title: MRSA and non-MRSA otorrhea in children: a comparative study of clinical course.
abstract: OBJECTIVE
  To test the perception that post-tympanostomy tube otorrhea caused by methicillin-resistant Staphylococcus aureus (MRSA) is a more virulent disease than otorrhea caused by other pathogens by analyzing the clinical differences and disease courses in children diagnosed with otorrhea caused by MRSA bacteria vs non-MRSA bacteria.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Tertiary children's hospital.
  
  
  METHODS
  We retrospectively examined the medical records of children who presented to a tertiary children's hospital from January 1, 2003, to December 31, 2008, with otorrhea that occurred after tympanostomy tube insertion.
  
  
  METHODS
  Otorrhea culture records were used to group the 1079 patients into those whose otitis media was due to MRSA (n = 170) and those with non-MRSA otitis media (n = 909). From the non-MRSA group, we randomly selected an age-matched group of 170 and examined the differences between the MRSA and age-matched non-MRSA groups in organisms isolated by culture, demographic factors (including type of medical insurance), medical history, treatments, surgical procedures performed, audiometric data, and other admissions for infection-related illnesses.
  
  
  RESULTS
  The overall incidence of MRSA in this series was about 16% (170 of 1079 patients). Of the 170 eligible children in each age-matched group, 135 with MRSA otorrhea and 141 with non-MRSA otorrhea had data in every category selected for statistical analysis. The groups did not differ significantly in type of insurance; history of tympanostomy tube placement, cholesteatoma, or prematurity; number or type (minor/major) of surgical procedures performed; or risk of subsequent infection-related diagnoses. More patients in the MRSA group received intravenous antibiotic therapy (11% vs 3.6%; P < .001).
  
  
  CONCLUSIONS
  In this study, a diagnosis of otorrhea due to MRSA did not carry an increased risk for surgical procedures or infection-associated sequelae compared with a diagnosis of non-MRSA otorrhea.
authors.affiliation: Pediatric ENT Associates of Alabama, Children's Hospital of Alabama, 1940 Elmer J. Bissell Road, Birmingham, AL 35243, USA.
authors.forename: Nathan S
authors.initials: NS
authors.lastname: Alexander
authors.forename: Brian D
authors.initials: BD
authors.lastname: Kulbersh
authors.forename: C Hope
authors.initials: CH
authors.lastname: Heath
authors.forename: Renee A
authors.initials: RA
authors.lastname: Desmond
authors.forename: Eric
authors.initials: E
authors.lastname: Caron
authors.forename: Audie L
authors.initials: AL
authors.lastname: Woolley
authors.forename: Jimmy Scott
authors.initials: JS
authors.lastname: Hill
authors.forename: W Peyton
authors.initials: WP
authors.lastname: Shirley
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Wiatrak
mesh_terms: D001301:Audiometry, Pure-Tone; D001309:Auditory Threshold; D001424:Bacterial Infections / Q000175:diagnosis* / Q000453:epidemiology; D001431:Bacteriological Techniques; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006192:Haemophilus Infections / Q000175:diagnosis / Q000453:epidemiology; D006193:Haemophilus influenzae; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008826:Microbial Sensitivity Tests; D008876:Middle Ear Ventilation; D010034:Otitis Media with Effusion / Q000175:diagnosis* / Q000453:epidemiology; D010035:Otitis Media, Suppurative / Q000175:diagnosis* / Q000453:epidemiology; D011008:Pneumococcal Infections / Q000175:diagnosis / Q000453:epidemiology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000453:epidemiology; D011550:Pseudomonas aeruginosa; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000175:diagnosis