title: Review of otorrhea microbiology: is there a pathogenic role of corynebacter?
abstract: OBJECTIVE
  Identification of a causative pathogen in otologic infections assists in maximizing therapy efficacy particularly in refractory and chronic cases. Current standards for treatment of otologic infections focus on targeted species (spp.) that are assumed to be the most common pathogens. Corynebacterium spp. may play a pathogenic role but are not routinely speciated or included in antibiotic susceptibility analysis. Our objective is to investigate the prevalence and pathogenicity of nondiphtheroid Corynebacterium spp. in commonly encountered purulent and mucopurulent otologic infections.
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  Academic tertiary referral center.
  
  
  METHODS
  Review of 140 microbiology cultures from adults and children presenting with purulent and mucopurulent otologic infections from 2010 to 2012.
  
  
  METHODS
  Clinical history, demographics, and microbiology cultures with speciation and antibiotic susceptibility analyses.
  
  
  METHODS
  Microbiologic speciation and census, species association with clinical characteristics, antibiotic susceptibility to oral and systemic agents, therapy frequency and agent selection.
  
  
  RESULTS
  Corynebacterium spp. was the second most common bacteria isolated from patients with clinically significant otologic infections. Corynebacterium spp. were found in 24 (33.3%) unique patients with otologic infections and were the only pathogen isolated in six (8.33%) patients. Corynebacterium-positive infections were significantly associated with the use of hearing aids, a diagnosis of chronic granular myringitis, and less otalgia. Corynebacterium isolates were highly resistant to first-line fluoroquinolone therapy. The majority of patients with Corynebacterium-positive infections harbored at least one resistant strain, and patients with strains resistant to first-line topical therapy had a nonsignificant trend to an alteration in antibiotic therapy after antibiotic susceptibility data became available.
  
  
  CONCLUSIONS
  Corynebacterium spp. may be underestimated in their potential to cause clinically significant otologic infections. Our results indicate a potential need for expanding surveillance for Corynebacterium spp.
authors.affiliation: *Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina; and †Section of Otolaryngology-Head and Neck Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, U.S.A.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Crowson
authors.forename: Katherine
authors.initials: K
authors.lastname: Callahan
authors.forename: James E
authors.initials: JE
authors.lastname: Saunders
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003352:Corynebacterium; D003354:Corynebacterium Infections / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010034:Otitis Media with Effusion / Q000382:microbiology*; D012189:Retrospective Studies; D055815:Young Adult