Microbiological Spectrum and Antibiotics Sensitivity Pattern of Chronic Suppurative Otitis Media (CSOM) Patients: A prospective study from a Tertiary Care Hospital in Peshawar

Abstract

Background & objective: Chronic suppurative otitis media is a fatal condition owing to its propensity for intracranial extension. The inadvertent use of antibiotics has led to resistance among causative organisms. The objectives of this study were to determine causative bacteria, their antibiotic resistance and susceptibility patterns, and their response to antibiotics after a one-month follow-up.

Method: It was a prospective study conducted in the ENT department of Khyber Teaching Hospital, Peshawar from June 2023 to March 2024. Ear swabs were collected for microscopy and bacterial culture. Statistical analysis was done using IBM-SPSS-20, and GraphPad Prism.

Results: Data was collected from 113 patients. The mean age of the patients was 22 + 2 years. Out of 113 samples, 97(85.5%) showed growth on culture whereas 16(14%) showed no growth, with 95 (98%) unimicrobial, while 2 (2%) showed polymicrobial growth. Pseudomonas aeruginosa was the commonest bacteria isolated 38(38%), followed by S. aureus, Proteus species, and S. saprophyticus. Gram-positive bacteria were susceptible to Linezolid (80%), followed by Vancomycin (76%), with resistance to Ciprofloxacin (75-84%), Ampicillin (70%), and Ceftriaxone (75-80%). Gram-negative bacteria showed susceptibility to carbapenem (50-100%) and Piperacillin/Tazobactam (50% to 93%), with resistance to Ciprofloxacin (50-87%), Ceftriaxone (87%), and Amoxicillin/Clavulanate (72-90%). After one month of follow-up, 82% of patients showed improvements, with noncompliance significantly associated with the persistence of symptoms (p<0.01).

Conclusion: Moderate to high resistance against ciprofloxacin, third-generation cephalosporin, ampicillin, amoxicillin plus clavulanate, and clindamycin is an eye-opener. Our results underscore the critical need for judicious administration of empirical antibiotics.

Keywords: Antibiotic resistance; Antibiotic sensitivity; CSOM; Pseudomonas aeruginosa; Staph aureus.

Fig.1

Distribution of bacteria isolated from CSOM patients.

Fig.2

Antibiotic resistance pattern in the two commonest isolated bacteria of CSOM patients.

Fig.3

Antibiotic sensitivity pattern of isolated bacteria from CSOM patients on MHA (Mueller Hinton Agar): 3692: E. coli, 3699: Citrobacter, 3769: Serratia marcescens, 3758: Proteus mirabilis, 3701, 3708: Pseudomonas aeruginosa, 3694: Staph aureus, 3746: Enterobacter.