title: [Bacterial etiology of acute otitis media in Spain in the post-pneumococcal conjugate vaccine era].
abstract: BACKGROUND
  Acute otitis media (AOM) is common in children aged <3 years. A pneumococcal conjugate vaccine (PCV) (PCV7; Prevenar, Pfizer/Wyeth, USA) has been available in Spain since 2001, which has a coverage rate of 50-60% in children aged <5 years.
  
  
  METHODS
  Children aged ≥3 to 36 months with AOM confirmed by an ear-nose-throat specialist were enrolled at seven centers in Spain (February 2009-May 2012) (GSK study identifier: 111425). Middle-ear-fluid samples were collected by tympanocentesis or spontaneous otorrhea and cultured for bacterial identification. Culture-negative samples were further analyzed using polymerase chain reaction (PCR).
  
  
  RESULTS
  Of 125 confirmed AOM episodes in 124 children, 117 were analyzed (median age: 17 months (range: 3-35); eight AOM episodes were excluded from analyses. Overall, 69% (81/117) episodes were combined culture- and PCR-positive for ≥1 bacterial pathogen; 44% (52/117) and 39% (46/117) were positive for Haemophilus influenzae (Hi) and Streptococcus pneumoniae (Spn), respectively. 77 of 117 episodes were cultured for ≥1 bacteria, of which 63 were culture-positive; most commonly Spn (24/77; 31%) and Hi (32/77; 42%). PCR on culture-negative episodes identified 48% Hi- and 55% Spn-positive episodes. The most common Spn serotype was 19F (4/24; 17%) followed by 19A (3/24; 13%); all Hi-positive episodes were non-typeable (NTHi). 81/117 AOM episodes (69%) occurred in children who had received ≥1 pneumococcal vaccine dose.
  
  
  CONCLUSIONS
  NTHi and Spn were the main etiological agents for AOM in Spain. Impact of pneumococcal vaccination on AOM requires further evaluation in Spain, after higher vaccination coverage rate is reached.
authors.affiliation: Hospital Vall d'Hebron, Unidad de ORL Pediátrica, Barcelona, España. Electronic address: fpumarol@vhebron.net.
authors.forename: Felix
authors.initials: F
authors.lastname: Pumarola
authors.affiliation: Instituto Hispalense de Pediatría, Unidad de Estudio e Investigación, Sevilla, España.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Salamanca de la Cueva
authors.affiliation: GSK Vacunas, Departamento Médico, Madrid, España.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Sistiaga-Hernando
authors.affiliation: GSK Vacunas, Departamento Médico, Madrid, España.
authors.forename: Pilar
authors.initials: P
authors.lastname: García-Corbeira
authors.affiliation: Hospital Vall d'Hebron, Unidad de Enfermedades Infecciosas Pediátricas, Barcelona, España.
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Moraga-Llop
authors.affiliation: Hospital de San Juan de Dios, Esplugues de Llobregat, Barcelona, España.
authors.forename: Sara
authors.initials: S
authors.lastname: Cardelús
authors.affiliation: GSK Vacunas, Departamento Médico, Madrid, España.
authors.forename: Cynthia
authors.initials: C
authors.lastname: McCoig
authors.affiliation: Hospital Universitario Central de Asturias, Servicio de Otorrinolaringología, Oviedo, España.
authors.forename: Justo Ramón
authors.initials: JR
authors.lastname: Gómez Martínez
authors.affiliation: Hospital Universitari Parc Taulí de Sabadell, Servicio de Otorrinolaringología, Sabadell, Barcelona, España.
authors.forename: Rosa
authors.initials: R
authors.lastname: Rosell Ferrer
authors.affiliation: Hospital Clínico Universitario Virgen de la Arrixaca, Servicio de Otorrinolaringología, El Palmar, Murcia, España.
authors.forename: Jesús
authors.initials: J
authors.lastname: Iniesta Turpin
authors.affiliation: GSK Pharmaceuticals Pvt. Ltd., Bangalore, India.
authors.forename: Raghavendra
authors.initials: R
authors.lastname: Devadiga
mesh_terms: D000208:Acute Disease; D001424:Bacterial Infections / Q000453:epidemiology* / Q000517:prevention & control*; D002675:Child, Preschool; D016021:Epidemiologic Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010033:Otitis Media / Q000453:epidemiology* / Q000382:microbiology*; D022242:Pneumococcal Vaccines; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology
chemical_list: D022242:Pneumococcal Vaccines
keywords: Acute otitis media; Children; España; Niños; Otitis media aguda; Pneumococcal conjugate vaccine; Spain; Vacuna neumocócica conjugada