What are the leading causative pathogens in acute otitis media with tympanic membrane perforation?

OBJECTIVES: Acute otitis media (AOM) is a common infectious disease in children. Data regarding the distribution of causative pathogens are not universal. Tympanic perforation due to AOM may occur in 5-30% of AOM patients. The causative pathogens for AOM with tympanic perforation are limited.

METHODS: This was a prospective study conducted at the Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Thailand. All consecutive children diagnosed as having AOM with tympanic perforation were enrolled. The age of the eligible patients was between 3 months and 5 years. Pus from the middle ear of each patient was swabbed and tested for culture/sensitivity.

RESULTS: There were 40 eligible patients diagnosed with AOM with tympanic perforation in this study. The mean age of all patients was 24.3 months and the patients were predominantly male (26 male; 65.0%). None of these patients received S. pneumoniae or H. influenzae vaccination. All specimens were culture positive (100%) and 13 organisms were identified. There were 53 identified pathogens; the most common pathogen was H. influenzae (19 times or 35.8%), followed by Staphylococcus aureus (14 times or 26.4%). H. influenzae was 100% sensitive to chloramphenicol, amoxicilllin/clavulanic acid, cefotaxime, and ciprofloxacin, while S. aureus was also 100% sensitive to oxacillin, vancomycin, and fusidic acid.

CONCLUSIONS: The two most common pathogens for AOM with tympanic perforation were H. influenzae and Staphylococcus aureus. Both pathogens were mostly sensitive to antibiotics.