|Year : 2021 | Volume
| Issue : 1 | Page : 44-46
Antimicrobial susceptibility in patients with chronic suppurative otitis media in a North-Central secondary health facility in Nigeria
Solomon Joseph Hassan1, Yikawe Stephen Semen1, Dabit Othniel Josep2, Ekuma Otu Gabriel2, Osisi Kingsley1, Solomon Ndudiri Calista3
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 Submission||21-Sep-2019|
|Date of Decision||30-Oct-2019|
|Date of Acceptance||26-Feb-2020|
|Date of Web Publication||26-Oct-2021|
Dr. Solomon Joseph Hassan
Department of ENT, Usmanu Danfodiyo University Teaching Hospital, Sokoto
Source of Support: None, Conflict of Interest: None
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|| |
Ear infection is a common clinical problem throughout the world and the major cause of preventable hearing loss in the developing world., The common bacteria implicated in chronic otitis media include Pseudomonas, Klebsiella, Proteus, and Staphylococcus spp. Pseudomonas spp. are notorious pathogens in the hospital setting;, their ability to form biofilm contributes to their frequency in CSOM. 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, 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. Although conductive hearing loss is the usual association, sensorineural deafness is also reported as sequel of chronic otitis media. 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|| |
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. The results were analyzed using IBM-SPSS 20 (IBM Corp, Chicago, Illinois, USA).
| Results|| |
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].
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.
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.
| Discussion|| |
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%, 89.4%, and 100% and in Benin, Nigeria: 81.9%. 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. and Fatma et al. reported 93.1% and 94% of monobacterial growth in their studies, respectively. In contrast, Vijaya 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. 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.,, In contrast, some studies recorded Proteus spp. and Staphylococcus aureus as the most frequent isolates, with Pseudomonas spp. occurring in second or third places.,,,,
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, Jordan, and Ethiopia, 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.
| Conclusion|| |
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
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]