WAR IN THE MIDDLE EAR: MICROBIOLOGY OF CHRONIC SUPPURATIVE OTITIS MEDIA WITH SPECIAL REFERENCE TO ANAEROBES AND ITS ANTIMICROBIAL SUSCEPTIBILITY PATTERN: OPTIMIZING ANTIMICROBIAL THERAPY IN A TERTIARY CARE HOSPITAL OF RURAL INDIA

PRIYA BHAT; UPASANA BHUMBLA; JASLEEN KAUR

doi:10.22159/ijpps.2025v17i1.52692

Authors

PRIYA BHAT Department of Microbiology, Adesh Institute of Medical Sciences and Research, Bathinda https://orcid.org/0009-0004-9484-7807
UPASANA BHUMBLA Department of Microbiology, Adesh Institute of Medical Sciences and Research, Bathinda https://orcid.org/0000-0002-4539-4993
JASLEEN KAUR Department of Microbiology, Adesh Institute of Medical Sciences and Research, Bathinda https://orcid.org/0009-0007-9998-102X

DOI:

https://doi.org/10.22159/ijpps.2025v17i1.52692

Keywords:

CSOM, Anaerobic profile, Biofilm, Demographic factors, Antibiotic resistance

Abstract

Objective: To isolate etiological organisms of Chronic Suppurative Otitis Media (CSOM), study the antimicrobial susceptibility pattern, study the risk factors and associated co-morbid conditions with CSOM, and detect biofilm production in isolated bacteria.

Methods: An ear discharge specimen was obtained from the diseased ear of the patient, using three separate sterilized swabs. One of the swabs was used for Gram staining and Aerobic culture. Antibiotic susceptibility testing was done by the Kirby-Bauer standard disc diffusion method all the g-negative isolates were screened for Extended-Spectrum Beta-Lactamase (ESBL) production and Amp C ß-lactamase production. Methicillin-Resistant Staphylococcus Aureus (MRSA) screening was done using a Cefoxitin disc. Biofilm production was done using the Tube method and Microtiter plate method. Anaerobic culture was inoculated into Robertson’s Cooked Meat (RCM) broth. Potassium hydroxide (KOH) mount was done using 10% KOH for the presence of budding yeast cells, fungal hyphae, and spores. Tubes showing positive cultures were examined by LactoPhenol Cotton Blue (LPCB) mount. Final Candida speciation and Antifungal susceptibility testing was done using VITEK-2.

Results: A total of 500 patients were included in the study, with 62.8% being males. The most common organism isolated was Pseudomonas aeruginosa. Fungi accounted for 30 isolates (5%) and anaerobes were 5 isolates (1%). Gram-negative bacteria were found to be most sensitive to Piperacillin-tazobactam (96%) while the highest resistance was noted to Amoxicillin-clavulanate (65%). 100% of Staphylococcus aureus isolates were sensitive to Vancomycin, Linezolid, and Teichoplanin.13% of S. aureus were found to be Cefoxitin resistant (MRSA). The highest resistance in S. aureus isolates was noted to Ciprofloxacin (65%).13% of isolates of Gram-negative bacteria had ESBL production while Amp C β-Lactamase production was noted in 9% of isolates. Out of 186 isolates tested for biofilm production, 149 isolates (80%) showed biofilm production. A total of 30 fungal isolates were obtained in culture. Aspergillus spp. Accounted for 66.6% of fungal isolates while Candida spp. accounted for 33.3% of fungal isolates. The sensitivity of Candida isolates was tested to Fluconazole, Itraconazole, Voriconazole, and Flucytosine and they were found to be 100% sensitive to all the antifungals tested.

Conclusion: CSOM often has polymicrobial pathology and creates a war in the middle ear environment, augmented by mixed aerobic and anaerobic organisms and synergism between aerobic and anaerobic organisms. A high rate of Clindamycin resistance was seen in anaerobe which is noteworthy because this is a frequently utilized antimicrobial for treating anaerobic infections.

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