title: Non-typeable Haemophilus influenzae and Streptococcus pneumoniae as primary causes of acute otitis media in colombian children: a prospective study.
abstract: BACKGROUND
  Acute otitis media (AOM) is one of the most frequently encountered bacterial infections in children aged < 5 years; Streptococcus pneumoniae (S. pneumoniae) and non-typeable Haemophilus influenzae (NTHi) are historically identified as primary AOM causes. Nevertheless, recent data on bacterial pathogens causing AOM in Latin America are limited. This prospective study aimed to identify and characterize bacterial etiology and serotypes of AOM cases including antimicrobial susceptibility in < 5 year old Colombian children.
  
  
  METHODS
  From February 2008 to January 2009, children ≥3 months and < 5 years of age presenting with AOM and for whom a middle ear fluid (MEF) sample was available were enrolled in two medical centers in Cali, Colombia. MEF samples were collected either by tympanocentesis procedure or spontaneous otorrhea swab sampling. Bacteria were identified using standard laboratory methods, and antimicrobial resistance testing was performed based on the 2009 Clinical and Laboratory Standards Institute (CLSI) criteria. Most of the cases included in the study were sporadic in nature.
  
  
  RESULTS
  Of the 106 enrolled children, 99 were included in the analysis. Bacteria were cultured from 62/99 (63%) of samples with S. pneumoniae, H. influenzae, or S. pyogenes. The most commonly isolated bacteria were H. influenzae in 31/99 (31%) and S. pneumoniae in 30/99 (30%) of samples. The majority of H. influenzae episodes were NTHi (27/31; 87%). 19F was the most frequently isolated pneumococcal serotype (10/30; 33%). Of the 30 S. pneumoniae positive samples, 8/30 (27%) were resistant to tetracycline, 5/30 (17%) to erythromycin and 8/30 (27%) had intermediate resistance to penicillin. All H. influenzae isolates tested were negative to beta-lactamase.
  
  
  CONCLUSIONS
  NTHi and S. pneumoniae are the leading causes of AOM in Colombian children. A pneumococcal conjugate vaccine that prevents both pathogens could be useful in maximizing protection against AOM.
authors.affiliation: Centro de Estudios en Infectologia Pediatrica CEIP, Cali, Colombia.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Sierra
authors.forename: Pio
authors.initials: P
authors.lastname: Lopez
authors.forename: Mercedes A
authors.initials: MA
authors.lastname: Zapata
authors.forename: Beatriz
authors.initials: B
authors.lastname: Vanegas
authors.forename: Maria M
authors.initials: MM
authors.lastname: Castrejon
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Deantonio
authors.forename: William P
authors.initials: WP
authors.lastname: Hausdorff
authors.forename: Romulo E
authors.initials: RE
authors.lastname: Colindres
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D015373:Bacterial Typing Techniques; D002675:Child, Preschool; D003105:Colombia / Q000453:epidemiology; D005260:Female; D006192:Haemophilus Infections / Q000453:epidemiology / Q000382:microbiology*; D006193:Haemophilus influenzae / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D008297:Male; D010033:Otitis Media / Q000453:epidemiology / Q000382:microbiology*; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000382:microbiology*; D011446:Prospective Studies; D013296:Streptococcus pneumoniae / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents