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Prevalence and Antimicrobial Resistance of Bacteria in Children With Acute Otitis Media and Ear Discharge: A Systematic Review

Prevalence and Antimicrobial Resistance of Bacteria in Children With Acute Otitis Media and Ear Discharge: A Systematic Review
Prevalence and Antimicrobial Resistance of Bacteria in Children With Acute Otitis Media and Ear Discharge: A Systematic Review

BACKGROUND: Of children with acute otitis media (AOM), 15%-20% present with acute onset ear discharge due to a spontaneous perforation of the tympanic membrane (AOMd). This review aims to quantify the prevalence and antimicrobial resistance (AMR) status of bacteria in children with AOMd in the pneumococcal conjugate vaccine (PCV) era.

METHODS: Systematic searches were performed in PubMed, EMBASE and Cochrane Library from inception to June 7, 2019. Two reviewers extracted relevant data and assessed risk of bias independently. All English studies reporting any prevalence and/or AMR data of bacterial middle ear isolates from children with AOMd were included. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal checklist.

RESULTS: Of 4088 unique records retrieved, 19 studies (10,560 children) were included. Overall quality was judged good. Streptococcus pneumoniae (median 26.1%, range 9.1%-47.9%), Haemophilus influenzae (median 18.8%, range 3.9%-55.3%), Staphylococcus aureus (median 12.3%, range 2.3%-34.9%) and Streptococcus pyogenes (median 11.8%, range 1.0%-30.9%) were the most prevalent bacteria. In 76.0% (median, range 48.7%-100.0%, 19 studies, 1,429 children) any bacterium was identified. AMR data were sparse and mainly limited to S. pneumoniae. We found no evidence of a clear shift in the prevalence of bacteria and AMR over time.

CONCLUSIONS: In children with AOMd, S. pneumoniae and H. influenzae are the 2 predominant bacteria, followed by S. aureus and S. pyogenes in the post-PCV era. AMR data are sparse and no clearly change over time was observed. Ongoing surveillance of the microbiology profile in children with AOMd is warranted to guide antibiotic selection and to assess the impact of children's PCV status.

acute otitis media, antimicrobial resistance, ear discharge, otopathogens, review
0891-3668
756-762
Hullegie, Saskia
03febba4-58b9-464a-becb-344e55ddd6b4
Venekamp, Roderick P
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van Dongen, Thijs M A
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Hay, Alastair D
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Moore, Michael V
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Little, Paul
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Schilder, Anne G M
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Damoiseaux, Roger A M J
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Hullegie, Saskia
03febba4-58b9-464a-becb-344e55ddd6b4
Venekamp, Roderick P
04309a42-770e-425b-9bc3-85930ca3bcc2
van Dongen, Thijs M A
8165c8ba-9f39-40d5-991b-6153aaf921a9
Hay, Alastair D
94eb9d29-ede8-4b4c-ad6a-b0039d0707e3
Moore, Michael V
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Little, Paul
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Schilder, Anne G M
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Damoiseaux, Roger A M J
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Hullegie, Saskia, Venekamp, Roderick P, van Dongen, Thijs M A, Hay, Alastair D, Moore, Michael V, Little, Paul, Schilder, Anne G M and Damoiseaux, Roger A M J (2021) Prevalence and Antimicrobial Resistance of Bacteria in Children With Acute Otitis Media and Ear Discharge: A Systematic Review. The Pediatric infectious disease journal, 40 (8), 756-762. (doi:10.1097/INF.0000000000003134).

Record type: Review

Abstract

BACKGROUND: Of children with acute otitis media (AOM), 15%-20% present with acute onset ear discharge due to a spontaneous perforation of the tympanic membrane (AOMd). This review aims to quantify the prevalence and antimicrobial resistance (AMR) status of bacteria in children with AOMd in the pneumococcal conjugate vaccine (PCV) era.

METHODS: Systematic searches were performed in PubMed, EMBASE and Cochrane Library from inception to June 7, 2019. Two reviewers extracted relevant data and assessed risk of bias independently. All English studies reporting any prevalence and/or AMR data of bacterial middle ear isolates from children with AOMd were included. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal checklist.

RESULTS: Of 4088 unique records retrieved, 19 studies (10,560 children) were included. Overall quality was judged good. Streptococcus pneumoniae (median 26.1%, range 9.1%-47.9%), Haemophilus influenzae (median 18.8%, range 3.9%-55.3%), Staphylococcus aureus (median 12.3%, range 2.3%-34.9%) and Streptococcus pyogenes (median 11.8%, range 1.0%-30.9%) were the most prevalent bacteria. In 76.0% (median, range 48.7%-100.0%, 19 studies, 1,429 children) any bacterium was identified. AMR data were sparse and mainly limited to S. pneumoniae. We found no evidence of a clear shift in the prevalence of bacteria and AMR over time.

CONCLUSIONS: In children with AOMd, S. pneumoniae and H. influenzae are the 2 predominant bacteria, followed by S. aureus and S. pyogenes in the post-PCV era. AMR data are sparse and no clearly change over time was observed. Ongoing surveillance of the microbiology profile in children with AOMd is warranted to guide antibiotic selection and to assess the impact of children's PCV status.

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Accepted/In Press date: 15 February 2021
Published date: 1 August 2021
Additional Information: This work is supported by a research grant from the Netherlands Organisation for Health Research and Development (ZonMw) [Rational Pharmacotherapy 5th Open Call grant number 84801 5006]. The funder has no role in design, conduct and report of this study.
Keywords: acute otitis media, antimicrobial resistance, ear discharge, otopathogens, review

Identifiers

Local EPrints ID: 453308
URI: http://eprints.soton.ac.uk/id/eprint/453308
ISSN: 0891-3668
PURE UUID: 8a3c0569-0723-453f-9e05-d67fd7f4351f
ORCID for Michael V Moore: ORCID iD orcid.org/0000-0002-5127-4509

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Date deposited: 12 Jan 2022 17:39
Last modified: 28 Apr 2022 01:54

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Contributors

Author: Saskia Hullegie
Author: Roderick P Venekamp
Author: Thijs M A van Dongen
Author: Alastair D Hay
Author: Michael V Moore ORCID iD
Author: Paul Little
Author: Anne G M Schilder
Author: Roger A M J Damoiseaux

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