title: Acute otorrhea in children with tympanostomy tubes: prevalence of bacteria and viruses in the post-pneumococcal conjugate vaccine era.
abstract: BACKGROUND
  Acute tympanostomy-tube otorrhea is a common sequela in children with tympanostomy tubes. Acute tympanostomy-tube otorrhea is generally a symptom of an acute middle ear infection, whereby middle ear fluid drains through the tube. The widespread use of pneumococcal conjugate vaccination (PCV) has changed the bacterial prevalence in the upper respiratory tract of children, but its impact on bacterial and viral pathogens causing acute tympanostomy-tube otorrhea is yet unknown.
  
  
  METHODS
  This study was performed in the post-PCV7 era parallel to a randomized clinical trial of the clinical and cost-effectiveness of ototopical and systemic antibiotics and initial observation in 230 children aged 1 to 10 years with untreated, uncomplicated acute tympanostomy-tube otorrhea. Otorrhea and nasopharyngeal samples were collected at baseline (before treatment) and at 2 weeks (after treatment). Conventional bacterial culture was performed followed by antimicrobial-resistance assessment. Viruses were identified by polymerase chain reaction.
  
  
  RESULTS
  At baseline, Haemophilus influenzae (41%), Staphylococcus aureus (40%) and Pseudomonas aeruginosa (18%) were the most prevalent bacteria in otorrhea, followed by Streptococcus pneumoniae (7%) and Moraxella catarrhalis (4%). Most pneumococci were non-PCV7 serotypes. Viruses were detected in 45 otorrhea samples at baseline (21%). Most infections were polymicrobial and overall antimicrobial resistance was low.
  
  
  CONCLUSIONS
  H. influenzae, S. aureus and P. aeruginosa are the most common microorganisms in children with untreated uncomplicated acute tympanostomy-tube otorrhea. Prevalence of S. pneumoniae has decreased since the introduction of PCV and most pneumococci are nonvaccine serotypes.
authors.affiliation: From the *Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; †Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands; ‡Virology Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands; §Department of Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; and ¶ENT Clinical Trials Programme, Ear Institute, University College London, London, United Kingdom.
authors.forename: Thijs M A
authors.initials: TM
authors.lastname: van Dongen
authors.forename: Roderick P
authors.initials: RP
authors.lastname: Venekamp
authors.forename: Annemarie M J
authors.initials: AM
authors.lastname: Wensing
authors.forename: Debby
authors.initials: D
authors.lastname: Bogaert
authors.forename: Elisabeth A M
authors.initials: EA
authors.lastname: Sanders
authors.forename: Anne G M
authors.initials: AG
authors.lastname: Schilder
mesh_terms: D001419:Bacteria / Q000145:classification / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D001431:Bacteriological Techniques; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008876:Middle Ear Ventilation; D010034:Otitis Media with Effusion / Q000453:epidemiology* / Q000382:microbiology / Q000821:virology; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D016133:Polymerase Chain Reaction; D015995:Prevalence; D014611:Vaccination / Q000706:statistics & numerical data; D014777:Virus Diseases / Q000453:epidemiology* / Q000821:virology; D014780:Viruses / Q000145:classification / Q000302:isolation & purification*
chemical_list: D022242:Pneumococcal Vaccines