Susceptibility Ptterns of Bcteril Pthogens Associted With Otitis Medi At Murtl Muhmmd Specilist Hospitl, Kno, igeri A. H. Kwo* 1, B. M. Diyb 1, M. Yush u 1 * 1 Microbiology Unit, Deprtment of Biologicl Scienc, Byero University, PMB 3011, Kno, IEIA * Corrponding uthor E-mil: mryushu@gmil.com Abstrct: A study on the susceptibility ptterns of bcteril pthogens ssocited with otitis medi t Murtl Muhmmd Specilist Hospitl (MMSH), Kno, igeri ws conducted between July 20 nd August 28, 2009. A hundred nd twenty (120) er swb smpl were collected from ptients of both sex (ged 0 50 yers) prenting with otitis medi using stndrd methods. Of the 120 er swb smpl exmined, only 105(87.5%) yielded growth. The mle ptients hd the hight positive growth of 61(50.8%) while the feml hd 59(49.2%). The ge group 0-5 yers hd the hight positive cs with 63(52.5%) while ge groups 41-45 nd 46-50 yers ech hd the lt of 2(1.7%). Culturl, morphologicl nd biochemicl nlysis of the smpl identified Pseudomons eruginos s the most predominnt isolt with totl occurrence of 37(35.2%), followed by Proteus {27(25.7%)}, Stphylococcus ureus {20(19.0%)}, Klebsiell pneumonie {6(5.7%)}, Escherichi coli nd Morgnell morgnii ech hd 5(4.8%), Streptococcus nd Citrobcter frundii ech hd 2(1.9%) while Providenci hd the lt of 1(0.9%). The ml hd the hight number of isolt {56(53.3%)} while the feml hd the lt {49(46.7%)}. Susceptibility tting of the isolt using multiple disc diffusion technique ginst some commercil ntibiotics indicted tht gentmycin ws the most ctive ginst the mjority of the isolt with 82(78.1%) while the lt ws moxicillin with 13(12.4%). Keywords: Otitis medi, bcteril isolt, susceptibility profile, MMSH, Kno. 1. Introduction: Otitis medi (OM) is the inflmmtion of the middle er (middle er infection). 1,2 It occurs between the er drum (end of the outer er) nd the inner er, including duct known s the Eustchin tube. It is one of the two ctegori of er inflmmtion tht underly wht is commonly clled n erche, the other being otitis extern. 1 Dis other thn er infections cn lso cuse er pin including cncers of ny structure tht shr nerve supply with the er. OM is very common in childhood, with the verge toddler hving two to three episod yer, lmost lwys ccompnied by virl upper rpirtory trct infection (UI), mostly the common cold. 1 The dignosis of OM is the prence of middle er effusion in the bsence of symptoms. The effusion of OM cn be serous, mucoid or purulent. 3 Seventy five percent (75.0%) of children experience t lt one episode of OM by their third birthdy. Almost hlf of the children will hve three or more er infections during their first 3 yers. Although OM is primrily dise of infnts nd young children, it cn lso ffect dults. 4 OM cn be ssocited with n infection or be sterile. In the first cse, OM is usully cused by bcteri tht migrte into the middle er vi the Eustchin tube. Occsionlly, OM is usully cused by fungi (Aspergillus or Cndid) or other pthogens such s the herp virus. Sterile OM is usully clled serous OM (SOM). 5 The serous vriety is often ttributed to llergy but my lso occur from numerous other potentil sourc including rdition tretment 6 or virus 7. Hemophilus influenz, Streptococcus pneumonie, Morxell ctrrhlis hve commonly been identified in numerous studi. This hs rulted in regrding bcteril infection s n importnt fctor in the pthogenis of OM with effusion. Ls commonly, OM cn be cused by Mycobcterium tuberculosis, Stphylococcus ureus, Streptococcus pyogen nd Mycoplsm pneumonie. 8 Clinicins hve yers of experience treting 74
middle er dise with ntibiotics. The fvorble nturl history of the conditions nd the mrginl impct of ntibiotics therpy re under pprecited. 9 Clinicins over timted the extent to which clinicl filure is due to ntibiotic ristnce, nd over timted the likelihood tht second line medictions will cover ristnt orgnisms. 9 socio-economic sttus, culturl, sonl nd ge fctors s well s fmily history of middle er dise re the significnt risk fctors 10, which my independently influence the prevlence of OM. The im of this study ws to isolte, chrcterize nd identify the bcteril pthogens from ptients prenting with OM t the MMSH, Kno, igeri. This is with view to determining the susceptibility profile of the isolt using commercilly vilble ntibiotics. 2. Mterils And Methods: 2.1 Study Popultion And Smple Collection: One hundred nd twenty (120) er swb smpl were collected from ptients of both sex (ged 0 50 yers) prenting with OM t the ET Clinic of MMSH, Kno, igeri, using sterile swb sticks. The clinicl dignosis of OM ws mde on the bsis of bulging tympnic membrne with pprent purulent dischrge. The er drum nd the surrounding er cnl were sterilized with 70% lcohol solution. Sterile norml sline (0.85%) ws used to irrigte the cnl nd remove ny remining lcohol, fter which the sline itself ws subsequently clered with sterile bsorber cotton wool. The mens were obtined by insertion nd gentle rottion of sterile swb sticks in the middle er. 11 The study covered period of July 20 August 28, 2009. 2.2 Culturl, Morphologicl And Biochemicl Chrcteriztion of The Bcteril Isolt: Swbs were cultured on chocolte (oxoid) gr nd McConkey (oxoid) gr plt, which were incubted t 37ºC erobiclly for 18-24 hours. Chocolte gr plt were incubted under 10% crbon dioxide jr. rowth on KIA (oxoid) medium nd H 2 S gs production were observed nd recorded while rm s stining ws crried out to scertin the morphology nd rm s rection-behviour of the isolt. In ddition, the following biochemicl tts were crried out: ctlse, oxidse, cogulse, citrte nd ure tts (Chebrough, 2004). 2.3 Antibiotic Sensitivity Discs: The ntibiotic sensitivity discs used in this study were multiple discs nd q second-genertion cephlosporin. This ws to determine the effect of the ntibiotics considering the fct tht most bcteril pthogens re currently producing ristnt strins, thus risting the ntibiotics tht re in use. The multiple susceptibility discs included the rifmpin (10µg), moxicillin (30µg), erythromycin (30µg), chlormphenicol (20µg), mpiclox (30µg), ciprofloxin (10µg), norfloxcin (30µg), gentmycin (10µg), levofloxcin (10µg), streptomycin (30µg) while the second- genertion cephlosporin (Conoid, Englnd) used ws cefuroxime (30µg). 2.4 Susceptibility Tting: Susceptibility tting ws crried out in ccordnce with the method of Chebrough (2004) using multiple discs diffusion technique. A suspension of 10 6 cfu/ml of ech isolte ws mde nd inoculted onto the entire surfce of Mueller-Hinton gr plte. The ntibiotic discs were septiclly plced on the inoculted plte nd incubted t 37ºC for 18-24 hours fter which the susceptibility profil were interpreted ccording to the tionl Committee for Clinicl Lbortory Stndrds guidelin. 3. ults nd discussion: A totl of one hundred nd twenty (61 ml nd 59 feml) er swb smpl from ptients prenting with cs of otitis medi were septiclly collected nd nlysed t Murtl Muhmmd Specilist Hospitl Kno, during the period of the study (July 20 August 20, 2009). Of the 120 smpl exmined, 105(87.5%) yielded growth while 15(12.5%) yielded no growth (Tble 1). The distribution of subjects ccording to ge, sex nd culture growth is shown in Tble 1. The mle ptients hd the hight positive growth of 61(50.8%) while the feml hd 59(49.2%). Age group 0-5 yers hd the hight number of subjects exmined with 63(52.5%) while the ge groups 41-45 nd 46-50 yers ech hd the lt of 2(1.7%). Fctors such s developmentl differenc between children nd dults with rpect to ntomicl positioning of Eustchin tube, ls developed immune system in children nd the socio-culturl behviour of children, often plying with whtever com their wy, could prtly explin why children hd more otitis medi cs or recurrent episod thn their dult counterprts. Tble 2 shows the morphologicl nd biochemicl chrcteristics of the bcteril isolt. The rults indicted tht the isolt belonged to nine (9) bcteril gener. Tble 3 shows the distribution of the isolt ccording to sex of subjects exmined. Pseudomons eruginos hd the hight occurrence of 37(35.2%) while Providenci e hd the lt occurrence of 1(0.9%). Tble 4 shows the susceptibility ptterns of the isolt to eleven (11) commercilly-vilble ntibiotics. entmycin hd the hight ctivity with 75
82(78.1%) while moxicillin hd the lt of 13(12.4%). Vrious studi hve been crried out by mny rerchers in different prts of the world tblishing the significnce of bcteril s etiologic gents of suppurtive middle er infection. The bcteri encountered in the prent study were similr to those erlier reported tht P. eruginos, E. coli, Stphylococcus nd Proteus contribute to the mjority of suppurtive otitis medi. 12, 2 With n overll prevlence of 87.5% in this study, the rults of the prent study clerly demonstrted tht the epidemiology of middle er infection ws not rtricted to prticulr sex or ge group, lthough mle children of ls thn 10 yers were most ffected more thn the older children. However, the prevlence reported in the prent study is below the vlue (90.4%) erlier reported The high incidence of otitis medi in developing ntions like igeri could prtly be due to poverty nd its ccompnying fctors of overcrowding, poor snittion nd indequte helth fciliti most pecilly t the rurl r. The ntimicrobil susceptibility profile obtined in this study hs shown tht gentmicin, streptomycin nd chlormphenicol were most effective (Tble 4). The findings re similr to erlier reports. 13, 14 Dpite extensive rerch in vrious spects of otitis medi, the dise hs remined n importnt helth cre problem of childhood. The rpid incre in ristnce to penicillin nd severl others by strins of Streptococcus pneumonie nd other bcteril isolt will most likely hve gret impct on ntibiotic tretment of cute otitis medi. In this study, more thn hlf of the bcteril isolt were found to be ristnt to moxicillin nd mpiclox, which re used s the first line ntibiotics in otitis medi. This high ristnce could be ttributed to the gross misuse of the drugs in chemotherpy prticulrly in this prt of the world. In order to fcilitte strtegi for preventing cute otitis medi nd recurrent otitis medi s well s chronic effusion further knowledge regrding the etiology, pthogenis nd risk fctors mentioned bove re 15, 16 sentil. Systemic immuniztions with good nd potent vccin, personl hygiene nd environmentl snittion s well s dequte primry helth cre eduction could surely help in controlling nd/or preventing otitis medi. Age group (yers) umber exmine d Ml Feml Positive growth egtive growth 0 5 63(52.5) 38(31.7) 25(20.8) 55(45.8) 08(6.7) 6 10 22(18.3) 08(6.7) 14(11.7) 19(15.8) 03(2.5) 11 15 09(7.5) 05(4.2) 04(3.3) 08(6.7) 01(0.8) 16 20 07(5.9) 01(0.8) 06(5.0) 07(5.8) 00(0.0) 21 25 04(3.3) 00(0.0) 04(3.3) 03(2.5) 01(0.8) 26 30 04(3.3) 02(1.7) 02(1.7) 03(2.5) 01(0.8) 31 35 03(2.5) 02(1.7) 01(0.8) 02(1.7) 01(0.8) 36 40 04(3.3) 02(1.7) 02(1.7) 04(3.3) 00(0.0) 41 45 02(1.7) 02(1.7) 00(0.0) 02(1.7) 00(0.0) 46 50 02(1.7) 01(0.8) 01(0.8) 02(1.7) 00(0.0) Totl 120(100) 61(50.8) 59(49.2) 105(87.5) 15(12.5) Tble 1: Distribution Of Subjects According To Age, Sex And Culture rowth At Mmsh 76
Bcte ril isolt e Citro bcte r freun dii E. coli Klebs iell pneu moni Morg nell morg nii Provi denci Prote us r m s re ct ion B Bioc hemi cl tts Ct lse rowt h on KIA (oxoid ) mediu m Cog ulse Ur e se Ci tr te Ox id se Sl o p e B u tt 0 0 + + 0 Y Y + 0 0 - - 0 Y Y - 0 0 + + 0 Y Y - 0 0 + - 0 Y - 0 0 - + 0 Y - 0 0 + + 0 Y + H 2 S Bcteril isolte Citrobcter freundii umber recovered Ml Feml 02(1.9) 01(0.9) 01(0.9) Escherichi coli 05(4.8) 02(1.9) 03(2.9) K. pneumonie 06(5.7) 03(2.9) 03(2.9) Morgnell morgnii Providenci 05(4.8) 05(4.8) 00(0.0) 01(0.9) 00(0.0) 01(0.9) Proteus 27(25.7) 13(12.4) 14(13.3) Pseud. eruginos 37(35.2) 19(18.1) 18(17.1) Stph. ureus 20(19.0) 11(10.5) 09(8.6) Streptococcus 02(1.9) 02(1.9) 00(0.0) Totl 105(100.0) 56(53.3) 49(46.7) seud omon s erug inos S. ureu s Strep tococ cus PC PC 0 0 0 0 + - + + 0 0 0 0 0 0-0 0 0 0 0 0 P Tble 2: Morphologicl And Biochemicl Chrcteristics Of The Bcteril Isolt Tble 3: Distribution Of Bcteril Isolt According To Sex Of Subjects At Mmsh 4. Acknowledgements: The Authors pprecite the permission grnted them to crry out this work by the uthoriti of MMSH, Kno. Specil thnks to stff of the Deprtments of ET nd Pthology of the hospitl for the collection nd nlysis of the er swb smpl rpectively. 5. eferenc: [1] M. J. Owen, C. D. Bldwin, P.. Swnk, A. K. Pnnu, D. L. Johnson, V. M. Howie, eltion of infnt feeding prctic cigrette smoke exposure nd group child cre to the onset nd durtion of otitis medi with effusion in the first two yers of life. Journl of Peditrics 123(5):702-11, (1993). [2] A. S. Kumury, A. H. Kwo, A. Ub, Prevlence nd in-vitro susceptibility studi of bcteri isolted from hospitl ptients prenting with otitis medi in Kno, igeri. 77
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