Postsurgical Otorrhea Severity Not Influenced by Pathogen Type

Otitis media infections associated with methicillin-resistant Staphylococcus aureus (MRSA) following pediatric tympanostomy tube placement did not result in worse outcomes than those caused by other pathogens, according to a new study.

Researchers at the Children's Hospital of Alabama (Birmingham, USA) conducted a retrospective review of the medical records of 1,079 children who presented at the children's hospital from January 1, 2003, to December 31, 2008, with otorrhea that occurred after tympanostomy tube insertion. Culture records were used to group the patients into those whose infection was due to MRSA (170 patients) and those with non-MRSA otitis media (909 patients). The researchers also randomly selected an age-matched group of 170 children and examined the differences between the MRSA and age-matched non-MRSA groups in organisms isolated by culture, demographic factors, medical history, treatments, surgical procedures performed, audiometric data, and other admissions for infection-related illnesses.

The results showed that of the 170 eligible children in each age-matched group, 135 with MRSA otorrhea and 141 with non-MRSA otorrhea had data in every category selected for statistical analysis. The groups did not differ significantly in medical insurance type, history of tympanostomy tube placement, cholesteatoma, number or type of surgical procedures performed, or risk of subsequent infection-related diagnoses. However, more patients in the MRSA group received the addition of oral antibiotics (40.7% vs. 24.8%) and intravenous (IV) antibiotic therapy (11% vs. 3.6%). The study was published in the December 2011 issue of Archives of Otolaryngology - Head & Neck Surgery.

“Treatment of MRSA otorrhea has undergone substantial changes over the last 10 years; many of the first patients with culture-proven MRSA otorrhea were hospitalized for a two-week course of parenteral antibiotics and were more likely to undergo mastoidectomy if they developed chronic infection of middle ear mucosa or granulation tissue,” said lead author Brian Wiatrak, MD, and colleagues of the pediatric ear, nose, and throat (ENT) department. “We believe that our selection of specific antibiotic agent based on the culture results and scrupulous attention to infection control practices helps to decrease the risk of new drug resistances developing.”

Otitis media is an inflammation of the middle ear that occurs in the area between the tympanic membrane and the inner ear, including a duct known as the eustachian tube. Though painful, otitis media is not threatening and usually heals on its own within 2–6 weeks. In chronic cases with effusions, insertion of a tympanostomy tube into the eardrum reduces recurrence rates in the six months after placement, but has little effect on long-term hearing. Thus, tubes are recommended in those who have more than three episodes of acute otitis media in six month or four in a year associated with an effusion.

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Children's Hospital of Alabama