Home Ahead of print Instructions Contacts
About us Current issue Submit article Advertise  
Editorial board Archives Subscribe Login   


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 27  |  Issue : 1  |  Page : 44-46

Antimicrobial susceptibility in patients with chronic suppurative otitis media in a North-Central secondary health facility in Nigeria


1 Department of ENT, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
2 Department of Paediatrics, Benue State University Teaching Hospital, Makurdi, Nigeria
3 Department of Paediatrics, Jos University Teaching Hospital, Jos, Nigeria

Date of Submission21-Sep-2019
Date of Decision30-Oct-2019
Date of Acceptance26-Feb-2020
Date of Web Publication26-Oct-2021

Correspondence Address:
Dr. Solomon Joseph Hassan
Department of ENT, Usmanu Danfodiyo University Teaching Hospital, Sokoto
Nigeria
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/indianjotol.INDIANJOTOL_91_19

Rights and Permissions
  Abstract 


Introduction: Antibiotic resistance is a major challenge in managing patients with chronic inflammation of the middle ear cleft in our facility. This is also a concern in many sub-Saharan African and Asian countries. Many secondary and primary health facilities lack the services of trained ear nose and throat nurses, and it is rare to have an otorhinolarynogologist in these centers. To reduce the risks of antibiotics resistance and complications from middle ear cleft infection, there is a need to know the pattern of microbial susceptibility to facilitate the selection of antibiotics in treating patients with chronic otitis media in the region. Methodology: We carried out a prospective, hospital-based study in a secondary health facility in Makurdi, North-Central Nigeria, for 11 months from August 2018 to July 2019. One hundred and twelve patients of all age groups with chronically discharging ear (s) were consecutively recruited for the study. Ear swabs were carefully taken from the middle ear using sterile swab sticks and quickly taken for microscopy culture and sensitivity. The results were analyzed using IBM-SPSS version 20. Results: One hundred and twelve patients were recruited with ages ranging from <1 year to 56 years. Nearly 57.1% were female and 42.9% were male. Thirty-two (28.6%) of the swab taken yielded no growth. Pseudomonas spp. was the most frequent isolate (50%), and Staphylococcus, Klebsiella, and Streptococcus spp. isolated in 10.7%, 7.1%, and 3.6%, respectively. Pseudomonas, Streptococcus, and Klebsiella spp. had the highest susceptibility to ciprofloxacin (88%–98%); only 50% by Staphylococcus spp. Gentamicin was effective against all the isolates (70%–97%). All four isolates also showed moderate-to-high susceptibility to levofloxacin and pefloxacin; organisms showed least sensitivity to ofloxacin (30%–58%). Conclusion: Pseudomonas spp. is the most common isolate in chronic otitis media patients in this subregion, with excellent susceptibility to ciprofloxacin (98%). All isolates had a good level of susceptibility to the commonly used topical antibiotics, except for ofloxacin (30%–58%). More studies should be done at intervals to note any change in microbial isolates and susceptibility pattern, this will enhance success in treating chronic otitis media.

Keywords: Antimicrobial susceptibility, chronic otitis media, North-Central Nigeria


How to cite this article:
Hassan SJ, Semen YS, Josep DO, Gabriel EO, Kingsley O, Calista SN. Antimicrobial susceptibility in patients with chronic suppurative otitis media in a North-Central secondary health facility in Nigeria. Indian J Otol 2021;27:44-6

How to cite this URL:
Hassan SJ, Semen YS, Josep DO, Gabriel EO, Kingsley O, Calista SN. Antimicrobial susceptibility in patients with chronic suppurative otitis media in a North-Central secondary health facility in Nigeria. Indian J Otol [serial online] 2021 [cited 2021 Dec 2];27:44-6. Available from: https://www.indianjotol.org/text.asp?2021/27/1/44/329101




  Introduction Top


Ear infection is a common clinical problem throughout the world and the major cause of preventable hearing loss in the developing world.[1],[2] The common bacteria implicated in chronic otitis media include Pseudomonas, Klebsiella, Proteus, and Staphylococcus spp.[3] Pseudomonas spp. are notorious pathogens in the hospital setting;[4],[5] their ability to form biofilm contributes to their frequency in CSOM.[6] Empiric treatment of ear infection is not always appropriate since drug susceptibility patterns change overtime and empiric antibiotic therapy may not be effective at times and could contribute to the development of antimicrobial resistance in the long run[7],[8] and pave the way for more avoidable complications such as hearing loss. About 13.8%–36.2% of chronic otitis media patients have hearing impairment.[9] Although conductive hearing loss is the usual association, sensorineural deafness is also reported as sequel of chronic otitis media.[10] We carried out this work to have a baseline picture of the microbial pattern and their antibiotics susceptibility in this region and also to add to the already existing pool of knowledge.


  Methodology Top


A prospective, cross-sectional study was conducted in a secondary health facility in Makurdi, North-Central Nigeria, for 11 months from August 2018 to July 2019. One hundred and twelve outpatients of all age groups with chronically discharging ear (s) were recruited for the study. Consecutive sampling technique was used to recruit participants, and ear discharge was reported by patients or parents' relatives and confirmed on presentation using headlight and/or otoscope. All patients who took antibiotics, systemic or local, within the previous 4 weeks were excluded from the study. The ear canal for each patient was suctioned of excess discharge, an aural speculum inserted (to avoid contamination by normal skin flora; commonly coagulase negative staphylococcus) before ear swabs were carefully taken from the middle ear using sterile swab sticks and quickly taken to the laboratory. Standard procedures were used to grow and identify the organisms, and antibiotic discs were selected based on the prescription pattern in the study area and recommendations from the Clinical Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing.[11] The results were analyzed using IBM-SPSS 20 (IBM Corp, Chicago, Illinois, USA).


  Results Top


One hundred and twelve outpatients were recruited with ages ranging from <1 year to 56 years, with females constituting 57.1% and 42.9% were male [Table 1].
Table 1: Age of patients

Click here to view


Thirty-two (28.6%) of the swabs taken yielded no growth [Figure 1]. Pseudomonas spp was the most frequent isolate (50%), and Staphylococcus, Klebsiella, and Streptococcus spp isolated in 10.7%, 7.1%, and 3.6%, respectively.
Figure 1: Bacterial isolates from ear swab culture

Click here to view


Pseudomonas, Streptococcus, and Klebsiella spp had the highest susceptibility to ciprofloxacin (88%–98%); only 50% by Staphylococcus spp. Gentamycin was effective against all the isolates (70%–97%). All four isolates also showed moderate-to-high susceptibility to levofloxacin and pefloxacin; organisms showed least sensitivity to ofloxacin (30%–58%). [Figure 2] shows the antimicrobial susceptibility pattern of the bacterial isolates.
Figure 2: Antimicrobial susceptibility of bacterial isolates

Click here to view



  Discussion Top


In this study, 71.43% of the ear swab culture yielded bacterial growth. The prevalence of positive culture is slightly lower compared to that in some studies done in Ethiopia: 91.7%,[12] 89.4%,[13] and 100%[14] and in Benin, Nigeria: 81.9%.[15] A lower bacterial yield in this study may be due to our inability to carry out some cultures, especially for anaerobic organisms. All samples in our study yielded single bacterial growth. Other researchers, Kumar et al.[16] and Fatma et al.[17] reported 93.1% and 94% of monobacterial growth in their studies, respectively. In contrast, Vijaya[18] reported only 51% monobacterial growth.

We recorded Pseudomonas spp. as the most frequent isolate (50%), and Staphylococcus, Klebsiella, and Streptococcus spp. were isolated in 10.7%, 7.1%, and 3.6%, respectively. This corroborates studies by Shirsendu et al.[19] who revealed that Pseudomonas spp. was the most common isolate in patients with chronic otitis media followed by Staphylococcus aureus. Other studies also recorded P. aeruginosa as the most common isolate.[20],[21],[22] In contrast, some studies recorded Proteus spp. and Staphylococcus aureus Scientific Name Search  as the most frequent isolates, with Pseudomonas spp. occurring in second or third places.[12],[23],[24],[25],[26]

Susceptibility pattern was done based on the commonly prescribed topical antimicrobial agents in our location. Pseudomonas, Streptococcus, and Klebsiella spp. had the highest susceptibility to ciprofloxacin (88%–98%); only 50% by Staphylococcus spp. Gentamycin was effective against all the isolates (70%–97%). All four isolates also showed moderate-to-high susceptibility to levofloxacin and pefloxacin, organisms showed least sensitivity to ofloxacin (30%–58%). This is similar to other studies conducted in India,[27] Jordan,[28] and Ethiopia[29],[30] where isolates had a good overall antimicrobial susceptibility pattern (>70%) to gentamycin and ciprofloxacin. In contrast to these reports; however, gentamycin and ciprofloxacin were reported as ineffective from a study conducted in Benin, southern part of Nigeria.[15]


  Conclusion Top


Our study revealed that Pseudomonas spp. is the most common causative agent in chronically discharging ear, and ciprofloxacin and gentamicin are the most effective antibiotics in the treatment. More studies should however be encouraged to develop a broader picture of isolates in chronic otitis media and their susceptibility pattern in this region; these studies must be repeated at intervals to facilitate the early identification of antimicrobial resistance among the implicated organisms.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ullauri A, Smith A, Espinel M, Jimenez C, Salazar C, Castrillon R. “WHO ear and hearing disorders survey: Ecuador national study 2008-2009,” Conference Papers in Science. Vol. 2014; 2014. p. 13.  Back to cited text no. 1
    
2.
World Health Organization. Deafness and hearing loss. Fact Sheet 300. World Health Organization; 2015. Available from: http://www.who.int/mediacentre/factsheets/fs300/en/. [Last accessed on 2019 Feb 07].  Back to cited text no. 2
    
3.
Shyamala R, Reddy PS. The study of bacteriological agents of chronic suppurative otitis media-Aerobic culture and evaluation. J Microbiol Biotechnol Res 2017;2:152-62.  Back to cited text no. 3
    
4.
Sahu MC, Dubey D, Rath S, Debata NK, Padhy RN. Multidrug resistance of Pseudomonas aeruginosa as known from surveillance of nosocomial and community infections in an Indian teaching hospital. J Public Health 2012;20:413-23.  Back to cited text no. 4
    
5.
Afolabi OA, Fadare JO, Omokanye HK, Olatoke F, Odi TO, Saka MJ. Socioeconomic challenges of chronic suppurative otitis media management in state tertiary health facility in Nigeria. Egypt J Ear Nose Throat Allied Sci 2004;15:17-22.  Back to cited text no. 5
    
6.
Couzos S, Lea T, Mueller R, Murray R, Culbong M. Effectiveness of ototopical antibiotics for chronic suppurative otitis media in aboriginal children: A community-based, multicentre, double-blind randomised controlled trial. Med J Aust 2003;179:185-90.  Back to cited text no. 6
    
7.
Grevers G; First International Roundtable ENT Meeting Group. Challenges in reducing the burden of otitis media disease: An ENT perspective on improving management and prospects for prevention. Int J Pediatr Otorhinolaryngol 2010;74:572-7.  Back to cited text no. 7
    
8.
Agrawal A, Kumar D, Goyal A, Goyal S, Singh N, Khandelwal G. Microbiological profile and their antimicrobial sensitivity pattern in patients of otitis media with ear discharge. Indian J Otology 2013;19:5.  Back to cited text no. 8
    
9.
Tos M. Causes of the disease. Ann Otolaryngol Head Neck Surg 1990;99:7.  Back to cited text no. 9
    
10.
Kenna MA. Treatment of chronic suppurative otitis media. Otolaryngol Clin North Am 1994;27:457-72.  Back to cited text no. 10
    
11.
Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing. Wayne, PA, USA: Clinical and Laboratory Standards Institute; 2016. p. 39-43.  Back to cited text no. 11
    
12.
Abera B, Kibret M. Bacteriology and antimicrobial susceptibility of otitis media at dessie regional health research laboratory Ethiopia. Ethiop J Health Dev 2011;25:161-7.  Back to cited text no. 12
    
13.
Seid A, Deribe F, Ali K, Kibru G. Bacterial otitis media in all age group of patients seen at Dessie referral hospital North East Ethiopia. Egypt J Ear Nose Throat Allied Sci 2013;14:73-8.  Back to cited text no. 13
    
14.
Diriba M, Solomon G, Hailu N. Isolation and antimicrobial susceptibility pattern of bacterial pathogens causing otitis media in children in Jimma Hospital, South Western Ethiopia. Ethiop J Health Sci 2014;14:89-100.  Back to cited text no. 14
    
15.
Osazuwa F, Osazuwa E, Osime C, Igharo EA, Imade PE, Lofor P, et al. Etiologic agents of otitis media in Benin city, Nigeria. N Am J Med Sci 2011;3:95-8.  Back to cited text no. 15
    
16.
Kumar S, Sharma R, Saxena AK, Pandey A, Gautam P, Jain R. A study of bacterial flora and sensitivity toantibiotics in cases of CSOM TTD in western UP. Indian J Otol 2008;14:204.  Back to cited text no. 16
    
17.
Fatma AA, Assiry S, Siraj MZ. Microbiological evaluation and aspects on management of chronic suppurativotitis media in Riyadh. Indian J Otol 1998;4:115-20.  Back to cited text no. 17
    
18.
Vijaya D. Aerobes anaerobes and fungi in chronic suppurative otitis media. Indian J Otol 2000;6:558.  Back to cited text no. 18
    
19.
Shirsendu M, Mnasi B, Sudip D. Evaluation of antimicrobial sensitivity pattern of chronic suppurative otitis media in a tertiary care hospital of West Bengal, India. Int J Basic Clin Pharmacol 2017;6:891-4.  Back to cited text no. 19
    
20.
Aslam MA, Ahmed Z, Azim R. Microbiology and drug sensitivity patterns of chronic suppurative otitis media. J Coll Physicians Surg Pak 2004;14:459-61.  Back to cited text no. 20
    
21.
Fatima G, Raza Z, Shoaib M, Hashmi SB. Antimicrobial susceptibility pattern of bacterial and fungal isolates from patients with chronic suppurative otitis media in perspective of emerging resistance. Pak J Otolaryngol 2013;29:49-53.  Back to cited text no. 21
    
22.
Weckwerth PH, de Magalhães Lopes CA, Duarte MA, Weckwerth AC, Martins CH, Neto DL, et al. Chronic suppurative otitis media in cleft palate: Microorganism etiology and susceptibilities. Cleft Palate Craniofac J 2009;46:461-7.  Back to cited text no. 22
    
23.
Seid A, Deribe F, Ali K, Kibru G. Bacterial otitis media in all age group of patients seen at Dessie referral hospital, North East Ethiopia. Egypt J Ear Nose Throat Allied Sci 2013;14:73-8.  Back to cited text no. 23
    
24.
Muluye D, Wondimeneh Y, Ferede G, Moges F, Nega T. Bacterial isolates and drug susceptibility patterns of ear discharge from patients with ear infection at Gondar University Hospital, Northwest Ethiopia. BMC Ear Nose Throat Disord 2013;13:10.  Back to cited text no. 24
    
25.
Argaw-Denboba A, Abejew AA, Mekonnen AG. Antibiotic-resistant bacteria are major threats of otitis media in Wollo Area, Northeastern Ethiopia: A ten-year retrospective analysis. Int J Microbiol 2016;2016.doi: 10.1155/2016/8724671.  Back to cited text no. 25
    
26.
Muleta D, Gebre-Selassie S. Isolation and antimicrobial susceptibility patterns of bacterial pathogens causing otitis media in children in JIMMA hospital, Southwestern Ethiopia. Ethiop J Health Sci 2004;14:89-99.  Back to cited text no. 26
    
27.
Poorey VK, Lyer A. Study of bacterial flora in CSOM and its clinical significance. Indian J Otolaryngol Head Neck Surg 2002;54:91-5.  Back to cited text no. 27
    
28.
Mohammad A. Etiology and antimicrobial susceptibility pattern of otitis media in children at princess Rhamah hospital in Jordan. New Iraqi J Med 2010;6:1.  Back to cited text no. 28
    
29.
Wasihun AG, Zemene Y. Bacterial profile and antimicrobial susceptibility patterns of otitis media in Ayder teaching and referral hospital, mekelle university, Northern Ethiopia. Springerplus 2015;4:701.  Back to cited text no. 29
    
30.
Hailu D, Mekonnen D, Derbie A, Mulu W, Abera B. Pathogenic bacteria profile and antimicrobial susceptibility patterns of ear infection at Bahir Dar Regional Health Research Laboratory Center, Ethiopia. Springerplus 2016;5:466.  Back to cited text no. 30
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Methodology
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed212    
    Printed0    
    Emailed0    
    PDF Downloaded12    
    Comments [Add]    

Recommend this journal