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Antimicrobial Agents and Chemotherapy, March 1998, p. 589-595, Vol. 42, No. 3
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Prevalence of Antimicrobial-Resistant Pathogens in Middle Ear Fluid: Multinational Study of 917 Children with Acute Otitis Media

Michael R. Jacobs,1,* Ron Dagan,2 Peter C. Appelbaum,3 and Daniel J. Burch4

Department of Pathology (Clinical Microbiology), Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Cleveland, Ohio1; Department of Pediatrics (Pediatric Infectious Disease Unit), Ben-Gurion University of the Negev and Soroka Medical Center, Beer-Sheva, Israel2; and Department of Pathology (Clinical Microbiology), Milton S. Hershey Medical Center, Hershey,3 and Department of Anti-Infectives, SmithKline Beecham Pharmaceuticals, Collegeville,4 Pennsylvania

Received 30 June 1997/Returned for modification 10 December 1997/Accepted 17 December 1997

The management of acute otitis media is complicated by the emergence of resistance to beta -lactam and other antibiotics among common pathogens. We conducted a large, international study of infants and children with acute otitis media to identify pathogens and susceptibility patterns. During the winter of 1994 to 1995, middle ear fluid samples were collected from 917 patients with acute otitis media in Bulgaria, the Czech Republic, Hungary, Romania, Slovakia, Israel, and the United States. A single reference laboratory performed in vitro susceptibility testing. Pathogens were isolated from 62% of the patients. For Streptococcus pneumoniae (30% of the patients), untypeable Haemophilus influenzae (17%), and Moraxella catarrhalis (4%), there was significant variation among geographic regions (P < 0.001). The composite susceptibilities of these three organisms to amoxicillin ranged from 62% in the United States to 89% in Eastern and Central Europe; the corresponding susceptibilities to amoxicillin-clavulanate ranged from 90% in Israel to 95% in Eastern and Central Europe. beta -Lactamase was produced by 31 and 100% of the isolates of H. influenzae and M. catarrhalis, respectively. More isolates of S. pneumoniae were susceptible to amoxicillin (90%) or amoxicillin-clavulanate (90%) than to penicillin (70%; P = 0.002). The prevalence of resistant S. pneumoniae was highest in patients less than 12 months of age. S. pneumoniae, H. influenzae, and M. catarrhalis remain the most important bacterial pathogens in patients with acute otitis media; however, their prevalence is variable and resistance patterns are changing.

* Corresponding author. Mailing address: Department of Pathology, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106. Phone: (216) 844-3484. Fax: (216) 844-5601.

Antimicrobial Agents and Chemotherapy, March 1998, p. 589-595, Vol. 42, No. 3
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


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