Evaluation of pathogenic agents and antimicrobial susceptibility of Chronic suppurative Otitis Media at Kigali University Teaching Hospital

Abstract

Background: Chronic suppurative otitis media is a chronic inflammation of the middle ear and mastoid cavity, with more than 2 weeks of otorrhoea. Bacteria migrate into the middle ear either from the nasopharynx through the Eustachian tube or from the external auditory canal via a perforated tympanic membrane. Various studies have shown that both gram-positive and gram-negative bacteria are responsible for infection of middle ear. The knowledge of the prevailing flora and their susceptibility to antibiotics is an important step for an appropriate treatment. Objectives: To determine the etiological agents and their antimicrobial susceptibility pattern in patient with CSOM at KUTH Patients and methods: The current study was crossectional survey involving enrolled 110 patients who consulted ENT Department at KUTH with active chronic suppurative otitis media or its complication, from November 2014 up to January 2015. The patient demographics, clinical presentation, microbiology and antibiotic sensitivity were collected using data collection sheet. A head light was used to examine ears and status of the tympanic membrane after aural toilet Results: The age of our population ranged between 2 and 89 years, the maximum was in the age range of 16- 30 years (55.5%). The proportion of male to female was almost similar, male constituted 50. 9% while female were 49.1%. The majority had discharge for more than 5 years. For the results of culture and sensitivity, 65.5% showed significant microbial growth of single organism, with majority being Staphylococcus aureus 35%, followed by Klepsiella spp 15%, and Pseudomonas aeruginosa together with Enterobacter spp accounting for 10 % for each. For overall of antimicrobial used, ciprofloxacin was revealed to be most effective antimicrobial drug against many organisms at 51.8%. Chloremphenicol was effective at 14.5% while cefotaxim and augmentin showed to be effective at 10% and 8.2% respectively. Conclusion: Staphylococcus aureus were the most common organisms isolated and showed high sensitivity to ciprofloxacin and clindamycin, but it were resistant to penicillin. Ciprofloxacin revealed to be an antimicrobial drug of choice for majority of isolated organisms in our study as well as in many other studies done. There is variation in isolated organisms as well as antimicrobial drugs. For this reason, to know the exact sensitive antibiotic to a certain ear infection treated without success, it is advisable to do culture of discharge and sensitivity.