date 04.04.2020
12. Yeo SG, Park DC, Hong SM, et al. Bacteriology of chronic suppurative otitis media--A multicenter study. Acta Otolaryngol 2007;127:1062-7.
13. Çeviker SA, Günal Ö, Mehel DM, et al. Üçüncü basamak hastanede kronik otitis media tanılı hastalardan alınan dış kulak yolu kültür sonuçlarının değerlendirilmesi:3 yıllık deneyimimiz. Balıkesir Sağlık Bil Derg 2019;8:87- 90.
14. Adoga A, Nimkur T, Silas O. Chronic suppurative otitis media: Socio-economic implications in a tertiary hospital in Northern Nigeria. Pan Afr Med J 2010;4:1- 8.
15. Sattar A, Alamgir A, Hussain Z, et al. Bacterial spectrum and their sensitivity pattern in patients of chronic suppurative otitis media. J Coll Physicians Surg Pak 2012;22:128-9.
16. Borsa BA, Kaplan HH, Aldağ ME, et al. Otitis eksterna ve otitis media hastalarında etken mikroorganizmaların ve antibiyotik duyarlılıklarının belirlenmesi. Ankem Derg 2016;30:48-52.
17. Malçok Kuzucu H, Uyanık MH, Aktaş O, et al. Dış kulak yolu kültür sonuçlarının değerlendirilmesi. EAJM 2006;38:85-8.
18. Tok D, Coşkun Ö. Kronik otitis medialı hastaların kültürlerinde üreyen mikroorganizmaların antibiyotik duyarlılıkları. TAF Prev Med Bull 2010;9:51-4.
19. Ronchetti F, Ronchetti R, Guglielmi F, et al. Detection of Chlamydia pneumoniae inCholesteatoma Tissue: Any Pathogenetic Role? Otol Neurotol 2003;24:353-7.
20. Madana J, Yolmo D, Kalaiarasi R, et al. Microbiological profile with antibiotic sensitivity pattern of cholesteatomatous chronic suppurative otitis media among children. Int J Pediatr Otorhinolaryngol 2011;75:1104–8.
21. Dommerich S, Frickmann H, Ostwald J, et al. Effects of high hydrostatic pressure on bacterial growth on human ossicles explanted from cholesteatoma patients. PLoS One 2012;7:30150.
22. Kim H, Choo OS, Jang JH, et al. Chronological changes in microbial profiles in externaland middle ear diseases: a 20-year study in Korea. Eur Arch Otorhinolaryngol 2017;274:1375-81.
23. Klein JO. Otitis externa, otitis media, mastoiditis. In: Mandel GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th editon. Philadelphia: Churchill Livingstone; 2010;831-7.
24. Vennewald I, Klemm E. Otomycosis: diagnosis and treatment. Clin Dermatol 2010;28:202-11.