Acute otitis media in infants younger than two months of age: microbiology, clinical presentation and therapeutic approach

doi:10.1097/00006454-200207000-00013

Paper

Acute otitis media in infants younger than two months of age: microbiology, clinical presentation and therapeutic approach

Published Jul 1, 2002 · D. Turner, E. Leibovitz, A. Aran

The Pediatric Infectious Disease Journal

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100

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2

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Abstract

Background. Information on the causative agents of acute otitis media (AOM) in infants <2 months of age is limited. Objectives of the study. To analyze the etiology, pathogen susceptibility patterns, clinical presentation and frequency of serious bacterial infections in infants <2 months of age with AOM and to determine the relationship between the organisms isolated systemically and those isolated from the middle ear fluid in the patients with serious bacterial infections in the presence of AOM. Methods. The medical records of 137 infants <2 months of age with AOM who underwent tympanocentesis in the emergency room of Soroka University Medical Center between January 1, 1995, and May 30, 1999, were reviewed. The main variables analyzed included demography, frequency of serious bacterial infections, bacteriologic results, susceptibility patterns of the pathogens and clinical presentation. Results. Median age was 38.7 ± 13 days; 112 of 137 (82%) infants were hospitalized. Six (4%), 27 (20%), 46 (34%) and 58 (42%) episodes were recorded at age 0 to 2, 3 to 4, 5 to 6 and 7 to 8 weeks, respectively. Fever (temperature >38°C) was present in 96 (70%) of the cases. Culture-negative (bacterial) meningitis was diagnosed in 3 cases. Blood and urine cultures were positive in 1 and 6 infants, respectively. None of the afebrile infants developed serious bacterial infection. One hundred twenty-two bacterial pathogens were isolated from the middle ear fluid of 109 of 137 (80%) patients:Streptococcus pneumoniae in 56 (46%), Haemophilus influenzae in 41 (34%), group A Streptococcus in 12 (10%), enteric Gram-negative bacilli in 9 (7%), Moraxella catarrhalis in 3 (2%) and Streptococcus faecalis in 1 (1%). Eleven (20%) of the 56 S. pneumoniae isolates were nonsusceptible to penicillin. Serious bacterial infections were diagnosed in 6 of 137 (4%) patients. Whereas blood and urine grew pathogens typical for blood and urinary tract infections, the middle ear fluid isolates represented different pathogens usually isolated in AOM without any correlation between these 2 groups of pathogens. Conclusions. (1) Most cases of AOM in infants <2 months of age are caused by pathogens similar to those causing AOM in older children; (2) antibiotic resistance may already be present at early age and should be considered in the empiric treatment of AOM in infants <2 months of age; (3) the presence of AOM does not predict a higher risk for serious bacterial infections in afebrile and febrile infants <2 months of age.

Observational Study

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Most cases of acute otitis media in infants 2 months of age are caused by pathogens similar to those in older children, and antibiotic resistance may already be present at early age, but the presence of AOM does not predict a higher risk for serious bacterial infections.

PopulationOlder adults (50-71 years)

Sample size24

MethodsObservational

OutcomesBody Mass Index projections

ResultsSocial networks mitigate obesity in older groups.

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Acute otitis media in infants younger than two months of age: microbiology, clinical presentation and therapeutic approach

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References

The clinical course of bronchiolitis associated with acute otitis media

Bronchiolitis in children with acute otitis media shows no significant difference in clinical and laboratory findings compared to those without ear infection.

Clinical significance of resistant organisms in otitis media

Antibiotic resistance in otitis media is widespread and increasing, reducing the success of eradicating pathogens from middle ear fluid, requiring careful antibiotic choice.

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In infants aged 0-8 weeks with isolated otitis media, serious bacterial infection is infrequent, suggesting outpatient treatment with oral antibiotics and close follow-up may be an option.

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This paper evaluates the prevalence of fever without source in infants aged birth to 3 months, the utility of history and physical examination, and the utility of laboratory and radiographic tests in evaluating the risk of serious underlying diseases.

Resistance pattern of middle ear fluid isolates in acute otitis media recently treated with antibiotics.

Recent antibiotic treatment increases the prevalence of pneumococcus in acute otitis media, and the effectiveness of commonly used beta-lactam drugs for Pnc is significantly higher in this setting.

Citations

The effect of pneumococcal conjugated vaccines on occurrence of recurrent acute otitis media among infants diagnosed with acute otitis media at an age younger than 2 months

Pneumococcal conjugate vaccines significantly decrease the occurrence of recurrent acute otitis media in infants diagnosed with early acute otitis media episodes.

Acute otitis media in the first two months of life and the impact of pneumococcal conjugate vaccines: A retrospective cohort study.

PCV13 introduction in southern Israel led to a decrease in acute otitis media in children 2 months of age, improved S. pneumoniae recovery, and shorter hospitalizations, with increased negative bacterial cultures from MEF.

Prevalence of Otitis Media in Children and Pattern of Antibiotic Prescription at a Tertiary Hospital in Makkah

Otitis media cases in children aged 3 years are higher in males (54.6%) than females (45.4%), and antibiotic prescriptions for otitis media often do not include further investigation of pathogens or recurrence.

Etiology, Diagnosis, Complications, and Management of Acute Otitis Media in Children

Surgical interventions are not proven to be effective in treating and preventing acute otitis media in children, and overdiagnosis contributes to antibiotic resistance.

Possibilities of effective topical therapy in treatment of acute otitis media in children: A review

Topical ear drops with lidocaine and phenazone effectively provide first-line pain relief for acute otitis media in children without systemic side effects, allowing for a wait-and-see approach to antibiotics.

Otologic Examination Findings In Afebrile Young Infants Clinically Diagnosed With Acute Otitis Media

Tympanic membrane erythema and 1 other otologic abnormality are common diagnostic criteria for acute otitis media in young infants, with differences in ear examination findings across age subgroups.

Otitis Media in Infants

Acute otitis media is a common infection in infants and young children, with a peak attack rate between 6 and 18 months of age, and most episodes continue through age 5 years.

Invasive Bacterial Infections in Afebrile Infants Diagnosed With Acute Otitis Media

Afebrile infants with clinician-diagnosed acute otitis media have a low prevalence of invasive bacterial infections and adverse events, making outpatient management without diagnostic testing reasonable.

Invasive Bacterial Infections in Afebrile Infants With Otitis Media: Worry Less but Still Worry

Invasive bacterial infections are rare in infants aged 90 days with acute otitis media, but still warrant monitoring for potential complications.