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. 2018 Sep 25;18(1):478.
doi: 10.1186/s12879-018-3398-9.

Resistant Streptococcus pneumoniae strains in children with acute otitis media- high risk of persistent colonization after treatment

Izabela Korona-Glowniak  1 , Piotr Zychowski  2 , Radoslaw Siwiec  3 , Elżbieta Mazur  4 , Grażyna Niedzielska  2 , Anna Malm  3
Affiliations

Resistant Streptococcus pneumoniae strains in children with acute otitis media- high risk of persistent colonization after treatment

Izabela Korona-Glowniak et al. BMC Infect Dis. .

Abstract

Background: Despite advances in the development of pneumococcal conjugate vaccines, acute otitis media (AOM) is a common childhood infection, caused mainly by Streptococcus pneumoniae. It has been suggested that persistence of pneumococcal nasopharyngeal carriage is a risk factor for subsequent recurrent infections.

Methods: In this study we evaluate the relationship between 55 pneumococcal strains obtained from nasopharynx/oropharynx (NP/OP) and middle ear fluid (MEF) of 62 children, aged between 1 and 16 years, during AOM (including recurrent/treatment failure AOM, and post-treatment visits), based on their phenotypic and genotypic characteristics performed by analyses of serotype, antibiotic susceptibility patterns and multilocus sequence typing.

Results: S.pneumoniae was isolated from 27.4% of MEF samples; it constituted 43.6% of all positive bacterial samples from MEF samples. There was statistically significant concordance between isolation from the MEF sample and NP/OP colonization by S. pneumoniae (p < 0.0001). During post-treatment visits S.pneumoniae was isolated from 20.8% of children; 91% of them were positive in pneumococcal NP/OP culture during AOM. The serotypes belonging to 10- and 13-valent pneumococcal conjugated vaccines constituted 84% and 92% of the strains, respectively. Multidrug resistance was found in 84% of the strains. According to multivariate analysis, pneumococcal colonization after antibiotic therapy was significantly associated with shorter length of therapy in children with bilateral AOM.

Conclusions: High persistent prevalence of antibiotic-resistant S.pneumoniae strains in children with AOM after unsuccessful bacterial eradication may presumably be regarded as a predisposing factor of infection recurrence.

Keywords: Acute otitis media; Antibiotic resistance; MLST; Risk factors; Streptococcus pneumoniae.

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Conflict of interest statement

Ethics approval and consent to participate

The Ethical Committee of the Medical University of Lublin approved the study protocol (No. KE-0254/75/211). From all children’s parents written informed consent was obtained.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart for pneumococcal isolation/colonization analysis. (Middle ear fluid (MEF) specimens, nasopharyngeal and oropharyngeal (NP/OP) swabs were collected during AOM visits. Two post-treatment visits were carried out: after the antibiotic therapy (post-treatment visit I) and two weeks after the antibiotic therapy (post-treatment visit II). NP and OP swabs were collected during these visits. Of all patients 53 patients participated in post-treatment visit I and 28 patients in both visits. A total of 348 microbiological cultures were analyzed)
Fig. 2
Fig. 2
Serotype distribution for 55 pneumococcal isolates obtained during AOM and post-treatment visits. (AOM, acute otitis media; MEF, middle ear fluid; NP, nasopharyngeal; OP, oropharyngeal)
Fig. 3
Fig. 3
Resistance to antibiotics for 55 pneumococcal isolates obtained during AOM and post-treatment visits. (AOM, acute otitis media; MEF, middle ear fluid; NP, nasopharyngeal; OP, oropharyngeal; MDR-SP, multidrug resistant S. pneumoniae)
See this image and copyright information in PMC

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