Bacterial etiology of acute otitis media in the era prior to universal pneumococcal vaccination in Taiwanese children.
BACKGROUND
Acute otitis media (AOM) is one of the most frequent bacterial infections in children. Streptococcus pneumoniae and nontypeable Haemophilus influenzae (NTHi) are the two major bacterial pathogens. Pneumococcal conjugate vaccine was introduced into Taiwan in 2005 and only some children were vaccinated. This retrospective study assessed the bacterial etiology of AOM and its antimicrobial susceptibility in the era prior to universal pneumococcal vaccination in Taiwan.


METHODS
From December 2009 to November 2011, children presenting with AOM and having a middle ear effusion sample collected by tympanocentesis were enrolled. The study period was divided into two parts. Demographic data of patients and antibiotic susceptibility of the pathogens were collected and analyzed. Serotypes of S. pneumoniae were identified.


RESULTS
Among the 151 episodes, 46% of samples found bacterial pathogens. S. pneumoniae and NTHi were the leading causes of AOM, detected in 55.7% and 22.9% of bacterial AOM episodes, respectively. The prevalent serotypes of S. pneumoniae were 19 A and 19 F. Significantly more pneumococcal and serotype 19 A AOM were found in the later study period (18.4% vs. 33.3%, p = 0.0036; 10.5% vs. 24.0%, p = 0.028). Among the 39 S. pneumoniae isolates, 11 strains (28.2%) were penicillin-susceptible. Of the 16 NTHi, 10 (62.5%) were susceptible to amoxicillin/clavulanate and all were susceptible to cefotaxime.


CONCLUSIONS
S. pneumoniae and NTHi were the leading causes of AOM in Taiwanese children in the study period. An increase in patient numbers and proportion of pneumococcal and serotype 19 A AOM occurred. Antimicrobial nonsusceptibility was common in the predominant pathogens.
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
Yen-Hsin
YH
Kung
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan.
Nan-Chang
NC
Chiu
Department of Otorhinolaryngology, Mackay Memorial Hospital, Taipei, Taiwan.
Kuo-Sheng
KS
Lee
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
Lung
L
Chang
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
Daniel Tsung-Ning
DT
Huang
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
Fu-Yuan
FY
Huang
Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
Yu-Chia
YC
Hsieh
Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Li-Min
LM
Huang
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: chi.4531@ms1.mmh.org.tw.
Hsin
H
Chi
D002675:Child, Preschool; D005260:Female; D006192:Haemophilus Infections / Q000453:epidemiology / Q000382:microbiology; D006193:Haemophilus influenzae; D006801:Humans; D007223:Infant; D008297:Male; D010033:Otitis Media / Q000453:epidemiology / Q000382:microbiology; D010034:Otitis Media with Effusion / Q000382:microbiology; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000382:microbiology; D022242:Pneumococcal Vaccines; D012189:Retrospective Studies; D013296:Streptococcus pneumoniae; D013624:Taiwan / Q000453:epidemiology
D022242:Pneumococcal Vaccines
Acute otitis media; Nontypeable Haemophilus influenzae; Streptococcus pneumoniae; Tympanocentesis