{'fraction_non_alphanumeric': 0.025786418253003915, 'fraction_numerical': 0.014175779667881734, 'mean_word_length': 5.199163179916318, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Recent trends in bacteriological and antibiogram profile of isolates from ear, nose and throat in a tertiary care hospital in coastal Karnataka

The etiologies of ENT infections are varied and it may be bacterial, viral or fungal. The signs and symptoms may often mislead about the etiology of the disease. At times it becomes very difficult for the physician to relate the bacteria with the disease. Hence the physician may advocate antibiotic therapy irrespective of the etiology of the disease. This may lead to unwanted economic loss and stress to the patient if the ENT infection is due to the virus or fungi. ABSTRACT


INTRODUCTION
The ear, nose and throat (ENT) are closely related and are interconnected and are colonized by a wide range of microorganisms, some of which are more or less harmless under normal conditions. 1 The ear, nose and throat come in contact with the physical environment directly and are exposed constantly to air borne microorganisms and therefore are frequent source of infection. These infections are one of the leading causes of significant morbidity and mortality in critically ill patients. 2 The etiologies of ENT infections are varied and it may be bacterial, viral or fungal. The signs and symptoms may often mislead about the etiology of the disease. At times it becomes very difficult for the physician to relate the bacteria with the disease. Hence the physician may advocate antibiotic therapy irrespective of the etiology of the disease. This may lead to unwanted economic loss and stress to the patient if the ENT infection is due to the virus or fungi. 3 Otitis externa, malignant otitis externa, chronic otitis media, nasal vestibulitis, chronic rhinosinusitis, URTI, neck abscess, septal abscess, tonsillitis represent few of the conditions seen on a daily basis in an ENT outpatient department by Otorhinolaryngologists. These conditions amongst others require an empirical antimicrobial treatment so as to provide relief and to prevent further complications.
Bacterial species such as Staphylococcus aureus, Streptococcus sp., Proteus spp., Haemophilus and Escherichia Coli forms were found to be responsible for most cases of ENT infections. 6 Antibiotic resistance seems to be progressively increasing for these common conditions. This increasing resistance appears to be largely related to the inadvertent use of antibiotics. The antibiogram of common organisms also changes from location to location.
The recent changes in the infectious etiology and the antibiotic resistance is a problem medical fraternity is facing worldwide, so it is necessary to do a study that could reveal the actual bacterial spectrum of infectious conditions in otorhinolaryngology and also the correct antibiotic treatment.

Objectives
The objectives of the study were to evaluate the bacteriological profile of patients attending ENT OPD or IPD in a tertiary care hospital and to study the antibiogram of the isolated organisms.

Source of data
Microbiology records of all pus exudates from inpatients or patients attending the outpatient Department of Otorhinolaryngology, Head and Neck Surgery (ENT HNS) of KVG Medical College and Hospital from September 2018 to September 2019.

Study design
Study design was retrospective study.

Sample collection
Exudate from ear or nasal cavity or middle meatus or throat or neck etc. was taken with a swab and transported to microbiology lab within an hour of collection.

Culture technique
The exudate was streak inoculated on blood agar, Mc Conkey's agar, chocolate agar and incubated at 37 degree C for 18 to 24 hr. 9 Hemolysis was studied on chocolate agar. Identification and characterization of isolates were performed on the basis of gram staining, microscopic characteristics, colony characteristic, and biochemical tests using standard microbiological methods. 9

Sensitivity profile
Antimicrobial susceptibility profile was determined by modified Kirby Bauer disc diffusion method. 10

Statistical analysis
The laboratory samples were statistically analysed by Microsoft office excel 2007, IBM SPSS version 21.

RESULTS
The following figure represents distribution of patients according to age group.

Figure 1: Age distribution of the study population.
Majority of patients belonged to age range 31 to 40 yrs, least number of cases were in 71 to 80 yrs. age group.

Figure 2: Gender distribution of the study population.
Males were majority with male to female ratio of 1.4:1.    P. aeruginosa was most sensitive to amikacin, ceftazidime, meropenem and piperacillin-tazobactam and least sensitive to cotrimoxazole and colistin. It was most resistant to sparfloxacin, cefaperazone-sulbactam, ceftriaxone-tazobactam and clindamycin.
MRSA was most sensitive to gentamicin, amikacin, clindamycin and most resistant to cephalexin, ampicillin and ciprofloxacin.
Klebsiella sp. was most sensitive to amikacin and cotrimoxazole and most resistant to sparfloxacin and ceftriaxone. E. coli was most sensitive to gentamicin and cotrimoxazole and most resistant to sparfloxacin.
Majority of samples were from ear 47%, followed by nose 39%. Samples from neck were responsible for 6.42%, throat swabs for 5.50%, and sputum for 2.75%. Pus from tonsil, peritonsillar abscess, swelling in front of ear, swelling in pinna, septal abscess, thyrocystic fluid and ulcer around tracheostomy site were responsible for 0.91% of samples each. According to Estifanos et al Ampicillin had the highest overall resistance rate (80.8%) followed by cephalothin (58.6.6%), cefazolin (57.14%), cefuroxime and cefuroxime axetil (53.6%) and cefpodoxime (48.27%). 2 On the other hand, majority of bacterial isolates were susceptible to levofloxacin, tobramycin, ciprofloxacin and gentamycin with overall resistance rates of 0%, 0%, 6.6%, and 11.11% respectively. 2 Study by Selvaraj et al showed that gram positive bacteria were most sensitive to vancomycin (100%) followed by amikacin (97.14%), and gram negative bacteria were sensitive to sulbactam or cefoperazone (97.14%), piperacillin or tazobactam (95.23%) and meropenem (94.28%) were the most effective drugs. 5 However according to our study gram negative organisms were most sensitive to amikacin, ceftazidime, meropenem and piperacillin-tazobactam and least sensitive to cotrimoxazole and colistin and were resistant to sparfloxacin, cefaperazone-sulbactam, ceftriaxonetazobactam and clindamycin.

DISCUSSION
Gram positive organisms were most sensitive to gentamicin, amikacin and clindamycin and resistant to cephalexin, ampicillin and ciprofloxacin.
This change in antibiogram pattern necessitates the need for such a study.

CONCLUSION
ENT infection is a frequent treatable health care problem worldwide but if left untreated it can cause a number of serious complications affecting the quality of life for patients and their relatives and lead to significant financial burden on them. Also, it leads to increased disease and economic burden on health care systems. The prevalence of ENT infections is more in developing countries due to lower living standards, poor hygiene conditions, lack of proper nutrition, over population and scarcity of health care systems. Therefore, taking simple steps such as sending pus samples for culture and sensitivity will helps us significantly in reducing this burden and in identifying trends in antibiogram secondary to increasing antibiotic resistance.