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. 2012 Sep;16(2):75-9.
doi: 10.7874/kja.2012.16.2.75. Epub 2012 Sep 20.

Nasal Colonization of Methicillin-Resistant Staphylococcus aureus in Patients with Chronic Suppurative Otitis Media

Eun Jung Lee  1 , Jin Ho Kwon  1 , Ah Young Park  1 , Won-Sang Lee  1 , Eun Jin Son  1
Affiliations

Nasal Colonization of Methicillin-Resistant Staphylococcus aureus in Patients with Chronic Suppurative Otitis Media

Eun Jung Lee et al. Korean J Audiol. 2012 Sep.

Abstract

Background and objectives: Methicillin-resistant Staphylococcus aureus (MRSA) is one of major pathogens in patients with chronic suppurative otitis media (CSOM). In addition to intrinsic MRSA infection of the mastoid air cell system, nasal colonization of MRSA, a known predictor of postoperative surgical site infection, may pose increased risk of postoperative complications. The purpose of this study is to describe microbiology of preoperative nasal swab screening and localized middle ear specimens in patients undergoing otologic surgeries.

Subjects and methods: Forty-nine consecutive patients with CSOM who underwent middle ear surgery were included. Preoperative nasal swabs for MRSA, and preoperative and intraoperative middle ear swabs were collected and compared for pathogens.

Results: Preoperative nasal swab screening confirmed MRSA colonization in 3/49 patients (6.1%) and methicillin-resistant coagulase-negative Staphylococcus (MRCNS) in 9/49 patients (18.4%). Correlation with preoperative culture results and nasal swab screening results were compatible in 2/4 patients with positive nasal swab for MRSA and 1/9 patients with positive nasal swab for MRCNS. Postoperative conversion to MRSA was observed in 3 patients.

Conclusions: The rate of nasal MRSA colonization among patients with CSOM was higher than among the general community. Preoperative MRSA colonization was associated with MRSA from middle ear specimens. Further studies are warranted to investigate the possible benefit of preoperative treatment of MRSA colonized patients undergoing middle ear surgeries.

Keywords: Culture; Methicillin-resistant Staphylococcus aureus; Otitis media.

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Figures

Fig. 1
Fig. 1
Comparison of organisms identified from perioperative cultures and nasal swab. (A) Preoperative ear culture results (Preop ear) and nasal swab (Nasal) culture results showed significant difference (p=0.001). However, no significant correlation was noted between Preop ear and postoperative (Postop) culture results (B). (C) Intraoperative middle ear cultures (Intraop) and Postop culture results showed significant difference (p=0.023). *p<0.05.
Fig. 2
Fig. 2
Comparison of culture results according to the presence of bacterial growth. No significant difference was noted between the presence of bacterial growth or no growth when the culture results were compared: (A) preoperative ear culture (Preop ear), and nasal swab (Nasal), (B) Preop ear and postoperative (Postop) culture, or (C) Nasal and Postop.
Fig. 3
Fig. 3
Comparison of culture results according to the presence of antibiotic resistance. No significant difference was noted between the antibiotic-susceptible and resistant strains identified when the culture results were compared between (A) preoperative ear culture (Preop ear), and nasal swab (Nasal), (B) Preop ear and postoperative (Postop) culture.
Fig. 4
Fig. 4
Diagram to show the analysis of the perioperative culture results from the patients identified with nasal MRSA or MRCNS colonization. MRSA: methicillin-resistant Staphylococcus aureus, MRCNS: methicillin-resistant coagulase-negative Staphylococcus, MSCNS: methicillin-sensitive coagulase-negative Staphylococcus, CRP: ciprobay-resistant Pseudomonas.
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