Bacterias causantes de otitis media aguda antes y después de la aplicación de la vacuna antineumococica 13-valente / Acute otitis media-causing bacteria before and after the application of the 13-valent pneumococcal conjugate vaccine

Los microorganismos más frecuentemente responsables de la otitis media aguda (OMA) (Streptococcus pneumoniae y Haemophilus influenzae) son los mismos en los países en vías de desarrollo que en los desarrollados. En los países que administraron la vacuna antineumocócica conjugada, los neumococos disminuyeron como causa de OMA, pero con el tiempo comenzaron a resurgir, sobre todo a expensas de cepas pertenecientes a serotipos no incluidos en la vacuna. El objetivo de este trabajo fue documentar el cambio generado en la bacteriología de la OMA a partir de la incorporación en el calendario oficial argentino de la vacuna conjugada antineumocócica 13-valente en el año 2012. Se realizaron dos estudios prospectivos, descriptivos, transversales, uno previo a la incorporación de la vacuna al calendario nacional (mayo 2009-agosto 2010) donde la población estudiada no se encontraba cubierta para S. pneumoniae y otro posterior, donde la mayoría de los pacientes se encontraban inmunizados (enero-diciembre 2016). Se obtuvieron 433 muestras de 324 pacientes en el primer período y 461 de 246 pacientes en el segundo. Se aisló un total de 326 bacterias en el primer período y 388 en el segundo. Los microorganismos respectivamente aislados en ambos períodos fueron S. pneumoniae (39,5-21,1%), H. influenzae (37,4-44,6%), Moraxella catarrhalis (6,1-7,5%), Staphylococcus aureus (8,6-9,8%), Streptococcus pyogenes (3,0-5,9%), Turicella otitidis (1,8-2,1%), Pseudomonas aeruginosa (0,9-4,1%) y otros (2,4-4,9%). Los neumococos pertenecientes a serotipos vacunales sufrieron una disminución significativa, especialmente el 6A, 9V, 14, 18C, 19A, mientras que los serotipos no vacunales aumentaron significativamente, en particular el 15B, el 11A, el 7C, el 16F y el 22F (AU)

Organisms most frequently responsible for acute otitis media (AOM) (Streptococcus pneumoniae and Haemophilus influenzae) are the same in developing countries as in developed ones. In countries that administered the pneumococcal conjugate vaccine, pneumococci decreased as a cause of AOM, but over time began to re-emerge, especially due to strains belonging to serotypes not included in the vaccine. The objective of this work was to document the change generated in the bacteriology of the OMA from the incorporation of the 13-valent pneumococcal conjugate vaccine in 2012 in the official Argentinean calendar. Two prospective, descriptive, cross-sectional studies were carried out prior to the incorporation of the vaccine into the national calendar (May 2009-August 2010), where the population studied was not covered for S. pneumoniae and a subsequent one, where most of the patients were immunized (January 2016-December 2016). We obtained 433 samples from 324 patients in the first period and 461 from 246 patients in the second. A total of 326 bacteria were isolated in the first period and 388 in the second. The microorganisms respectively isolated in both periods were S.pneumoniae (39.5-21.1%), H.influenzae (37.4-44.6%), Moraxella catarrhalis (6.1-7.5%), Staphylococcus aureus (8.6-9.8%), Streptococcus pyogenes (3.0-5.9%), Turicella otitidis (1.8-2.1%), Pseudomonas aeruginosa (0.9-4.1%) and others (2.4-4.9%). Pneumococci belonging to vaccine serotypes suffered a significant decrease, especially 6A, 9V, 14, 18C, 19A, while nonvaccine serotypes increased significantly, particularly 15B, 11A, 7C, 16F, and 22F (AU)

Microbiology of Chronic Suppurative Otitis Media at Queen Elizabeth Central Hospital; Blantyre; Malawi: A Cross-Sectional Descriptive Study

Background.Chronic suppurative otitis media (CSOM) is still a significant health problem in developing countries. Therefore; it was pertinent to determine the local Malawian microbiology in order to guide adequate treatment; avoid complications; and provide records for future reference. Aim. The study sought to determine the CSOM-causing microorganisms at Queen Elizabeth Central Hospital in Blantyre; Malawi; and establish their relationship signs and symptoms; and with the demographic pattern of the study.Methods.This was a hospital-based cross-sectional descriptive study carried out at the ENT outpatient clinic and the Microbiology Department of Queen Elizabeth Central Hospital.The sample comprised 104 patients with unilateral or bilateral active CSOM; who met the inclusion criteria. All patients were evaluated through a detailed history and clinical examination. Pus samples from draining ears were collected by aspiration with a sterile pipette. The specimens were immediately sent for microbiological analysis. Data were analyzed using SPSS version 20.The study found that Proteus mirabilis; Pseudomonas aeruginosa; and Staphylococcus aureus were the most prevalent aerobic bacteria; while Bacteroides spp. and Peptostreptococcus spp. were the commonest anaerobic bacteria causing CSOM. These CSOM-causing microorganisms were predominant among males aged 18 years and below. Some CSOM-causing microorganisms were-significantly more so than the others-characteristically associated with each of the following clinical features: quantity of pus drainage; mode of onset; otalgia; hearing loss; location of tympanic membrane perforation; and mucosal appearance

Macrolide resistance in Streptococcus pneumoniae isolated from Argentinian pediatric patients suffering from acute otitis media / Macrolide resistance in Streptococcus pneumoniae isolated from Argentinian pediatric patients suffering from acute otitis media.

Macrolide-resistant Streptococcus pneumoniae emerged in Argentina in 1995, representing 26

of invasive infection isolates in children under 5 years old. The objectives of this study were to describe the prevalence of ermB and mefA genes in macrolide-resistant S. pneumoniae isolates from acute otitis media (AOM) and to determine their genetic relatedness. Between May 2009 and August 2010, 126 S. pneumoniae isolates from 324 otherwise healthy children with a first episode of AOM were included. Twenty six of these isolates (20.6

) were resistant to erythromycin. Most frequent serotypes were: 14 (46.2

) and 9V (7.7

) carried the mefA gene, 5 (19.2

) have the ermB gene, and 1 (3.9

) both ermB + mefA. Ten clonal types were identified, mostly related to Sweden(15A)-25/ST782 (SLV63), CloneB(6A)/ST473 and England(14)-9/ ST9. This is the first study assessing the mechanisms of macrolide resistance in pneumococci isolates from pediatric AOM in Argentina and their genetic relatedness.

Serotype distribution of pneumococci isolated from pediatric patients with acute otitis media and invasive infections, and potential coverage of pneumococcal conjugated vaccines / Distribución de serotipos de neumococos aislados de pacientes pediátricos con otitis media aguda e infecciones invasivas y su cobertura potencial a través de vacunas conjugadas

A 16-month prospective, descriptive study was conducted on pneumococcal serotype distribution isolated from children with acute otitis media (AÜM) and invasive infections (INV). Eighty-nine children with pneumococcal INV and 324 with a first episode of AOM were included. Bacterial pathogens (N = 326) were isolated from the middle-ear fluid of 250 patients. A total of 30 pneumococcal serotypes were identified. Prevalent serotypes were 14, 19A, 9V, 3, 19F, 6A, 23F, and 18C in AOM and 14, 1, 19A, 5, 12F, 6B, and 18C in INV. Potential coverage with PCV10 vaccine would be 46.5 % and 60.7 % for pneumococci involved in AOM and INV, respectively; it would be 71.7 % and 73 % with PCV13. PCV10, conjugated with a Haemophilus protein, would have an immunologic coverage of 39.9 % for AOM vs. 18.5 % with PCV13. However, differences in the prevention of INV were crucial for the decision to include the 13-valent vaccine in the national calendar for children less than two years old in Argentina.

Se realizó un estudio prospectivo descriptivo sobre la distribución de serotipos de neumococos aislados de niños con otitis media aguda (OMA) y con infecciones invasivas (INV) en un período de 16 meses. Se incluyeron 89 niños con INV neumocócicas y 324 con un primer episodio de OMA. Trescientos cuarenta y seis patógenos se aislaron de las secreciones de oído medio obtenidas de 250 pacientes. Se identificaron 30 serotipos y los más prevalentes fueron el 14, 19A, 9V, 3, 19F, 6A, 23F y 18C en OMA y el 14, 1, 19A, 5, 12F, 6B y 18C en INV. La cobertura potencial con la vacuna PCV10 sería de 46,5 % y 60,7 % para neumococos involucrados en OMA y en INV, respectivamente; con la PCV13, esta sería de 71,7 % y 73 %. La PCV10 conjugada con una proteína de Haemophilus tendría una cobertura inmunológica del 39,9 % para OMA, contra una cobertura del 18,5 % de la PCV13. Sin embargo, las diferencias en la prevención de INV fueron determinantes a la hora de considerar incorporarla al calendario nacional de vacunación para niños menores de 2 años en la Argentina.

Tuberculous Otitis Media.

Considerable variation exists between the clinical presentation of tuberculous otitis media (TOM) seen nowadays and what was described earlier. Confusing clinical picture and subsequent delay in diagnosis of TOM permits it to progress unhindered and results in permanent disabling conditions like facial paralysis and profound hearing loss. Hence an early diagnosis of TOM and timely commencement of appropriate therapy remains a challenging task. A high index of suspicion is required on part of the clinician to diagnose this fabled entity.

Streptococcus pneumoniae serotypes isolated from the middle ear of Mexican children diagnosed with acute otitis media / Serotipificación de Streptococcus pneumoniae aislados de líquido de oído medio en niños mexicanos con diagnóstico de otitis media aguda

OBJECTIVE: The aim of this study was to identify the etiology and the serotypes of S. pneumoniae (Sp) in Mexican children with acute otitis media (AOM). MATERIALS AND METHODS: The study includessamples frompatientsdiagnosed with AOM at the Federico Gomez Children's Hospital of Mexico (2002-2003),with positive culture for Sp bacteriologically confirmed in middle ear fluid obtained by tympanocentesis. All Sp were serotyped. A total of 138 samples from 135 children with AOM were included. RESULTS: Sp was isolated in 72 samples from 70 children. Sixty (85.7 percent) were previously healthy and 10 (14.3 percent) were immunocompromised. The most common serotypes were 6B and 19F (16.67 percent), and 6 A, 14 and 23F (15.27 percent). CONCLUSION: The distribution of serotypes among the children with AOM in the study is similar to that reported in developing cities, and 63.9 percent of the isolated serotypes are found to be included in the 7-Valent Pneumococcal Conjugate Vaccine (PCV), 68.1 percent in the 10-Valent PCV and 83.3 percent in 13-Valent PCV.

OBJETIVO: Conocer la etiología y serotipos de S. pneumoniae (Sp) en niños mexicanos, con otitis media aguda (OMA). MATERIAL Y MÉTODOS: Se incluyeron las muestras de pacientes con OMA del Hospital Infantil de México Federico Gómez (2002-2003), con cultivo positivo para Sp, (bacteriológicamente confirmados en el líquido del oído medio obtenido por timpanocentesis). Todos los Sp. fueron serotipificados. Se incluyeron 138 muestras de 135 niños con OMA. RESULTADOS: Sp. se aisló en 72 muestras de 70 niños: 60 (85.7 por ciento) eran previamente sanos y 10 (14.3 por ciento) eran inmunocomprometidos. Los serotipos más frecuentes fueron 6B y 19F (16.67 por ciento), y 6 A, 14 y 23F (15.27 por ciento). CONCLUSIONES: La distribución de los serotipos en niños con otitis media aguda fue similar a la reportada en ciudades en desarrollo y se observó que 63.9 por ciento de los serotipos aislados están incluidos en la vacuna conjugada 7-valente, 68.1 por ciento en la 10-valente y 83.3 por ciento en la 13-valente.

Achados bacterianos encontrados na secreção da otite média cronica: estudo comparativo entre o colesteatoma (OMCC) e a otite média cronica simples (OMCS) / Bacterial findings found in the chronic otitis media secretion: comparative study between cholesteatoma (OMCC) and simple chronic otitis media (SCOM)

Introdução: Foi feita uma comparação na frequencia com que os patogenos infectantes foram detectados na supuração causada pelo colesteatoma e pela otite crônica simples no período de 2006 a 2008. Objetivo: Fazer um estudo comparativo entre os achados bacterianos encontrados na secreção da otite crônica simples e a colesteatomatosa. Método: Foram estudados a bacterioscopia de 83 pacientes (125 orelhas) portadores de otite média crônica, sendo 43 (52 orelhas) com colesteatoma e 40 (73 orelhas) com otite crônica simples, com predominância de idade dos 16 aos 20 anos. A duração da otorreia variou entre 2 meses e 10 anos. Para a colheita do material utilizamos um equipamento bastante pratico com caldo de tioglicolato dentro e fora enviados ao laboratório por um período máximo de até 18 horas. Resultados: O S. aureus foi mais frequente na otite crônica simples, enquanto que os anaeróbios foram mais frequentes no colesteatoma. A P. aeruginosa foi mais frequente na otite crônica simples e o Corynebacterium sp. apresentou maior frequencia no colesteatoma. o S. epidermidis apareceu com frequencias iguais em ambas as doenças otológicas. Conclusão: Não encontramos mudanças notáveis na bacteriologia dessas duas doenças. Na otite crônica simples os achados mais frequentes foram S. aureus, Pseudomonas sp. e fungos. No colesteatoma os achados mais frequentes foram os Anaeróbios e o Corynibacterium sp. A frequencia de aparecimento para S. epidermidis, Klebisiela sp. e Streptococcus sp. foi igual em nosso estudo.

Introduction: This study carried out a comparison in the frequency with which the infecting pathogens were detected in the suppuration caused by cholesteatoma and simple chronic otitis media in the period from 2006 to 2008. Objective: To carry out a comparative study between the bacterial findings found in the simple and cholesteatomatous chronic otitis media secretion. Method: We studied the bacterioscopy of 83 patients (125 ears) with chronic otitis media, 43 (52 ears) with cholesteatoma and 40 (73 ears) with simple chronic otitis, and age prevalence from 16 to 20 years. The duration of otorrhea ranged between 2 months and 10 years. For collection of the material we used very practical instrument with tioglicolate broth inside and outside sent to the laboratory for a maximum period of until 18 hours. Results: The S. aureus was more frequent in the simple chronic otitis, and the anaerobic were more frequent in the cholesteatoma. The P. aeruginosa was more frequent in the simple chronic otitis and the Corynebacterium sp. presented a higher frequency in cholesteatoma. The S. epidermidis appeared with the same frequencies in both otologic diseases. Conclusion: We did not find any critical changes in the bacteriology of either disease. In the simple chronic otitis, the most frequent findings were S. aureus, Pseudomonas sp. and fungi. In the cholesteatoma, the most frequent findings were the Anaerobios and Corynibacterium sp. The frequency of S. epidermidis, Klebisiela sp. and Streptococcus sp. was the same in our study.

[Identification of effective biotherapy for bacterial otitis media in children presenting to private clinics in Sanaa city]

To identify the causative agents of otitis media of children aged up to 15 years, and determine the proper antibiotics and compare them with those empirically prescribed by Yemeni pediatricians. A total of 429 bacteriology results of middle ear swabs, agent microorganisms, and their susceptibility to antibiotics of children aged up to 15 years old with otitis media resistant to prescribed antibiotics were collected from three main microbiology lab in Sana 'a city during the period from June 2006 till June 2007. Fifty pediatricians were asked to list their 5 antibiotics of choice in treatment of otitis media to compare empirical prescription with microbiology A total of 429 children were enrolled in this study, 145 [33.8%] of them aged 2 year or less, 101 between 3-5 years [23.5%], while 183 aged 6 years old and above [42.7%]. Males were 266 [62.0%] while 163 [38.0%] were females. The most common pathogens were Staphylococcus aureus [41.7%], Pseudomonas aeruginosa [17.7%], Proteus spp [11.2%] and Hemophilus influenza [7.7%]. Concerning antibiotics, pathogens were more sensitive to ceftriaxone [77.7%] followed by cefotaxime [72.0%], cefuroxime [69.1%], amoxil/clavulanic [57.3%]. Most common empirically prescribed antibiotics were amoxil/clavulanic [92%]. Practicing pediatricians used to prescribe amoxil/ davulanic first and a considerable proportion are prescribing amoxil which is not effective. Staphylococcus aureus, Pseudomonas aeruginosa and Proteus spp. are the most common pathogens associated with otitis media in Yemeni children. Otitis media pathogens are sensitive to ceftriaxone, cefotaxime and amoxil/clavulanic respectively

Microflora and antibiograms of discharging ears in a cross - section of population in Quetta, Balochistan

To study the micro flora and the antibiograms of patients with discharging ears due to Otitis externa / Otitis media in Quetta, Balochistan and to analyse and compare the results with other domestic and international studies. Prospective, descriptive study. Department of ENT, Combined Military Hospital, FC Hospital, Saleem Medical Complex and Mideast Hospital Quetta, from January 2003 to June 2005. The ear swabs of 1105 patients with otorrhoea were prospectively analyzed. Antibiotic testing was done using modified Kirby Bauer disc diffusion method. In addition to the usual antibiotics, the two most common topically available antibiotics [gentamicin and Ofloxacin] were also tested. There were 1057 positive cultures for organisms from the 1105 patients with 1125 isolates. The most common causal organisms isolated were staphylococcus aureus [40%] with 10.29% Methicillin resistant staphylococcus aureus [MRSA] positive followed by pseudomonas aeruginosa [38.4%]. Fungi accounted for 3.7% of isolates. Out of the two antibiotics commonly available as topical eardrops, Ofloxacin has a very high overall susceptibility rate [97.3%] to all organisms cultured. Staphylococcus aureus is the commonest organism, replacing pseudomonas aeruginosa in discharging ears. All the isolates cultured were highly sensitive to Ofloxacin / Ciprofloxacin. Thus apart from fungal infection of the ear Ofloxacin eardrops should be the mainstay of treatment

Otitis media aguda: Diagnóstico y tratamiento / Acute otitis media: Diagnosis and treatment

Acute otitis media (AOM) is one of the most common causes of medical visit and antimicrobial use in children. A rationale management approach requires a thorough clinical exam and updated knowledge on local patterns of microorganisms involved and antimicrobial susceptibility profiles. Clinical diagnosis should be performed with pneumatic otoscopy. The most common microorganism causing AOM in Santiago, Chile according to local studies are Streptococcus pneumoniae (40 percento), non-capsulated Haemophilus influenzae (29 percent), Streptococcus pyogenes (7 percent) and Moraxella catarrhalis (4 percent). S. pneumoniae has acquired resistance to penicillin in the last decade, resistance that has been extrapolated to other (b lactams such as amoxicillin, reason why broader spectrum antimicrobials are routinely prescribed. Clinical practice has consistently shown although that the great majority of children receiving amoxicillin at a dose of 80-100 mg/kg/day resolve their AOM. Recent studies from our group have demonstrated that resistance to penicillin can not be extrapolated to amoxicillin. In vitro high level resistance to penicillin vs amoxicillin is 18 percent> vs 0.5 percent. Based on this data, our current recommendation for AOM is amoxicillin 80 mg/kg/day, q 12 hours for 10 days in infants and for 5-7 days in children > 2 years of age who have not had an episode within the previous month. For amoxicillin failures, amoxicillin + (b lactam inhibitor or a second generation cephalosporin are recommended, especially in areas with a high prevalence of (b lactam producing H. influenzae and M. catarrhalis. Treatment of children with AOM universally require appropriate follow-up in order to comply with the proposed algorithm.

Otitis media aguda (OMA) es una de las principales causas de consulta y de indicación de antimicrobianos en pediatría. El manejo racional de esta patología implica un diagnóstico acucioso y un conocimiento actualizado de las especies bacterianas involucradas en su etiología y de su susceptibilidad a antimicrobianos. El diagnóstico es clínico, a través de neumo-otoscopia. Los principales agentes involucrados en OMA en estudios hechos en Santiago de Chile son Streptococcus pneumoniae (40 por cientoo), Haemophilus influenzae no capsulado (29 por ciento), Streptococcus pyogenes (7 por ciento) y Moraxella catarrhalis (4 por ciento). S. pneumoniae ha adquirido resistencia a penicilina en la última década, lo que se ha extrapolado a otros (b lactámicos, como amoxicilina, y ha sido el principal argumento para indicar otros antimicrobianos en el manejo de esta patología. Pese a esta observación, en la práctica clínica los pacientes tratados con amoxicilina a dosis de 80 a 100 mg/kg/día responden satisfactoriamente, con mínimos fracasos terapéuticos. Estudios actuales, hechos en nuestro medio muestran que la susceptibilidad a penicilina y amoxicilina no son equivalentes, mostrando resistencia de alto nivel en 18 y 0,5 por ciento> respectivamente. El tratamiento recomendado hoy, de acuerdo con datos nacionales, es amoxicilina, 80 mg/kg/día, fraccionada cada 12 hrs, por 10 días en el lactante y por 5-7 días en niños > de 2 años, sin antecedentes de OMA a repetición. Como alternativa de tratamiento, frente a una falla del mismo, se propone el uso de amoxicilina + inhibidores de (b lactamasas o cefalosporinas de segunda generación en ambientes con alta prevalencia de H. influenzae productores de (b lactamasas y M. catarrhalis. El tratamiento de un niño con OMA implica, necesariamente, control y seguimiento hasta su mejoría.

Outpatient antibiotic therapy as a predisposing factor for bacterial resistance: a rational approach to airway infections

OBJETIVOS: Apresentar as recomendações baseadas em evidência para uso de antibióticos no tratamento das infecções respiratórias agudas (IRA) mais freqüentes e as informações disponíveis sobre a importância desse tipo de conduta. FONTES DOS DADOS: Bases de dados MEDLINE, LILACS, publicações técnicas de organizações internacionais, diretrizes nacionais e internacionais. Foram utilizados os unitermos acute respiratory infection, otitis, sinusitis, tonsillitis, pneumonia, antibiotic, guidelines, bacterial resistance. Artigos citados pelos artigos incluídos foram analisados quanto à apresentação de informação de interesse. SíNTESE DOS DADOS: A resistência bacteriana tem crescido, sendo atualmente reconhecida como problema mundial de saúde pública. As IRA são a causa mais freqüente para uso de antibiótico na comunidade; grande parte desses casos, tanto nas vias aéreas superiores (otite, sinusite, faringoamidalite) como nas inferiores (pneumonia), são decorrente de infecção viral. As recomendações para racionalizar o uso de antibióticos nos pacientes com IRA têm como objetivo comum minimizar o uso desnecessário de antibióticos, visto que a "pressão antibiótica" é um dos fatores desencadeantes da resistência bacteriana. CONCLUSÕES: É de grande importância a distinção, entre os pacientes com IRA, daqueles que podem se beneficiar do uso de antibióticos. O uso das recomendações para a prescrição de antibióticos é uma estratégia para minimizar a freqüência de resistência bacteriana.

OBJECTIVES: To present evidence-based recommendations for the use of antibiotics for the treatment of the most common acute respiratory infections (ARI) and the available information on the importance of this type of management. SOURCES: MEDLINE and LILACS databases, technical publications by international organizations, national and international directives. The search terms acute respiratory infection, otitis, sinusitis, tonsillitis, pneumonia, antibiotic, guidelines and bacterial resistance were used. Articles cited by the articles selected were analyzed for information of interest. SUMMARY OF THE FINDINGS: Bacterial resistance has grown, to the extent that today it is recognized as a global public health problem. ARI are the most common cause of antibiotic usage within the community; yet a large proportion of these cases, compromising the upper (otitis, sinusitis, tonsillitis) or the lower airways (pneumonia), are the result of viral infections. Recommendations to rationalize the use of antibiotics in patients with ARI have the common objective of minimizing unnecessary antibiotic use, since "antibiotic pressure" is one of the factors triggering bacterial resistance. CONCLUSIONS: It is of great importance to differentiate among ARI patients those who will benefit from the use of antibiotics. The establishment of recommendations for the prescription of antibiotics is one strategy for minimizing the frequency of bacterial resistance.

Risk of acute otitis media in relation to acute bronchiolitis in children

A prospective study was carried out to evaluate the prevalence and the etiology of acute otitis media [AOM] In children with acute bronchiolitis. Also to determine whether AOM occurring with acute bronchiolitis "Which mainly due to respiratory syncytial virus [RSV]" is accompanied with another pathogens "which usually found in the middle ear aspirate [MEA]" or not. Thirty-six children with acute bronchiolitis aged 3 to 18 months that were admitted to pediatrics department, El-Minia University Hospital during the period from September 2005 to December 2005 were included In this study. In patients with AOM at entry or developed AOM within 14 days, Gram-stained smears, bacterial cultures, and enzyme-linked immunosorbent assay [ELISA] were performed on middle-ear aspirates to detect the presence of bacterial pathogens and RSV respectively. Twenty children [55.6%] with acute bronchiolitis had AOM at entry or developed AOM within 14 days, 9 patients [25%] had developed otitis media with effusion, and only 7 patients [19.4%] remained free of both AOM and otitis media with effusion, throughout the 2-weeks observation period. Of 27 middle-ear aspirates [13 unilateral and 7 bilateral], bacterial pathogens were isolated in 23 [85%] [10 bacteria alone "37%" and 13 mixed bacteria and RSV "48%"], RSV was identified in 15 [55.5%] of middle ear aspirates [mixed with bacteria in 13 and RSV alone in 2 cases [7.5%]], so RSV was identified in 15 of 20 patients [75%] with AOM. Streptococcus pneumoniae was isolated in 11 middle ear aspirates, Haemophilus influenza in 6, Moraxella catarrhalis in 4, Staphylococcus aureus in 2, Streptococcus pyogenes in one aspirate and Pseudomonas aeruginosa in one aspirate only. Of 20 cases of AOM, 15 [75%] responded clinically to usual dose of antibiotic [Amoxicillin and clavulanic acid and/or Cefotaxime]. Finally we concluded that bacterial AOM is a complication In most children with acute bronchiolitis. Streptococcus pneumoniae and Haemophilus influenza were the commonest organisms isolated from middle ear aspirate. RSV is identified in most cases of acute otitis media [75%] and mixed with bacterial pathogens. Accordingly, in patients with acute bronchiolitis and associated AOM, antimicrobial treatment is indicated

Comparison of Streptococcus pneumoniae serotypes causing acute otitis media & invasive disease in young children in the Czech Republic.

BACKGROUND & OBJECTIVES: The availability of a type-specific pneumococcal vaccine for children is a worldwide problem. It is necessary to study the serotypes prevalent in a country before introducing a type-specific vaccine. The objective of the present study was to analyse the prevalence of Streptococcus pneumoniae serotypes in children suffering from acute otitis media or invasive pneumococcal disease and to compare a coverage of serotypes by individual pneumococcal vaccines. METHODS: Children suffering from acute otitis media and invasive pneumococcal disease were analysed in the Czech Republic from October 1999 to November 2000. Serotyping was performed by the quellung technique using antisera from Statens Serum Institute (Denmark). RESULTS: The most frequent serotypes in patients with acute otitis media were 3, 19F, 23F, 14, 9V, 1, 6B, 11A and 28F. Vaccine coverage for the identified serotypes in acute otitis media patients was 52.1 per cent for the 7-valent vaccine, 57.8 per cent for the 9-valent vaccine and 75.7 per cent for the 11-valent form of the vaccine. In 108 patients with invasive pneumococcal disease, the most frequent serotypes were 6B, 9V, 14, 19F, 3 and 23F. Vaccine coverage for the identified serotypes in patients with invasive pneumococcal disease was 62 per cent for the 7-valent vaccine, 66.4 per cent for the 9-valent vaccine and 77.5 per cent for the 11-valent form of the vaccine. INTERPRETATION & CONCLUSION: Vaccine coverage for the identified serotypes for the 11-valent pneumococcal vaccine was better than the other two vaccines.