title: Prospective evaluation of the aetiology of acute otitis media with spontaneous tympanic membrane perforation.
abstract: OBJECTIVE
  To evaluate the aetiological role of the main bacterial pathogens associated with acute otitis media (AOM) in children with AOM and spontaneous tympanic membrane perforation (STMP).
  
  
  METHODS
  Between 1 May 2015 and 30 April 2016, 177 children, aged 6 months to 7 years, with AOM complicated by STMP within 12 h were prospectively enrolled. Middle ear fluid (MEF) was tested by real-time PCR for Streptococcus pneumoniae, non-typeable Haemophilus influenzae, Streptococcus pyogenes, Moraxella catarrhalis and Staphylococcus aureus.
  
  
  RESULTS
  Among the 177 children with AOM and STMP, 92/100 (92.0%) of those with recurrent AOM and 13/77 (16.9%) without recurrent AOM had recurrent STMP (p <0.001). A single pathogen was identified in 70 (39.5%) MEF samples, whereas two, three and four bacteria were detected in 54 (30.5%), 20 (11.3%), and 7 (4.0%) cases, respectively. Non-typeable H. influenzae was the most common and was identified in 90 children (50.8%), followed by M. catarrhalis (62 cases, 35.0%) and S. pneumoniae (48 cases, 27.1%). Non-typeable H. influenzae was the most frequent pathogen in children with co-infections. Children with co-infections, including non-typeable H. influenzae, had significantly more frequent recurrent AOM (adjusted OR 6.609, 95% CI 1.243-39.096, p 0.029).
  
  
  CONCLUSIONS
  Recurrent AOM episodes appear to be associated with an increased risk of AOM with STMP. In AOM with STMP, non-typeable H. influenzae is detected at a high frequency, especially in children with recurrent STMP and often in association with other pathogens.
authors.affiliation: Paediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Marchisio
authors.affiliation: Paediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Paediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy. Electronic address: susanna.esposito@unimi.it.
authors.forename: S
authors.initials: S
authors.lastname: Esposito
authors.affiliation: Primary Care Paediatrician, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Picca
authors.affiliation: Paediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Baggi
authors.affiliation: Paediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Terranova
authors.affiliation: Laboratory of Medical Statistics, Epidemiology and Biometry 'G.A. Maccacaro', Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Orenti
authors.affiliation: Laboratory of Medical Statistics, Epidemiology and Biometry 'G.A. Maccacaro', Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Biganzoli
authors.affiliation: Paediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Principi
mesh_terms: D001419:Bacteria / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D005122:Exudates and Transudates / Q000382:microbiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010033:Otitis Media / Q000150:complications* / Q000209:etiology*; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D018058:Tympanic Membrane Perforation / Q000453:epidemiology* / Q000209:etiology*
keywords: Acute otitis media; Moraxella catarrhalis; Non-typeable Haemophilus influenzae; Spontaneous tympanic membrane perforation; Staphylococcus aureus; Streptococcus pneumoniae; Streptococcus pyogenes