Evaluating the ototoxicity of an anti-MRSA peptide KR-12-a2 / Avaliando a ototoxicidade de um peptídeo anti-MRSA KR-12-a2

Abstract Introduction Methicillin-resistant staphylococcus aureus is an emerging problem for the treatment of chronic suppurative otitis media, and also for pediatric tympanostomy tube otorrhea. To date, there are no effective topical antibiotic drugs to treat methicillin-resistant staphylococcus aureus otorrhea. Objective In this study, we evaluated the ototoxicity of topical KR-12-a2 solution on the cochlea when it is applied topically in the middle ear of guinea pigs. Methods The antimicrobial activity of KR-12-a2 against methicillin-resistant staphylococcus aureus strains was examined by using the inhibition zone test. Topical application of KR-12-a2 solution, gentamicin and phosphate buffered saline were applied in the middle ear of the guinea pigs after inserting ventilation tubes. Ototoxicity was assessed by auditory brainstem evoked response and scanning electron microscope examination. Results KR-12-a2 produced an inhibition zone against methicillin-resistant staphylococcus aureus from 6.25 µg. Hearing threshold in the KR-12-a2 and PBS groups were similar to that before ventilation tube insertion. However, the gentamicin group showed elevation of the hearing threshold and there were statistically significant differences compared to the phosphate buffered saline or the KR-12-a2 group. In the scanning electron microscope findings, the KR-12-a2 group showed intact outer hair cells. However, the gentamicin group showed total loss of outer hair cells. In our experiment, topically applied KR-12-a2 solution did not cause hearing loss or cochlear damage in guinea pigs. Conclusion In our experiment, topically applied KR-12-a2 solution did not cause hearing loss or cochlear damage in guinea pigs. The KR-12-a2 solution can be used as ototopical drops for treating methicillin-resistant staphylococcus aureus otorrhea; however, further evaluations, such as the definition of optimal concentration and combination, are necessary.

Resumo Introdução O staphylococcus aureus resistente à meticilina é um problema emergente não só para a otite média supurativa crônica, mas também para casos de otorreia crônica em crianças com tubo de ventilação. Até o momento, não há antibióticos tópicos efetivos para a otorreia causada por staphylococcus aureus resistente à meticilina. Objetivo Nesse estudo, avaliamos a ototoxicidade da solução tópica de KR-12-a2 na cóclea quando aplicada topicamente na orelha média de cobaias. Método A atividade antimicrobiana de KR-12-a2 contra cepas de staphylococcus aureus resistente à meticilina foi avaliada utilizando-se o teste de zona de inibição de crescimento. Foram aplicados na orelhas médias de 3 grupos de cobaias, ou solução tópica de KR-12-a2, ou gentamicina ou solução salina tamponada com fosfato após timpanostomia. A ototoxicidade foi avaliada através do exame auditivo de potencial evocado auditivo de tronco encefálico e por microscopia eletrônica de varredura. Resultados O KR-12-a2 produziu uma zona de inibição contra o staphylococcus aureus resistente à meticilina a partir de 6,25 µg. Alterações do limiar de audição no grupo KR-12-a2 e no grupo com solução salina foram semelhantes aos observados antes da inserção do tubo de ventilação. No entanto, o grupo gentamicina apresentou um limiar auditivo mais elevado, estatisticamente significativo em comparação ao grupo solução salina ou ao grupo KR-12-a2. Nos achados da microscopia eletrônica, o grupo KR-12-a2 apresentou células ciliadas externas intactas. No entanto, o grupo gentamicina apresentou perda total das células ciliadas externas. Em nosso experimento, a solução de KR-12-a2 aplicada topicamente não causou perda auditiva ou dano coclear em cobaias. Conclusão Em nosso experimento, a solução de KR-12-a2 aplicada topicamente não causou perda auditiva ou dano coclear em cobaias. A solução de KR-12-a2 pode ser utilizada como gotas otológicas para o tratamento da otorreia causada por staphylococcus aureus resistente à meticilina; no entanto, são necessárias outras avaliações, para a definição da concentração e das associações ideais.

Surveillance of bacteria Pseudomonas aeruginosa and MRSA associated with chronic suppurative otitis media / Vigilância de bactérias Pseudomonas aeruginosa e MRSA associadas à otite média crônica supurativa

Abstract Introduction: Suppurative otitis media is a critical disease causing perforation of the tympanic membrane associated with changes of the mucoperiosteum of the middle ear cleft. Objective: To isolate causative bacteria from chronic suppurative ear discharges and to ascertain their antibiotic profiles, of patients attending outpatients department in 3 years. Methods: For isolation of bacteria, samples of ear discharges were grown in suitable media and bacteria were subjected to antibiotic profiling by the Kirby-Bauer's method with presently used antibiotics. Results: A total of 1043 bacteria were isolated, including Pseudomonas aeruginosa and methicillin resistant Staphylococcus aureus, along with 121 fungal isolates. Among 371 P. aeruginosa isolates, tobramycin 30 had the highest susceptibility rate 93.2%, followed by ceftazidime 30, 91.5% and amikacin 10 µg/disk 64.4%. Of 359 S. aureus isolates, there were 236 coagulase negative S. aureus + methicillin sensitive S. aureus isolates, while 123 isolates were methicillin resistant Staphylococcus aureus with 95.2% isolates susceptible to cloxacillin 15, 83.3% isolates to erythromycin 15 and 78.5% isolates to gentamicin 30 µg/disk. Of 1164, 49 patients presented post aural abscess, 12 patients had intracranial complications, 9 patients had facial palsy and 3 patients had labyrinthitis. More than 90% P. aeruginosa and 90% S. aureus isolates were sensitive to tobramycin 30 and cloxacillin 30 µg/disk, respectively. Conclusion: Multidrug resistant strains of P. aeruginosa were more prevalent than those of S. aureus in ear discharges. Tobramycin and cloxacillin may be included in the formulatory antibiotic regimen to overcome bacterial infections in chronic suppurative otitis media.

Resumo Introdução: Otite média supurativa é uma doença importante que causa perfuração da membrana timpânica, além de alterações do mucoperiósteo da orelha média. Objetivo: Isolar as bactérias causadoras a partir da secreção auricular crônica e verificar seus perfis de sensibilidade aos antibióticos em pacientes ambulatoriais durante três anos. Método: Para o isolamento das bactérias, as amostras de secreções auriculares foram cultivadas em meios adequados e as bactérias foram submetidas à detecção de perfis de sensibilidade aos antibióticos com o método de Kirby-Bauer para antibióticos usados na atualidade. Resultados: No total, 1.043 bactérias, incluindo Pseudomonas aeruginosa resistente à meticilina e Staphylococcus aureus, e 121 fungos isolados foram identificados. Entre 371 isolados de P. aeruginosa, tobramicina 30 µg/disco apresentou a maior taxa de suscetibilidade (93,2%), seguida por ceftazidima 30 µg/disco (91,5%) e amicacina 10 µg/disco (64,4%). De 359 isolados de S. aureus, 236 eram S. aureus coagulase-negativos + S. aureus sensíveis à meticilina (MSSA), enquanto 123 eram MRSA com 95,2% de suscetibilidade à cloxacilina 15 µg/disco, 83,3% sensíveis à eritromicina 15 µg/disco e 78,5% à gentamicina 30 µg/disco. Entre 1.164 pacientes, 49 apresentaram abscesso aural, 12 complicações intracranianas, nove paralisia facial e três labirintite. Mais de 90% das P. aeruginosa isoladas e de 90% de S. aureus eram sensíveis à tobramicina 30 µg/disco e cloxacilina 30 µg/disco, respectivamente. Conclusão: Cepas multirresistentes de P. aeruginosa foram mais prevalentes do que as de S. aureus nas secreções auriculares. Tobramicina e cloxacilina podem ser consideradas na formulação de regime de antibióticos para tratar as infecções bacterianas na OMCS.

Chronic suppurative otitis media; empiric quinolones in children

The aim of the study was to determine the most prevalent organisms in chronic otitis media in children and their susceptibility to various antibimicrobials so that an appropriate empiric antibiotic can be started promptly while awaiting the results of the culture and sensitivity. Prospective observational study. The study was conducted at Combined Military Hospital Lahore from Jan 2006 to Dec 2007. A total of 156 patients less than 15 years of age who were having discharge from one or both ears for at least 1 week with tympanic membrane perforation were included in the study. A sample of the ear discharge was collected on the swab and cultured on appropriate media. The Gram positive organisms were identified on the basis of Gram staining, catalase and coagulase test, the Gram negative organisms were identified by API 20e. A total of 156 patients were included in the study of which 96 [61.5%] were males and 59 [37.8%] were females. The organisms isolated were Staphylococcus aureus in 79 [50.6%], Pseudomonas-aeruginosa in 45 [28.8%] patients and Proteus mirabilis 17 [10.9%], Escherichia coli, Acinetobacter sp and streptococi were isolated in occasional patients. Staphylococcus aureus was the commonest organism isolated followed by Pseudomonas aeruginosa and Proteus mirabilis fifty four. [34.6%] of Staphylococcus aureus were sensitive to gentamicin, fifty two [33.3%] to ciprofloxacin and 42 [26.9%]% to both ciprofloxacin and gentamicin. Among the Pseudomonas aeruginosa isolates 40 [25.6%] were sensitive to gentamicin, 27 [17.3%] to ciprofloxacin and 22 [14.1%] to both ciprofloxacin and gentamicin. Out of 156 patients 91 [58.3%] had isolates which were sensitive to ciprofloxacin and 62 [39.7%] were resistant to it. One hundred fourteen patients [73.1%] had isolates which were sensitive to gentamicin whereas 33 [21.2%] were resistant. Similarly 35 isolates [22.4%] were sensitive to sulphamethoxazole/trimethoprim whereas 66 [42.3%] were resistant. Among Proteus mirabilis isolates 12 were sensitive to gentamicin, 11 were sensitive to ciprofloxacin and 11 were sensitive to both ciprofloxacin and gentamicin. Ciprofloxacin ear drops can be recommended to be given empirically in children with chronic discharging ears. The initial therapy can be modified and appropriate therapy started if the result of the culture and sensitivity report shows the isolate to be resistant to the antibiotic started empirically

Use of Al-Sidr honey for treatment of suppurative otitis media, in vivo study

Suppurative otitis media is a common disease affecting all ages and both sexes. Development of bacterial resistance is very common making difficulties in management of both acute suppurative otitis media [Ac s o m] and chronic suppurative otitis media [Ch s o m] cases. More recently, interest in honey as a therapeutic agent has undergone a renaissance. Honey is used for management of infected wounds, burns and exhibited excellent results against Gram +ve and Gram-ve organisms in vitro and in some in vivo studies on infected wounds. To compare results of using Al-sidr honey and antibiotics for treatment of acute and chronic suppurative otitis media. Culture and sensitivity of honey, using agar incorporation technique to prepare plates containing serial dilutions of honey to detect MIC for the selected organisms. Preparing honey as ear drops 10% more than MIC. One hundred twenty patients, 60 with [Ac s o m] and 60 with [Ch s o m] divided into 2 groups, Group 1 honey group divided into Group 1A: 30 patients with ac s o m [10 with Streptococcus pneumonia, 10 with Haemophilus influenza and 10 with Moraxtila catarrhalis] and Group IB 30 patients with ch s o m [10 with Pseudomonas aeroginosa, 10 iuith KLebsiella and 10 with Proteus] treated by Al-sidr honey local ear drops. Group 2 antibiotic group same distribution as group 1 and treated by antibiotics. There is significant differences between using honey and traditional approach for antibiotic use even after CIS without side effects or complications. We recommend start thinking to use Al-sidr honey as local ear drops for management policies of suppurative otitis media

Bacteriological study of paediatric and adult chronic suppurative otitis media.

Chronic suppurative otitis media (CSOM) is one of the commonest illnesses in ENT practice which requires medical attention all the more in children of poor socio-economic status having in past inadequate treatment and negligent medical care. The present study was conducted to find out the various aerobic and anaerobic microorganisms associated with CSOM in paediatric and adult cases and their current antimicrobial susceptibility pattern as a guide to therapy. Samples were collected from 109 clinically diagnosed cases of CSOM and processed according to standard protocols. Out of 74 paediatric CSOM cases, 72 (97.2%) were bacterial culture positive while out of 35 adult CSOM cases, 28 (80%) were culture positive. Bilateral CSOM was slightly more common in adults (25%) than paediatric (21.4%) age group. Polymicrobial nature of CSOM was noted in both paediatric (70.8%) and adult (71.4%) cases while number of organisms isolated per lesion was slightly higher in adults (2.5) as compared to paediatric (1.95) cases. In paediatric CSOM, Staphylococcus aureus was the commonest aerobic isolate while in adult CSOM, Pseudomonas aeruginosa was the commonest one. Among anaerobes Peptostreptococcus spp. was commonest in CSOM where as Prevotella melaninogenica in adult CSOM. Sensitivity of S. aureus to cefuroxime was 72.2% while that of gram negative bacilli was higher to cefotaxime (90 to 100%). Among anaerobes higher sensitivity was seen to metronidazole (98.6%), clindamycin (95.7%) and chloramphenicol (98.6%). In view of the polymicrobial etiology of CSOM, prompt appropriate antimicrobial therapy can effectively reverse the disease process thereby preventing longterm sequelae.

Caracterização dos principais patógenos bacterianos relacionados com a otite média crônica supurativa em fissurados palatais pelos métodos da cultura e da Reação em Cadeia de Polimerase (PCR) / Characterization of principal bacterial pathogen related with chronic suppurative otitis media in cleft lip and palate patientes for culture - Polymerase Chain Reactions (PCR) methods

A otite média crônica supurativa (OMCS) é uma condição comum em pacientes portadores de fissuras palatal e lábio-palatal não reparadas cirurgicamente. Devido a uma anormalidade muscular, existe disfunção da tuba auditiva que, por sua vez, não equilibra a pressão diferencial do ar entre o ouvido médio e a nasofaringe, ocasionando acúmulo de fluídos na cavidade do ouvido médio, predispondo-o à infecção. Amostras efusivas de OMCS de 35 pacientes portadores de fissura palatal e lábio-palatal matriculados no Hospital de Reabilitação de Anomalias Craniofaciais – HRAC/USP – Bauru – SP, foram analisadas através de culturas bacteriológicas e Reação em Cadeia da Polimerase (PCR). Foram isoladas na cultura bacteriológica, em ordem de freqüência, as seguintes bactérias: Pseudomonas aeruginosa (54,9%), Staphylococcus aureus (25,9%) e Enterococcus faecalis (19,2%). Não foram isolados germes anaeróbios pela cultura. A PCR foi positiva para uma ou mais das bactérias estudadas em 97,1% das efusões analisadas. Bacteróides fragilis, Fusobacterium nucleatum e Peptostreptococcus anaerobius foram detectados somente pela PCR. A comparação entre os métodos da cultura bacteriológica e técnica de PCR foi estaticamente significativa (p menor que 0,05) somente para os germes anaeróbicos...

Micropathogens in chronic suppurative otitis media an experience of 208 pus cultures at Abbasi Shaheed Hospital

To determine the causative pathogens of chronic suppurative otitis media and their antimicrobial sensitivity. Prospective analytic study. Two hundreds patients were enrolled for the study attending the ENT out patient department of Karachi Medical and Dental College and Abbasi Shaheed Hospital. Majority of the patients were children and young adult, with male predilection. 208 Pus cultures were taken from the ears of the 175 selected patients and Gram staining and antibiotic sensitivity was done on all of them. Staphlococcus aureus and Pseudomonas aeruginosa were responsible for most of infections in this study about 68%. Proteus spp., Klebsiella spp. and E.coli were also found in the cultures but in very low figure. Quinolones and aminoglycosides were found extremely effective against the two major pathogens, i.e., Staph.aureus and Pseudomonas aeruginosa with sensitivity index of 91% and 98% respectively. Macrolides and cephalosporins were also highly effective with 80-88% sensitivity whereas both Staph.aureue and Pseudomonas were quite resistant to Ampicillin and Amoxicillin. Chronic suppurative otitis media is primarily the disease of children and young adults, and incidence in adult and old population being very less. Staphylococcus aureus and Pseudomonas aeruginosa are most frequent causative organism and extremely sensitive to quinolones and aminoglycosides

Otitis media crónica superada en niños / Chronic suppurative otitis media in children

La otitis media crónica supurada es una enfermedad del oído medio caracterizada por inflamación crónica de la mucosa del oído medio y mastoides, perforación de la membrana timpánica y otorrea. Para determinar las características clínicas de la OMC en niños se realizó un estudio prospectivo, longitudinal y descriptivo durante 3 meses en el Servicio de Otorrinolaringología del Hospital Nacional de Pediatría “Prof. Dr. J. P. Garrahan”. Población, material y métodos. De los pacientes asistidos en el Servicio de ORL se seleccionaron los que cumplían con los criterios diagnósticos de otitis media crónica: otorrea (permanente o intermitente) de más de tres meses de evolución, a través de perforación timpánica documentada por otomicroscopia. Se excluyeron aquellos con sospecha de colesteatoma, enfermedades tumorales, inmunodeficiencias primarias y secundarias, anomalías craneofaciales, síndromes genéticos y los que no concurrieron a controles posteriores. A todos se les realizó otomicroscopia, toma de material para cultivo y tratamiento local inicial con alcohol 70 boricado a saturación. Resultados. De 115 niños con otitis media crónica se incluyeron 96 en el estudio (51 por ciento [n igual 49] masc menos 49 por ciento [n igual 47] fem). Edad media: 77 más o menos 43,78 meses. El tiempo medio de otorrea fue de 12 meses (rango 1 menos 175 m). Presentaban sinusopatía maxilar 48 (50 por ciento) pacientes. La otitis crónica era bilateral en 33,3 por ciento (32) y unilateral en 66,7 por ciento (64). Microbiología: se aislaron 153 gérmenes del material aspirado de oído medio, 50 por ciento (48) de los cultivos fueron polimicrobianos. Las bacterias más comunes fueron Pseudomonas aeruginosa (53/153) y Proteus (33/153). Desarrollaron gérmenes anaerobios 18/153 cultivos. El tratamiento inicial con alcohol 70 boricado a saturación resolvió la otorrea en el 77 por ciento de los casos

Chromobacterium violaceum septicemia.

Chromobacterium violaceum is an extremely rare human pathogen. We report a rare case of septicemia with multiple abscesses and otitis media in a newborn caused by chromobacterium violaceum.

Pathological analysis of 596 cases of chronic otitis media in Karachi

Chronic otitis media may cause permanent damage to the ear, mastoid pathologies and extra-cranial complications. Selection of an effective drug by culture analysis of discharge may reduce the risk of serious complications. In a multicentre study of 596 ear-swabs, Staphylococcus aureus and Pseudomonas were found in 40% and 29.6% respectively among 11 types of bacteria, Aspergillus [6.2%] and Candida [3.1%] were additional irritants. However, approximately 14.4% of swabs were culture-negative, suggesting a viral or non-infective etiology. The finding that Pseudomonas was increasingly implicated in recent years and that 37.9% of our Staphylococci isolates were betalactamase producers and Methicillin-resistant, necessitate the choice of 'enzyme-stable' antibiotics as first-line treatment. The high number of gram-negative aerobes isolated suggests faeco-aural route as a major contributor to this infective process which is consistent with our environmental conditions

Procesamiento bacteriológico y micológico de muestras de infecciones de vías respiratorias superiores: otitis media (OMA) y sinusitis / Processing specimens of upper respiratory tract infections for bacteria and fungi: otitis media and sinusitis

Las infecciones del tracto respiratorio superior son la causa infecciosa más frecuente de consulta al médico. En el caso de la otitis media y sinusitis aguda, los agentes etiológicos más frecuentes son S. pneumoniae, H. influenzae no "b" y M. catarrhalis; en tanto que en las formas crónicas aumenta la incidencia de anaerobios, bacilos gram negativos y S. aureus. La punción de oído medio y de senos paranasales se recomienda para casos puntuales como inmunocomprometidos, fracaso terapéutico, complicaciones supurativas, neonatos con otitis media, pacientes intubados con sinusitis y tal vez pacientes provenientes de áreas con alto porcentaje de cepas resistentes

Bacteriological patterns of chronic suppurative otitis media in Ludhiana.

A series of 300 cases of chronic suppurative otitis media encountered in Dayanand Medical College and Hospital, Ludhiana was surveyed for type specificity to determine latest trends of bacterial prevalence in Ludhiana. Punjab Pseudomonas, staphylococcus and proteus head the list. The problem of resistance is discussed in the present context.

Bacterias aisladas de exudados óticos en pacientes pediátricos / Bacteria isolated from otic exudates of pediatrics patients

En el período comprendido entre el 1 de junio de 1989 y el 30 de diciembre de 1992, se estudiaron 290 exudados óticos en pacientes, cuyas edades oscilaban entre 2 meses y 16 años. De acuerdo con los microorganismos aislados, se dividieron en tres grupos: grupo 1 :microorganismos provenientes de orofaringe (90 casos); grupo 2: bacilos Gram negativos no fermentadores y fermentadores de glucosa (166 casos) y grupo 3: flora mixta (38 casos). En el grupo 1 se encontraron los niños con diagnóstico de otitis media aguda con efusión y los microorganismos más halados fueron Haemophilus influenzae, Streptococcus pneumoniae y Streptococcus pyogenes. En el grupo 2 los microorganismos más hallados fueron Pseudomonas aeruginosa y proteus mirabilis solos o acompañados. En el grupo 3 se aisló flora mixta (se entiende cocos Gram positivos, bacilos Gram positivos, Bacilos Gram negativos por lo menos tres tipos de microorganismos

Las otoinfecciones recidivantes / Recurrent otoinfections

En los procesos infecciosos de difícil curación de la esfera otológica, juegan un importante papel la existencia de Colesteatomas, de afecciones rinosinusales alérgicas y la existencia de flora microbiana mixta, de asociaciones hongos bacterias y de la presencia de cepas de alta resistencia a los antimicrobianos habituales como lo son las pseudomonas

Etiologia bacteriana en otitis media supurativa en etapas aguda y crónica / Bacterial etiology in suppurative otitis media in acute and chronic phases

Estudiamos 100 niños con Otitis Media Supurada Aguda y Crónica en la Consulta Externa del Centro Materno Infantil San Lorenzo de los Mina en el período mayo-octubre 1984. Las bacterias reportadas fueron: proteus specie (33%), pseudomonas specie (14%), estafilococo coagulasa positivo (11%), Escherichia coli (8%), estreptococo beta hemolítico (2%). Además, Cándida albicans (28%), y dos resultados de gérmes asociados. La mayor incidencia fue en el sexo masculino. Los más afectados fueron los lactantes. El 38% de los niños presentó algún grado de desnutrición. Las patologías asociadas fueron: Infecciones vías respiratorias superiores, alergias sarampión y otras