title: Bacteriology of medically refractory acute otitis media in children: a 9-year retrospective study.
abstract: OBJECTIVE
  To identify the causative organisms for medically refractory acute otitis media (AOM) in children, and to recommend the appropriate antibiotics for these patients.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  The medical records for 671 children (1258 ears) undergoing myringotomies between January 1993 and December 2001 were retrospectively reviewed. "Medically refractory" AOM is defined as AOM requiring emergency myringotomy because of toxicity persisting despite second-phase antibiotics. Of these, 18 children were enrolled in our study, with 25 of the ears affected by medically refractory AOM. Myringotomy was performed for pus drainage, bacterial culture and susceptibility studies in all cases. Clinical factors were analyzed to demonstrate possible relationships with microbiological findings.
  
  
  RESULTS
  Bacteria were recovered in specimens taken from 12 ears. The positive culture rate was 48%. Bacteriological studies showed mostly growing gram-positive bacteria, such as coagulase negative staphylococcus, Staphylococcus aureus and Streptococcus pneumoniae (in decreasing order of incidence). The sensitivity rate to pre-myringotomy antibiotics was 85.7%. With the exception of Pseudomonas aeruginosa and two ears with intracranial complications or pneumonia, all other isolated microorganisms were susceptible to first-generation cephalosporins. No statistically significant differences were noted between culture rates and clinical factors.
  
  
  CONCLUSIONS
  The distribution of organisms in our medically refractory AOM cases differed from that for simple AOM, with gram-positive bacteria having significantly higher rates of incidence. Combining intravenous aminoglycoside with first-generation cephalosporin is considered an inexpensive and effective treatment covering all potential microorganisms. Vancomycin or third-generation cephalosporins are only needed for major complications or other coincident infections extant during the initial presentation.
authors.affiliation: Department of Otolaryngology, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei 112, Taiwan. ycguo@pchome.com.tw
authors.forename: An-Suey
authors.initials: AS
authors.lastname: Shiao
authors.forename: Yuan-Ching
authors.initials: YC
authors.lastname: Guo
authors.forename: Shun-Ta
authors.initials: ST
authors.lastname: Hsieh
authors.forename: Tung-Lung
authors.initials: TL
authors.lastname: Tsai
mesh_terms: D000208:Acute Disease; D001424:Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D004432:Ear, Middle / Q000382:microbiology / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D008876:Middle Ear Ventilation; D010033:Otitis Media / Q000150:complications / Q000382:microbiology* / Q000601:surgery; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification*; D012189:Retrospective Studies; D013210:Staphylococcus / Q000302:isolation & purification*; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*