The appropriate medical management of methicillin-resistant Staphylococcus aureus in chronic suppurative otitis media

Abstract

Conclusion: Methicillin-resistant Staphylococcus aureus (MRSA) was the most prevalent species (28.1%) in the bacteriological study of 577 patients with chronic suppurative otitis media (CSOM). Frequent and appropriate aural cleansing and irrigation using diluted acetic acid or other solutions such as Burow's solution can be an effective method for the medical treatment of MRSA in CSOM.

Objectives: To investigate the bacteriological results of 577 patients with CSOM and the medical treatment results of 91 non-cholesteatomatous MRSA patients and to consider the most appropriate medical treatment modality for MRSA in patients with CSOM.

Patients and methods: This study was conducted retrospectively from January 2005 through July 2008 using the medical records of 577 patients with otorrhoea caused by CSOM. We analyzed the bacteriological results by dividing all patients into cholesteatomatous CSOM and non-cholesteatomatous CSOM and investigated the medical treatment results of 91 non-cholesteatomatous MRSA patients. We used three treatment modalities: aural cleansing and irrigation (50 cases), intravenous injection of teicoplanin (22 cases) and intravenous injection of vancomycin (15 cases).

Results: Overall, MRSA (28.1%) was the most prevalent species, followed by methicillin-susceptible Staphylococcus aureus (MSSA) (20.4%), Pseudomonas (18.6%) and coagulase-negative staphylococci (CNS) (15.0%). In non-cholesteatomatous MRSA treatment for dry ear, there were no significant differences between the three groups. The results showed that 79.5% of the group treated with aural cleansing and irrigation succeeded in achieving dry ears in 19.0 days. Similarly, 78.9% of another group with intravenous injection of teicoplanin eventually had dry ears, taking 16.0 days. Finally, the number of patients with dry ear in the group treated with intravenous injection of vancomycin was up to 80% of the total in 15.2 days.