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Bacterial etiology of otitis media and their antibiogram among patients attending tertiary care hospital

Otitis media is a common infection of mastoid process and middle ear, which can leads to acute purulent otitis media and chronic suppurative otitis media. Among children acute otitis media is most common infection in the ear and leads to more use of antibiotics. The chronic suppurative otitis media is a chronic infection of mastoid process and the middle ear which causes perforation of tympanic membrane and ear discharge for at least 2 weeks. The global data showed 65-300 million people suffered from otitis media, among them 60% patients suffering from hearing loss. Geographically the causative agent of otitis media varies, but in acute infection most common bacteria are such as, Staphylococcus aureus, Streptococcus pneumoniae, Hemophilus influenza. In case of chronic infection organisms are such as, Staphylococcus aureus, Klebsiella pneumoniae, Proteus mirabilis, Escherichiae coli and Pseudomonas aeruginosa. Different geographical distributions, clinical practices and prevalent of resistant bacteria strains results varies in antimicrobial sensitivity profile. Therefore this study aimed to find out the bacterial profile and their antibiotic sensitivity pattern in patients suffering from otitis media.

the period from October 2019 to January 2020. A total of 120 patients attending ENT clinic were involved in this study.
This study was approved by institutional ethical committee. All the specimens were collected according to the standard operating procedure. The detailed consent form was taken from participants, except from children, which was collected from parents. A sterile wooden swab was used to collect the throat swab from posterior pharyngeal wall and sent it immediately to microbiology laboratory. Before collecting the throat swab, total procedure was described to the participants. Specimen culture and sensitivity was performed as per the standard microbiological protocol. 14,18 All the throat swab was cultured in blood agar and MacConkey agar media and incubated at 37ºC temperature overnight aerobically and anaerobically. Antibiotic sensitivity testing was done according to Kirby Bauer disc diffusion method and zone diameter was collected to interpret the sensitivity pattern. 14,18

Statistical analysis
All the data were analyzed by SPSS 20.0 statistical analysis software.

DISCUSSION
Ear infection is the worldwide problem for all age group. The problem of ear infection is rising day by day. The Otitis media is more common in children than adults. [1][2][3] The younger children are more susceptible to otitis media due to their weaker immune status and frequent exposure to upper respiratory infection. 6,7 In this present study it was revealed that gram negative bacterial infection was more common than gram positive bacterial infection. Bacterial colonization of otitis media strongly depends on temperature, if rise in temperature, the isolation of bacteria will be more. 9 In recent scenario patients flow was increased in ENT department. Therefore, perfect knowledge of bacteria and their antibiotic sensitivity pattern is most important to manage the ear related bacterial infection. Hence, the present study focused on common bacterial isolates from ear infection and their antibiotic sensitivity pattern. Based on Table 2, the overall sensitivity pattern of antibiotics was as such; pipercillin tazobactum (85%), amikacin (90%) and gentamicin (90.2%) were mostly sensitive. Other than these drugs ampicillin (90.1%), cefazolin (90%), cefuroxime (89.4%), ceftriaxone (81%), oxacillin (83.4%), penicillin (88.2%) showed highly resistant to bacterial isolates. This study results were comparable with study done by Ferede et al. 3 But the chloramphenicol and tetracycline showed different pattern may be due to the emergence of resistance strains in this area. This study reported Staphylococcus aureus showed highly sensitive to vancomycin, amikacin, gentamicin, linezolid, also same organism also showed resistance to cefotaxime, ceftriaxone, ceftazidime, penicillin, oxacillin drugs. Pseudomonas aeruginosa also reported sensitive to amikacin, gentamicin, and it reported resistant to ceftriaxone, ceftazidime. Similar findings were reported by Abera et al and Worku et al. 1,19 Therefore according to the present study it is clear that almost all isolates were resistant to single or multiple drugs. The higher rate of multidrug resistance may be due to the miss use of antibiotics.

CONCLUSION
Therefore, in this study authors found Staphylococcus aureus, Enterobacteriaceae group and Pseudomonas aeruginosa were common isolates in otitis media in children and adult. Most of these isolates were resistant to commonly used drugs. Therefore, culture and antibiotic sensitivity report of ear infection cases are most important for appropriate management of otitis media.