Resistant Microorganisms Isolated from Cases of Chronic Suppurative Otitis Media: A Therapeutic Concern

Abstract

Introduction: Chronic Suppurative Otitis Media (CSOM) still is a common health care problem in developing countries like India with its potential for serious local damage and complications. Knowledge of causative microorganisms and their antimicrobial sensitivity pattern is essential so that early and effective therapeutic measures can be initiated for better patient outcome. Aim: The study was carried out to determine the clinicomicrobiological spectrum of CSOM from this geographical area and to evaluate the susceptibility pattern of aerobic bacterial isolates. Materials and Methods: The prospective study was carried out for a period of one year from December 2013 to November 2014 in Chhatrapati Shivaji Subharti Hospital, a Tertiary Care Hospital in Meerut city. A total of 113 ear discharge was collected from clinically suspected cases of CSOM. The discharge was cultured on blood agar and Mac Conkey’s agar plates for isolation of bacterial pathogen and Sabourauds Dextrose Agar (SDA) slants for isolation of fungal pathogens. Identification of the bacterial and fungal isolates was done using standard bacteriological and mycological methods respectively. Antimicrobial susceptibility testing of the bacterial isolates was performed by Kirby-Bauer’s disc diffusion method as per the Clinical Laboratory Standards Institute (CLSI) guidelines. Further, detection of Metallo Beta Lactamase (MBL) production, Methicillin Resistance in Staphylococcus aureus (MRSA) and Extended Spectrum Beta –Lactamase (ESBL) production was carried out by phenotypic methods. Result: A total of 73.45% cases were culture positive. Pure bacterial pathogen was isolated from 67.46 % followed by pure fungal pathogen 22.89% and mixed pathogen (bacteria and fungus) from 9.63% of cases. Pseudomonas aeruginosa and Staphylococcus aureus were the predominant bacterial pathogen and Aspergillus spp. and Candida species were the predominant fungal pathogens isolated. Overall the rate of MBL producers, MRSA and ESBL producers were 18.18%, 52.94% and 62.5% respectively. Conclusion: High level of resistance was observed in cases of CSOM from our hospital. Therefore, knowledge of the causative microorganisms and its susceptibility pattern is required and this data may contribute to an effective management of cases of CSOM.

Keywords

• microbiological spectrum
• otorrhea
• susceptibility pattern