Prevalence of common bacterial etiology and antimicrobial susceptibility pattern in patients with otitis media in Duhok Province –Iraq

  • Zubaidah Husham Mahmood Agha Department of Biology, Collage of Science, University of Duhok, Kurdistan Region, Iraq
  • Muna S. Al-Delaimi Department of Biology, Collage of Science, University of Duhok, Kurdistan Region, Iraq
Keywords: Ear infection, Otitis Media, Bacterial etiology, MDR, XDR, ESBL.

Abstract

     Otitis media is the most frequent type of ear infection. It is a major health problem for both children and adults but the proportion is different in different countries. The current study was designed to determine the frequency of bacterial isolates causing otitis media and their antimicrobial resistance profile to assess the incidence of multidrug-resistant (MDR), extensively drug-resistant (XDR), and pan drug resistance (PDR) among the isolated pathogens. Also, to determine the various risk factors (age, gender, type, and site of infection) associated with ear infection. A total of 200 ear discharge samples were collected from patients aged 1-77 years attending the Ear, Nose, and Throat (ENT) unit in Azadi Teaching Hospital in Duhok city from November 2018 to September 2019. The clinical samples were cultured and bacterial isolates were identified by standard microbiological methods then confirmed by VITEK® 2 Compact automated system. All gram-negative bacterial isolates were studied phenotypically for Extended Spectrum Beta Lactamase production. Out of 200 ear swabs, 95% confirmed positive culture; 85.8% were bacterial isolates. From the total bacterial isolates, 57% were gram-positive bacteria, while gram-negative bacteria were 43%; with predominant of Pseudomonas aeruginosa, (22%) followed by Staphylococcus aureus (19%) and Coagulase negative Staphylococci (18%). The prevalence of otitis media was not significantly affected by gender. The majority of patients belonged to the age group (1-10) years old. 64.1% of the isolates were characterized as MDR, 31.7% were XDR, with one (0.7%) as PDR. Among these, 60.7% isolates were ESBL producers, Pseudomonas aeruginosa was the most frequent ESBL- producing isolates (45.9%), followed by Proteus spp (18.9%). The in-vitro sensitivity results indicated that Gentamycin and Ciprofloxacin were effective antibiotics in the treatment of otitis media. Additionally, Meropenem, Imipenem, Cefepime, and Azetronam were also the most effective drug against Pseudomonas aeruginosa. We concluded that the drug resistant isolates were common, worryingly high, leaving only limited drugs as a treatment choice.

Downloads

Download data is not yet available.

References

Abera, B. and Kibret, M., 2011. Bacteriology and antimicrobial susceptibility of otitis media at dessie regional health research laboratory, Ethiopia. Ethiopian Journal of Health Development, 25(2), pp.161-167.
Ako‐Nai, A.K., Oluga, F.A., Onipede, A.O., Adejuyigbe, E.A. and Amusa, Y.B., 2002. The Characterization of Bacterial Isolates from Acute Otitis Media in Ile‐Ife, Southwestern Nigeria. Journal of tropical pediatrics, 48(1), pp.15-23.
Akter, S., Shamsuzzaman, S.M., Nehar, N., Siddiqui, I., Jahan, F. and Islam, S., 2015. Bacterial isolates and drug susceptibility patterns of ear discharge from patients with ear infection at Shaheed Monsur Ali Medical College. Bangladesh Journal of Medical Microbiology, 9(2), pp.20-23.
Alberti, P.W., 2001. Chapter 3: Pathology and physiology of the ear. University of Toronto, Canada Occupational exposure to noise: Evaluation, prevention, and control, https://www.who.int/occupational health/publications/noise2.pdf .
Aldhaher, Z.A., Hassan, H.F., Al-Jassim, Z.G. and Mahmood, M.A., 2018. Bacterial isolates and antibiotic susceptibility of ear infections in Iraqi patients. International Journal of Biosciences, 13(1), pp. 292-297.
Al-Marzoqi, A.H., Al-Janabi, H.S.O., Hussein, H.J., Al Taee, Z.M. and Yheea, S.K., 2013. Otitis media; etiology and antibiotics susceptibility among children under ten years old in Hillah city, Iraq. Journal of Natural Sciences Research, 3(3), pp.2224-3186.
Al-Mosawi, R.M., 2018. Microbiological study and antimicrobial susceptibility pattern of ear infections in patients with Chronic Suppurative Otitis Media (CSOM) in Basrah Province. University of Thi-Qar Journal of Science, 6(4), pp.109-116.
Alsaimary, I.E., Alabbasi, A.M. and Najim, J.M., 2010. Impact of multi drugs resistant bacteria on the pathogenesis of chronic suppurative otitis media. Afr J Microbiol Res, 4(13), pp.1373-1382.
Balan, S. and Viswanatha, B., 2017. Microbiology of chronic suppurative otitis media: a prospective study in a tertiary care hospital. J Otolaryngol ENT Res, 9(1), p.00277.
Basnet, R., Sharma, S., Rana, J.C. and Shah, P.K., 2017. Bacteriological study of otitis media and its antibiotic susceptibility pattern. Journal of Nepal Health Research Council, 15(2), pp.124-129.
Bello, R.H.,Agbo,E.B., and Olabode, H.O.K., 2011. Antibiogram of bacteria and fungal isolates associated with otitis media amongst children in Bauchi state, Nigeria. International Journal of Pharma and Bio Sciences, 2(3), pp.200-207.
Chaudhary, B.L. and Shukla, S., 2014. Bacteriological Profile and their Antibiotic Susceptibility pattern in cases of otitis media. Bulletin of Pharmaceutical and Medical Sciences (BOPAMS), 2(2).
Chika, E., Ifeanyichukwu, I., Michael, A. and Charles, E., 2013. SUSCEPTIBILITY AND DETECTION OF EXTENDED SPECTRUM [Beta]-LACTAMASE ENZYMES FROM OTITIS MEDIA PATHOGENS. American Journal of Infectious Diseases, 9(1), p.24.
Chonmaitree, T., 2000. Viral and bacterial interaction in acute otitis media. The Pediatric infectious disease journal, 19(5), pp.S24-S30.
CLSI, C., 2016. Performance standards for antimicrobial susceptibility testing. Clinical Lab Standards Institute.
Endaylalu, K., Abera, B. and Mulu, W., 2020. Extended spectrum beta lactamase producing bacteria among outpatients with ear infection at FelegeHiwot Referral Hospital, North West Ethiopia. PloS one, 15(9), p.e0238891.
Ettehad, G.H., Refahi, S., Nemmati, A., Pirzadeh, A. and Tazakori, Z., 2007. P742 Microbial and antimicrobial susceptibility patterns from patients with chronic otitis media in Ardebil, Iran. International Journal of Antimicrobial Agents, (29), p.S183.
Fernando, M.M.P.S.C., Luke, W.A.N.V., Miththinda, J.K.N.D., Wickramasinghe, R.D.S.S., Sebastiampillai, B.S., Gunathilake, M.P.M.L., Silva, F.H.D.S. and Premaratna, R., 2017. Extended spectrum beta lactamase producing organisms causing urinary tract infections in Sri Lanka and their antibiotic susceptibility pattern–a hospital based cross sectional study. BMC infectious diseases, 17(1), p.138.
Filius, P.M.G., Van Netten, D., Roovers, P.J.E., Vulto, A.G., Gyssens, I.C., Verbrugh, H.A. and Endtz, H.P., 2003. Comparative evaluation of three chromogenic agars for detection and rapid identification of aerobic Gram‐negative bacteria in the normal intestinal microflora. Clinical microbiology and infection, 9(9), pp.912-918.
Gehanno, P. and French Study Group, 1997. Multicenter study of the efficacy and safety of oral ciprofloxacin in the treatment of chronic suppurative otitis media in adults. Otolaryngology—Head and Neck Surgery, 117(1), pp.83-90.
Gellatly, S.L. and Hancock, R.E., 2013. Pseudomonas aeruginosa: new insights into pathogenesis and host defenses. Pathogens and disease, 67(3), pp.159-173.
Gorems, K., Beyene, G., Berhane, M. and Mekonnen, Z., 2018. Antimicrobial susceptibility patterns of bacteria isolated from patients with ear discharge in Jimma Town, Southwest, Ethiopia. BMC Ear, Nose and Throat Disorders, 18(1), p.17.
Haider, A., 2002. Chronic suppurative otitis media (CSOM): Bacteriological study. ORION, vol. 13.
Hailu, D., Mekonnen, D., Derbie, A., Mulu, W. and Abera, B., 2016. Pathogenic bacteria profile and antimicrobial susceptibility patterns of ear infection at Bahir Dar Regional Health Research Laboratory Center, Ethiopia. SpringerPlus, 5(1), p.466.
Hassan, O. and Adeyemi, R.E., 2007. A study of bacterial isolates in cases of otitis media in patients attending oauthc, Ile-Ife. African Journal of Clinical and Experimental Microbiology, 8(3), pp.130-136.
Hassooni, H.R., Fadhil, S.F., Hameed, R.M., Alhusseiny, A.H. and Jadoo, S.A.A., 2018. Upper respiratory tract infection and otitis media are clinically and microbiologically associated. Journal of Ideas in Health, 1(1), pp.29-33.
Jakribettu, R.P., Fysal, N., Sushanth P.S., Ahmed, S.M., Shamseer, P.T., 2014. Microbiological study of acute otitis media in children aged 2 months to 18 years. Journal of Evolution of Medical and Dental Sciences, 3(02), pp.393-398
Javed, M., Arshad, M. and Khan, M.A., 2020. 69. Pathogenic bacteria profile and antimicrobial susceptibility patterns of ear infection at Ayub Medical Complex Abbottabad, Pakistan. Pure and Applied Biology (PAB), 9(1), pp.714-719.
Jik, A., Ogundeji, E., Maxwell, I., Ogundeji, A., Samaila, J., Sunday, C., Gullek, J.S., Baso, L.A., Agbaje, A.O. and Onuoha, M.N., 2015. Identification of microorganism associated with otitis media among children in Ganawuri area of plateau state, Nigeria. IOSR J Dent Med Sci, 14(12), pp.61-67.
Justin, R., Tumweheire, G., Kajumbula, H. and Ndoleriire, C., 2018. Chronic suppurative otitis media: bacteriology, susceptibility and clinical presentation among ENT patients at Mulago Hospital, Uganda. South Sudan Medical Journal, 11(2), pp.31-35.
Juyal, D., Sharma, M., Negi, V., Prakash, R. and Sharma, N., 2017. Pseudomonas aeruginosa and its sensitivity spectrum in chronic suppurative otitis media: A study from Garhwal hills of Uttarakhand State, India. Indian Journal of Otology, 23(3), p.180.
Karim, A. 2008. Effect of Tris-EDTA and ascorbate in increasing antibiotic activity against bacteria isolated from otitis media. Doctoral dissertation, Al-Nahrain University.
Kashyap, S., Pandey, A., Thakuria, B., Saxena, A.K., Asthana, A.K. and Madan, M., 2017. Resistant microorganisms isolated from cases of chronic suppurative otitis media: a therapeutic concern. National Journal of Laboratory Medicine, 6(2), pp.M001-M006.
Khatoon, A., Rizvi, M., Sultan, A., Khan, F., Sharma, M., Shukla, I. and Khan, H.M., 2015. Chronic suppurative otitis media: a clinico-microbiological menace. Int J Res Med Sci, 3(8), pp.1932-6.
Kvestad, E., Kværner, K.J., Røysamb, E., Tambs, K., Harris, J.R. and Magnus, P., 2004. Otitis media: genetic factors and sex differences. Twin Research and Human Genetics, 7(3), pp.239-244.
Leylabadlo, H.E., Pourlak, T., Aghazadeh, M., Asgharzadeh, M. and Kafil, H.S., 2017. Extended-spectrum beta-lactamase producing gram negative bacteria In Iran: A review. African journal of infectious diseases, 11(2), pp.39-53.
Lieberthal, A.S., Carroll, A.E., Chonmaitree, T., Ganiats, T.G., Hoberman, A., Jackson, M.A., Joffe, M.D., Miller, D.T., Rosenfeld, R.M., Sevilla, X.D. and Schwartz, R.H., 2013. The diagnosis and management of acute otitis media. Pediatrics, 131(3),pp.e964-e999.
Loy, A.H.C., Tan, A.L. and Lu, P.K.S., 2002. Microbiology of chronic suppurative otitis media in Singapore. Singapore medical journal, 43(6), pp.296-299.
MacFaddin, J.F. 2000. Biochemical Tests for Identification of Medical Bacteria. 3rd Edition, Lippincott Williams & Wilkins, Philadelphia.
Magiorakos, A.P., Srinivasan, A., Carey, R.B., Carmeli, Y., Falagas, M.E., Giske, C.G., Harbarth, S., Hindler, J.F., Kahlmeter, G., Olsson-Liljequist, B. and Paterson, D.L. 2012. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance, Clinical microbiology and infection, 18(3), pp.268-281.
Mansoor, T., Musani, M.A., Khalid, G. and Kamal, M., 2009. Pseudomonas aeruginosa in chronic suppurative otitis media: sensitivity spectrum against various antibiotics in Karachi. J Ayub Med Coll Abbottabad, 21(2), pp.120-3.
Marom, T., Nokso-Koivisto, J. and Chonmaitree, T., 2012. Viral–bacterial interactions in acute otitis media. Current allergy and asthma reports, 12(6), pp.551-558.
Morris, P.S. and Leach, A.J., 2009. Acute and chronic otitis media. Pediatric Clinics, 56(6), pp.1383-1399.
Muluye, D., Wondimeneh, Y., Ferede, G., Moges, F. and Nega, T., 2013. Bacterial isolates and drug susceptibility patterns of ear discharge from patients with ear infection at Gondar University Hospital, Northwest Ethiopia. BMC Ear, Nose and Throat Disorders, 13(1), p.10.
Mushi, M.F., Mwalutende, A.E., Gilyoma, J.M., Chalya, P.L., Seni, J., Mirambo, M.M. and Mshana, S.E., 2016. Predictors of disease complications and treatment outcome among patients with chronic suppurative otitis media attending a tertiary hospital, Mwanza Tanzania. BMC Ear, Nose and Throat Disorders, 16(1), p.1.
Nazir, A. and Kadri, S.M., 2014. Aerobic bacteriology of chronic suppurative otitis media: a hospital based study. Int J Res Med Sci, 2(4), pp.1521-5.
Nwabuisi, C. and Ologe, F.E., 2002. Pathogenic agents of chronic suppurative otitis media in Ilorin, Nigeria. East African medical journal, 79(4), pp.202-205.
Nwokoye, N.N., Egwari, L.O., Coker, A.O., Olubi, O.O., Ugoji, E.O. and Nwachukwu, S.C.U., 2012. Predisposing and bacteriological features of otitis media. African Journal of Microbiology Research, 6(3), pp.520-525.
Ogbogu, P.I., Eghafona, N.O. and Ogbogu, M.I., 2013. Microbiology of otitis media among children attending a tertiary hospital in Benin City, Nigeria. Journal of Public Health and Epidemiology, 5(7), pp.280-284.
Ogefere, H.O., Aigbiremwen, P.A. and Omoregie, R., 2015. Extended-spectrum beta-lactamase (ESBL)–producing Gram-negative isolates from urine and wound specimens in a tertiary health facility in southern Nigeria. Tropical Journal of Pharmaceutical Research, 14(6), pp.1089-1094. Chamberlain, N.R., 2009. Medical microbiology, chapter 11, McGraw –hill companies pp115-119.
Paterson, D.L. and Bonomo, R.A., 2005. Extended-spectrum β-lactamases: a clinical update. Clinical microbiology reviews, 18(4), pp.657-686.
Pincus, D.H. 2006. Microbial identification using the bioMérieux Vitek® 2 system, Encyclopedia of rapid microbiological methods, 1, pp.1-32.
Prakash, R., Juyal, D., Negi, V., Pal, S., Adekhandi, S., Sharma, M. and Sharma, N., 2013. Microbiology of chronic suppurative otitis media in a tertiary care setup of Uttarakhand state, India. North American journal of medical Sciences, 5(4), p.282.
Qureishi, A., Lee, Y., Belfield, K., Birchall, J.P. and Daniel, M., 2014. Update on otitis media–prevention and treatment. Infection and drug resistance, 7, p.15.
Sah, B.P., Chettri, S.T., Bhattarai, N.R., Shah, S.P., Paudel, D., Sarraf, D.P. and Mishra, S., 2020. Microbiological profile and their antibiotic sensitivity pattern in patients of chronic suppurative otitis media at eastern tertiary care center of Nepal. IP Journal of Otorhinolaryngology and Allied Science, 3(3), pp.86-90.
Sahu, M.C. and Swain, S.K., 2019. Surveillance of antibiotic sensitivity pattern in chronic suppurative otitis media of an Indian teaching hospital. World Journal of Otorhinolaryngology-Head and Neck Surgery, 5(2), pp.88-94.
Saleh, I.A., Saleh, I.A.A., Saleh, N.A.A. and Mḃ, M.S., 2014. Bacteria and fungi associated with Acute Otitis media. Int J Curr Eng Technol, 4(1), pp.316-318.
Seid, A., Deribe, F., Ali, K. and Kibru, G., 2013. Bacterial otitis media in all age group of patients seen at Dessie referral hospital, North East Ethiopia. Egyptian Journal of Ear, Nose, Throat and Allied Sciences, 14(2), pp.73-78.
Shyamala, R. and Reddy, P.S., 2012. The study of bacteriological agents of chronic suppurative otitis media–aerobic culture and evaluation. J Microbiol Biotechnol Res, 2, pp.152-62.
Sierra, A., Lopez, P., Zapata, M.A., Vanegas, B., Castrejon, M.M., DeAntonio, R., Hausdorff, W.P. and Colindres, R.E., 2011. Non-typeable Haemophilus influenzae and Streptococcus pneumoniaeas primary causes of acute otitis media in colombian children: a prospective study. BMC infectious diseases, 11(1), p.4
Tesfa, T., Mitiku, H., Sisay, M., Weldegebreal, F., Ataro, Z., Motbaynor, B., Marami, D. and Teklemariam, Z., 2020. Bacterial otitis media in sub-Saharan Africa: a systematic review and meta-analysis. BMC Infectious Diseases, 20(1), pp.1-12.
Uyanga, F.Z., Ekundayo, E.O., Nwankwo, E.O. and Inimfon, A.I., 2019. Evaluation of CHROMagar ESBL and Double Disk Synergy Test (DDST) for Screening of Extended Spectrum Beta-lactamase Producing Uropathogens in South-South Nigeria. Journal of Advances in Microbiology, 17(4), pp.1-11.
Vaidya, K., Madhup, S.K., Shrestha, B.L., Gautam, A. and Tuladha, N.R., 2015. Bacteriological and mycological profile of chronic suppurative otitis media among patients visiting Dhulikhel Hospital. Annals of Clinical Chemistry and Laboratory Medicine, 1(1), pp.37-41.
Verhoeff, M., van der Veen, E.L., Rovers, M.M., Sanders, E.A. and Schilder, A.G., 2006. Chronic suppurative otitis media: a review. International journal of pediatric otorhinolaryngology, 70(1), pp.1-12
Vijayvargiya, V., Gupta, S., Goyal, J., and Kumar, U., 2016. Chronic Otitis Media- Bacteriological Spectrum and Antibiogram. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS), 15(12), PP. 95-98.
Wasihun, A.G. and Zemene, Y., 2015. Bacterial profile and antimicrobial susceptibility patterns of otitis media in Ayder Teaching and Referral Hospital, Mekelle University, Northern Ethiopia. SpringerPlus, 4(1), p.701.
Worku, M. and Bekele, M., 2014. Bacterial isolate and antibacterial resistance pattern of ear infection among patients attending at Hawassa university referral Hospital, Hawassa, Ethiopia. Indian J Otol, 20(4), p.155.
Published
2021-08-18
How to Cite
Mahmood Agha, Z. and S. Al-Delaimi, M. (2021) “Prevalence of common bacterial etiology and antimicrobial susceptibility pattern in patients with otitis media in Duhok Province –Iraq”, Zanco Journal of Pure and Applied Sciences, 33(4), pp. 11-25. doi: 10.21271/ZJPAS.33.4.2.
Section
Biology and Medical Researches