title: Clinical manifestations and microbiology of acute otitis media with spontaneous otorrhea in children.
abstract: OBJECTIVE
  In Taiwan, clinical and microbiological data on acute otitis media (AOM) with spontaneous otorrhea in children are limited.
  
  
  METHODS
  We retrospectively collected data on children with AOM and spontaneous otorrhea between January 2011 and June 2012. Otorrhea samples were collected using sterile swabs and sent for cultures. Pathogens found were Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pyogenes, and Staphylococcus aureus. Pneumococcal isolates collected from October 2011 to June 2012 were serotyped.
  
  
  RESULTS
  A total of 92 patients were enrolled in the study for demographic and microbiological analysis. Their median age was 2.5 years. After excluding those with lobar pneumonia, 84 patients were included for analysis of clinical manifestation. The mean febrile duration was 6 days. Leukocytosis and C-reactive protein (CRP) level >50 mg/L were noted in 29 (34.5%) patients and 38 (45.2%) patients, respectively. Patients with pneumococcal infection were older (p = 0.007) and had more severe symptoms [fever (p = 0.001), otalgia (p = 0.055), respiratory symptoms (p = 0.002-0.03), and higher CRP level (p = 0.015)] than children with other bacterial infection. Otorrhea cultures were obtained from 69 (75%) patients, of whom 52 had definitive AOM pathogens. The most common causative pathogen was S. pneumoniae (61.5%), followed by S. aureus (36.5%). Serotype 19A accounted for two-thirds of pneumococcal isolates and had a high rate of nonsusceptibility to penicillin (66.7%) and ceftriaxone (83.3%).
  
  
  CONCLUSIONS
  S. pneumoniae was found to be the most important source of AOM with spontaneous otorrhea in children and caused more severe symptoms. Serotype 19A, which was usually nonsusceptible to antimicrobial agents, was the most prevalent serotype in these patients.
authors.affiliation: Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
authors.forename: Yi-Jen
authors.initials: YJ
authors.lastname: Chen
authors.forename: Yu-Chia
authors.initials: YC
authors.lastname: Hsieh
authors.forename: Yhu-Chering
authors.initials: YC
authors.lastname: Huang
authors.forename: Cheng-Hsun
authors.initials: CH
authors.lastname: Chiu
mesh_terms: D000293:Adolescent; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005122:Exudates and Transudates / Q000382:microbiology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010033:Otitis Media / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology*; D015995:Prevalence; D012189:Retrospective Studies; D012703:Serotyping; D013624:Taiwan / Q000453:epidemiology
keywords: Acute otitis media; Children; Otorrhea; Streptococcus pneumoniae; Taiwan