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Grant LR, Apodaca K, Deshpande L, Kimbrough JH, Hayford K, Yan Q, Mendes R, Cané A, Gessner BD, Arguedas A. Characterization of Streptococcus pneumoniae isolates obtained from the middle ear fluid of US children, 2011-2021. Front Pediatr 2024; 12:1383748. [PMID: 39077066 PMCID: PMC11284096 DOI: 10.3389/fped.2024.1383748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 06/17/2024] [Indexed: 07/31/2024] Open
Abstract
Introduction Pneumococcal conjugate vaccines (PCVs), including higher valency vaccines such as PCV20, have the potential to reduce pediatric otitis media. We assessed serotype distribution, potential PCV coverage, and antimicrobial susceptibility of Streptococcus pneumoniae isolates cultured from middle ear fluid (MEF) of US children age ≤5 years. Methods S. pneumoniae isolates identified from US hospitals participating in the SENTRY Antimicrobial Surveillance program from 2011 to 2021 were included. Serotypes were determined by in silico analysis based on Pneumococcal Capsular Typing methodology. The percentage of isolates belonging to serotypes included in PCV13 (serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 23F), PCV15 (PCV13 plus 22F, 33F), and PCV20 (PCV13 plus, 8, 10A, 11A, 12F, 15B, 22F and 33F) was calculated. Antimicrobial susceptibility testing was performed by broth microdilution and interpreted using CLSI criteria. Nonsusceptibility was defined as isolates that were intermediate or resistant to a selected antimicrobial. Results Among the 199 S. pneumoniae isolates that were identified, 56.8% were from children age <2 years. Six serotypes accounted for around 60% of isolates: 35B (16.6%), 15B (14.6%), 15A (7.5%), 19A (7.5%), 19F (7.5%), and 3 (7.0%). Serotypes included in PCV13, PCV15, and PCV20 accounted for 23.1%, 30.2%, and 54.8% of isolates, respectively. Overall, 45.2% of isolates were penicillin non-susceptible, and 13.6% were MDR, of which 48% were serotype 19A. Seven serotypes (19A, 15A, 15B, 15C, 23A, 33F, and 35B) accounted for the majority of non-susceptible isolates. Discussion PCVs, particularly PCV20, may prevent a substantial fraction of S. pneumoniae otitis media (OM), including OM due to non-susceptible serotypes. The addition of serotypes 15A, 23A, and 35B would improve coverage against susceptible and non-susceptible pneumococcal OM.
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Affiliation(s)
- Lindsay R. Grant
- Vaccines and Antivirals, Pfizer Inc., Collegeville, PA, United States
| | - Kevin Apodaca
- Vaccines and Antivirals, Pfizer Inc., Collegeville, PA, United States
| | | | | | - Kyla Hayford
- Vaccines and Antivirals, Pfizer Inc., Collegeville, PA, United States
| | - Qi Yan
- Vaccines and Antivirals, Pfizer Inc., Collegeville, PA, United States
| | | | - Alejandro Cané
- Vaccines and Antivirals, Pfizer Inc., Collegeville, PA, United States
| | | | - Adriano Arguedas
- Vaccines and Antivirals, Pfizer Inc., Collegeville, PA, United States
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Liang X, Zhang B, Ding Y, Guan Y, Zhou P, Deng Y, Zeng D, Su R. Clinical observation of Otitis Media Secretory during Covid-19. Otol Neurotol 2024; 45:475-481. [PMID: 38412019 DOI: 10.1097/mao.0000000000004158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
OBJECTIVE This study aims to analyze the onset of otitis media secretory, the peak period of infection with the Omicron strain of SARS-CoV-2 virus, and the time of transmigration during a pandemic of the Omicron strain. Additionally, the study aims to investigate to study the presence of SARS-CoV-2 virus in the middle ear cavity of patients with otitis media secretory and the survival time through a new method for detecting SARS-CoV-2 virus antigen in middle ear effusion. METHODS Retrospective comparison of the incidence of otitis media secretory during infection with SARS-CoV-2 virus Omicron strain from December 15, 2022, to January 15, 2023, versus the noninfection period from December 15, 2021, to January 15, 2022. We used a questionnaire star application to investigate the demographic and epidemiological characteristics of the 40 patients with otitis media secretory who participated in this study were investigated. A novel coronavirus (2019-nCoV) antigen detection kit (colloidal gold method) was used to detect middle ear effusion in patients with otitis media secretory. The data were statistically analyzed using SPSS 29.0 software. The measurement data are expressed as x ± s , the count data are expressed as the number of cases (%), and the data were compared using the χ 2 test. p < 0.05 indicated a statistically significant difference. RESULTS During the SARS-CoV-2 virus Omicron strain pandemic, the incidence of otitis media secretory increased by 15% compared with the noninfection period. The peak infection period for the SARS-CoV-2 virus Omicron strain was December 25, 2022, and December 15, 2022, and the peak time of conversion was 7 to 9 days after the infection. Middle ear effusion SARS-CoV-2 virus antigen testing was performed in patients with otitis media secretory after conversion; 5 patients (12%) were positive, and 35 patients (88%) were negative. The disease duration in patients with negative results was more than 3 weeks. CONCLUSIONS Otitis media secretory is one of the most common ear complications after infection with the Omicron strain of SARS-CoV-2 virus, and the significantly higher incidence is associated with middle ear viral infection. Middle ear effusion SARS-CoV-2 virus antigen test detected the virus, which survived longer in the middle ear effusion than in the nasal cavity. The middle ear effusion test can detect SARS-CoV-2 virus antigen and determine whether the organism contains virus residue.
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Affiliation(s)
- Xiuni Liang
- Division of Otolaryngology, Department of Surgery, Head and Neck Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518000, PR China
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Ricci Conesa H, Skröder H, Norton N, Bencina G, Tsoumani E. Clinical and economic burden of acute otitis media caused by Streptococcus pneumoniae in European children, after widespread use of PCVs-A systematic literature review of published evidence. PLoS One 2024; 19:e0297098. [PMID: 38564583 PMCID: PMC10986968 DOI: 10.1371/journal.pone.0297098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/21/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Acute otitis media (AOM) is a common childhood disease frequently caused by Streptococcus pneumoniae. Pneumococcal conjugate vaccines (PCV7, PCV10, PCV13) can reduce the risk of AOM but may also shift AOM etiology and serotype distribution. The aim of this study was to review estimates from published literature of the burden of AOM in Europe after widespread use of PCVs over the past 10 years, focusing on incidence, etiology, serotype distribution and antibiotic resistance of Streptococcus pneumoniae, and economic burden. METHODS This systematic review included published literature from 31 European countries, for children aged ≤5 years, published after 2011. Searches were conducted using PubMed, Embase, Google, and three disease conference websites. Risk of bias was assessed with ISPOR-AMCP-NPC, ECOBIAS or ROBIS, depending on the type of study. RESULTS In total, 107 relevant records were identified, which revealed wide variation in study methodology and reporting, thus limiting comparisons across outcomes. No homogenous trends were identified in incidence rates across countries, or in detection of S. pneumoniae as a cause of AOM over time. There were indications of a reduction in hospitalization rates (decreases between 24.5-38.8% points, depending on country, PCV type and time since PCV introduction) and antibiotic resistance (decreases between 14-24%, depending on country), following the widespread use of PCVs over time. The last two trends imply a potential decrease in economic burden, though this was not possible to confirm with the identified cost data. There was also evidence of an increase in serotype distributions towards non-vaccine serotypes in all of the countries where non-PCV serotype data were available, as well as limited data of increased antibiotic resistance within non-vaccine serotypes. CONCLUSIONS Though some factors point to a reduction in AOM burden in Europe, the burden still remains high, residual burden from uncovered serotypes is present and it is difficult to provide comprehensive, accurate and up-to-date estimates of said burden from the published literature. This could be improved by standardised methodology, reporting and wider use of surveillance systems.
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Affiliation(s)
| | | | | | - Goran Bencina
- Center for Observational and Real-World Evidence, MSD, Madrid, Spain
| | - Eleana Tsoumani
- Center for Observational and Real-World Evidence, MSD, Athens, Greece
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Frost HM, Keith A, Fletcher DR, Sebastian T, Dominguez SR, Kurtz M, Parker SK, Wilson ML, Jenkins TC. Clinical Outcomes Associated with Amoxicillin Treatment for Acute Otitis Media in Children. J Pediatric Infect Dis Soc 2024; 13:203-210. [PMID: 38314853 DOI: 10.1093/jpids/piae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/04/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Acute otitis media (AOM) is the most common reason children are prescribed antibiotics. Bacteria that produce beta-lactamase are an increasingly frequent cause of AOM and may be resistant to amoxicillin, the currently recommended treatment for AOM. We aimed to evaluate the clinical outcomes of children treated with amoxicillin for AOM and assessed whether outcomes vary by infecting pathogen or beta-lactamase production. METHODS 205 children 6-35 months old diagnosed with AOM and prescribed amoxicillin were included. Bacterial culture and qualitative multiplex real-time polymerase chain reaction were performed on nasopharyngeal swabs collected at enrollment. Parents completed surveys assessing symptoms, antibiotic adherence, and potential adverse events. The primary outcome was treatment failure with amoxicillin. Secondary outcomes included recurrence, symptom improvement, resolution, and adverse drug events (ADE). RESULTS 8 children (5.4%) experienced treatment failure and 14 (6.8%) had recurrence. By day 5, 152 (74.1%) children had symptom improvement and 97 (47.3%) had resolution. Parents reported ADE for 56 (27.3%) children. Among 149 children who did not take any amoxicillin before enrollment, 98 (65.8%) had one or more beta-lactamase-producing bacteria. Common bacterial otopathogens were Moraxella catarrhalis (79, 53.0%), Streptococcus pneumoniae (51, 34.2%), Haemophilus influenzae (30, 20.1%), and Staphylococcus aureus (21, 14.1%). Treatment failure did not differ between children that did (5, 5.1%) and did not (3, 5.9%) have beta-lactamase-producing otopathogens (p = .05). CONCLUSIONS Among children diagnosed with AOM treated with amoxicillin, treatment failure was uncommon and did not differ by pathogen or beta-lactamase production. These data support guidance recommending amoxicillin despite an increasing prevalence of beta-lactamase-producing bacteria.
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Affiliation(s)
- Holly M Frost
- Department of Pediatrics, Denver Health and Hospital Authority, Denver, CO, USA
- Center for Health Systems Research, Denver Health and Hospital Authority, Denver, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amy Keith
- Center for Health Systems Research, Denver Health and Hospital Authority, Denver, CO, USA
| | | | - Thresia Sebastian
- Department of Pediatrics, Denver Health and Hospital Authority, Denver, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Pediatrics, Alameda Health System, Oakland, CA, USA
| | - Samuel R Dominguez
- Department of Pediatric Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Pediatric Infectious Diseases, Children's Hospital Colorado, Aurora, CO, USA
| | - Melanie Kurtz
- Center for Health Systems Research, Denver Health and Hospital Authority, Denver, CO, USA
| | - Sarah K Parker
- Department of Pediatric Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Pediatric Infectious Diseases, Children's Hospital Colorado, Aurora, CO, USA
| | - Michael L Wilson
- Department of Pathology and Laboratory Services, Denver Health and Hospital Authority, Denver, CO, USA
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Timothy C Jenkins
- Division of Infectious Diseases, Department of Medicine, Denver Health and Hospital Authority, Denver, CO, USA
- Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Fu X, Wang Z, Chen B, Sun H, Lyu J, Shao J, Lu X, Xu J, Yang J, Chi F, Huang Y, Ren D. Detection of SARS-CoV-2 virus in middle ear effusions and its association with otitis media with effusion. J Med Virol 2024; 96:e29545. [PMID: 38506248 DOI: 10.1002/jmv.29545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 03/21/2024]
Abstract
A large-scale outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) occurred in Shanghai, China, in early December 2022. To study the incidence and characteristics of otitis media with effusion (OME) complicating SARS-CoV-2, we collected 267 middle ear effusion (MEE) samples and 172 nasopharyngeal (NP) swabs from patients. The SARS-CoV-2 virus was detected by RT-PCR targeting. The SARS-CoV-2 virus, angiotensin-converting enzyme 2 (ACE2), and transmembrane serine protease 2 (TMPRSS2) expression in human samples was examined via immunofluorescence. During the COVID-19 epidemic in 2022, the incidence of OME (3%) significantly increased compared to the same period from 2020 to 2022. Ear symptoms in patients with SARS-CoV-2 complicated by OME generally appeared late, even after a negative NP swab, an average of 9.33 ± 6.272 days after COVID-19 infection. The SARS-CoV-2 virus was detected in MEE, which had a higher viral load than NP swabs. The insertion rate of tympanostomy tubes was not significantly higher than in OME patients in 2019-2022. Virus migration led to high viral loads in MEE despite negative NP swabs, indicating that OME lagged behind respiratory infections but had a favorable prognosis. Furthermore, middle ear tissue from adult humans coexpressed the ACE2 receptor for the SARS-CoV-2 virus and the TMPRSS2 cofactors required for virus entry.
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Affiliation(s)
- Xiao Fu
- Department of Otology and Skull Base Surgery, EYE and ENT Hospital of Fudan University, Shanghai, China
- Shanghai clinical medical center of hearing medicine, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Shanghai, China
| | - Zhujian Wang
- Department of Laboratory Medicine, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Binjun Chen
- Department of Otology and Skull Base Surgery, EYE and ENT Hospital of Fudan University, Shanghai, China
- Shanghai clinical medical center of hearing medicine, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Shanghai, China
| | - Haojie Sun
- Department of Otology and Skull Base Surgery, EYE and ENT Hospital of Fudan University, Shanghai, China
- Shanghai clinical medical center of hearing medicine, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Shanghai, China
| | - Jihan Lyu
- Department of Otology and Skull Base Surgery, EYE and ENT Hospital of Fudan University, Shanghai, China
- Shanghai clinical medical center of hearing medicine, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Shanghai, China
| | - Jing Shao
- Department of nursing, EYE and ENT Hospital of Fudan University, Shanghai, China
| | - Xiaoling Lu
- Department of Otology and Skull Base Surgery, EYE and ENT Hospital of Fudan University, Shanghai, China
- Shanghai clinical medical center of hearing medicine, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Shanghai, China
| | - Jianghong Xu
- Department of Otology and Skull Base Surgery, EYE and ENT Hospital of Fudan University, Shanghai, China
- Shanghai clinical medical center of hearing medicine, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Shanghai, China
| | - Juanmei Yang
- Department of Otology and Skull Base Surgery, EYE and ENT Hospital of Fudan University, Shanghai, China
- Shanghai clinical medical center of hearing medicine, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Shanghai, China
| | - Fanglu Chi
- Department of Otology and Skull Base Surgery, EYE and ENT Hospital of Fudan University, Shanghai, China
- Shanghai clinical medical center of hearing medicine, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Shanghai, China
| | - Yibo Huang
- Department of Otology and Skull Base Surgery, EYE and ENT Hospital of Fudan University, Shanghai, China
- Shanghai clinical medical center of hearing medicine, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Shanghai, China
| | - Dongdong Ren
- Department of Otology and Skull Base Surgery, EYE and ENT Hospital of Fudan University, Shanghai, China
- Shanghai clinical medical center of hearing medicine, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Shanghai, China
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Zahid A, Wilson JC, Grice ID, Peak IR. Otitis media: recent advances in otitis media vaccine development and model systems. Front Microbiol 2024; 15:1345027. [PMID: 38328427 PMCID: PMC10847372 DOI: 10.3389/fmicb.2024.1345027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
Otitis media is an inflammatory disorder of the middle ear caused by airways-associated bacterial or viral infections. It is one of the most common childhood infections as globally more than 80% of children are diagnosed with acute otitis media by 3 years of age and it is a common reason for doctor's visits, antibiotics prescriptions, and surgery among children. Otitis media is a multifactorial disease with various genetic, immunologic, infectious, and environmental factors predisposing children to develop ear infections. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common culprits responsible for acute otitis media. Despite the massive global disease burden, the pathogenesis of otitis media is still unclear and requires extensive future research. Antibiotics are the preferred treatment to cure middle ear infections, however, the antimicrobial resistance rate of common middle ear pathogens has increased considerably over the years. At present, pneumococcal and influenza vaccines are administered as a preventive measure against otitis media, nevertheless, these vaccines are only beneficial in preventing carriage and/or disease caused by vaccine serotypes. Otitis media caused by non-vaccine serotype pneumococci, non-typeable H. influenza, and M. catarrhalis remain an important healthcare burden. The development of multi-species vaccines is an arduous process but is required to reduce the global burden of this disease. Many novel vaccines against S. pneumoniae, non-typeable H. influenza, and M. catarrhalis are in preclinical trials. It is anticipated that these vaccines will lower the disease burden and provide better protection against otitis media. To study disease pathology the rat, mouse, and chinchilla are commonly used to induce experimental acute otitis media to test new therapeutics, including antibiotics and vaccines. Each of these models has its advantages and disadvantages, yet there is still a need to develop an improved animal model providing a better correlated mechanistic understanding of human middle ear infections, thereby underpinning the development of more effective otitis media therapeutics. This review provides an updated summary of current vaccines against otitis media, various animal models of otitis media, their limitations, and some future insights in this field providing a springboard in the development of new animal models and novel vaccines for otitis media.
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Affiliation(s)
- Ayesha Zahid
- Institute for Glycomics, Griffith University, Gold Coast, QLD, Australia
| | - Jennifer C. Wilson
- School of Pharmacy and Medical Science, Griffith University, Gold Coast, QLD, Australia
| | - I. Darren Grice
- Institute for Glycomics, Griffith University, Gold Coast, QLD, Australia
- School of Pharmacy and Medical Science, Griffith University, Gold Coast, QLD, Australia
| | - Ian R. Peak
- Institute for Glycomics, Griffith University, Gold Coast, QLD, Australia
- School of Pharmacy and Medical Science, Griffith University, Gold Coast, QLD, Australia
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Conway IO, Kurs-Lasky M, Shaikh N. Moraxella Catarrhalis Infrequently Cultured from Middle Ear Fluid of Children with Acute Otitis Media. Pediatr Infect Dis J 2023; 42:e416-e417. [PMID: 37406212 PMCID: PMC10592497 DOI: 10.1097/inf.0000000000004028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
We compared the distribution of organisms in the nasopharynx and the middle ear fluid in 164 episodes of acute otitis media in children 6-35 months of age. In contrast to Streptococcus pneumoniae and Haemophilus influenzae , Moraxella catarrhalis is isolated from the middle ear in only 11% of episodes with nasopharyngeal colonization with this organism.
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Affiliation(s)
- Isabella O Conway
- From the Division of General Academic Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
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Frost HM, Jenkins TC, Sebastian T, Parker SK, Keith A, Kurtz M, Fletcher DR, Wilson ML, Dominguez SR. Reliability of nasopharyngeal PCR for the detection of otopathogens in children with uncomplicated acute otitis media compared to culture. Diagn Microbiol Infect Dis 2023; 107:116040. [PMID: 37549633 PMCID: PMC10529968 DOI: 10.1016/j.diagmicrobio.2023.116040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/17/2023] [Accepted: 07/22/2023] [Indexed: 08/09/2023]
Abstract
Otopathogens in acute otitis media (AOM) have implications for care because the likelihood of resolution without antibiotics and optimal antibiotic agent varies by microorganism. We aimed to determine the sensitivity, specificity, positive predictive value, and negative predictive value of nasopharyngeal (NP) qualitative polymerase chain reaction (PCR) for common bacterial otopathogens in children with AOM compared to NP culture. NP flocked swabs collected from enrolled children aged 6 to 35 months with uncomplicated AOM in Denver, CO were tested by culture and multiplex PCR. The sensitivity and negative predictive value of PCR using culture as a reference were high (H. influenzae 93.3%, 98.0%; S. pneumoniae 94.2%, 95.1%; M. catarrhalis 92.3%, 86.4%); whereas the specificity and positive predictive value were lower and varied by organism (54.2%-84.1%, 55.1%-69.2%, respectively). PCR detected 1.5 times more organisms than culture. NP PCR has a high predictive value for excluding otopathogens compared to culture and warrants exploration as a diagnostic tool.
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Affiliation(s)
- Holly M Frost
- Department of Pediatrics, Denver Health and Hospital Authority, Denver, CO, USA; Center for Health Systems Research, Denver Health and Hospital Authority, Denver, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Timothy C Jenkins
- Division of Infectious Diseases, Department of Medicine, Denver Health and Hospital Authority, Denver, CO, USA; Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Thresia Sebastian
- Department of Pediatrics, Denver Health and Hospital Authority, Denver, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA; Department of Pediatrics, Alameda Health System, Oakland, CA, USA
| | - Sarah K Parker
- Department of Pediatric Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA; Department of Pediatric Infectious Diseases, Children's Hospital Colorado, Aurora, CO, USA
| | - Amy Keith
- Center for Health Systems Research, Denver Health and Hospital Authority, Denver, CO, USA
| | - Melanie Kurtz
- Center for Health Systems Research, Denver Health and Hospital Authority, Denver, CO, USA
| | | | - Michael L Wilson
- Department of Pathology and Laboratory Services, Denver Health and Hospital Authority, Denver, CO, USA; Department of Pathology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Samuel R Dominguez
- Department of Pediatric Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA; Department of Pediatric Infectious Diseases, Children's Hospital Colorado, Aurora, CO, USA
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Lobb B, Lee MC, McElheny CL, Doi Y, Yahner K, Hoberman A, Martin JM, Hirota JA, Doxey AC, Shaikh N. Genomic classification and antimicrobial resistance profiling of Streptococcus pneumoniae and Haemophilus influenza isolates associated with paediatric otitis media and upper respiratory infection. BMC Infect Dis 2023; 23:596. [PMID: 37700242 PMCID: PMC10498559 DOI: 10.1186/s12879-023-08560-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023] Open
Abstract
Acute otitis media (AOM) is the most common childhood bacterial infectious disease requiring antimicrobial therapy. Most cases of AOM are caused by translocation of Streptococcus pneumoniae or Haemophilus influenzae from the nasopharynx to the middle ear during an upper respiratory tract infection (URI). Ongoing genomic surveillance of these pathogens is important for vaccine design and tracking of emerging variants, as well as for monitoring patterns of antibiotic resistance to inform treatment strategies and stewardship.In this work, we examined the ability of a genomics-based workflow to determine microbiological and clinically relevant information from cultured bacterial isolates obtained from patients with AOM or an URI. We performed whole genome sequencing (WGS) and analysis of 148 bacterial isolates cultured from the nasopharynx (N = 124, 94 AOM and 30 URI) and ear (N = 24, all AOM) of 101 children aged 6-35 months presenting with AOM or an URI. We then performed WGS-based sequence typing and antimicrobial resistance profiling of each strain and compared results to those obtained from traditional microbiological phenotyping.WGS of clinical isolates resulted in 71 S. pneumoniae genomes and 76 H. influenzae genomes. Multilocus sequencing typing (MSLT) identified 33 sequence types for S. pneumoniae and 19 predicted serotypes including the most frequent serotypes 35B and 3. Genome analysis predicted 30% of S. pneumoniae isolates to have complete or intermediate penicillin resistance. AMR predictions for S. pneumoniae isolates had strong agreement with clinical susceptibility testing results for beta-lactam and non beta-lactam antibiotics, with a mean sensitivity of 93% (86-100%) and a mean specificity of 98% (94-100%). MLST identified 29 H. influenzae sequence types. Genome analysis identified beta-lactamase genes in 30% of H. influenzae strains, which was 100% in agreement with clinical beta-lactamase testing. We also identified a divergent highly antibiotic-resistant strain of S. pneumoniae, and found its closest sequenced strains, also isolated from nasopharyngeal samples from over 15 years ago.Ultimately, our work provides the groundwork for clinical WGS-based workflows to aid in detection and analysis of H. influenzae and S. pneumoniae isolates.
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Affiliation(s)
- Briallen Lobb
- Department of Biology and Waterloo Centre for Microbial Research, University of Waterloo, Waterloo, ON, Canada
| | - Matthew C Lee
- University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC, Division of General Academic Pediatrics, Pittsburgh, USA
| | - Christi L McElheny
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Yohei Doi
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kristin Yahner
- University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC, Division of General Academic Pediatrics, Pittsburgh, USA
| | - Alejandro Hoberman
- University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC, Division of General Academic Pediatrics, Pittsburgh, USA
| | - Judith M Martin
- University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC, Division of General Academic Pediatrics, Pittsburgh, USA
| | - Jeremy A Hirota
- Department of Biology and Waterloo Centre for Microbial Research, University of Waterloo, Waterloo, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Firestone Institute for Respiratory Health, St. Joseph's Hospital, Hamilton, ON, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andrew C Doxey
- Department of Biology and Waterloo Centre for Microbial Research, University of Waterloo, Waterloo, ON, Canada.
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - Nader Shaikh
- University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC, Division of General Academic Pediatrics, Pittsburgh, USA.
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Levy C, Varon E, Bidet P, Béchet S, Batard C, Wollner A, Thollot F, Bonacorsi S, Cohen R. Otorrhea bacterial profile, epidemiology before widespread use of the third-generation pneumococcal conjugate vaccine in French children, a prospective study from 2015 to 2023. Infect Dis Now 2023; 53:104738. [PMID: 37331698 DOI: 10.1016/j.idnow.2023.104738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/30/2023] [Accepted: 06/10/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVES The aim of this study was to describe the bacterial profile of middle ear fluid from spontaneous perforation of the tympanic membrane (SPTM) prior to widespread utilization of third- generation pneumococcal conjugate vaccines (PCVs). PATIENTS AND METHODS From October 2015 to January 2023, children with SPTM were prospectively enrolled by pediatricians. RESULTS Among the 852 children with SPTM, 73.2% were less than 3 years old; more frequently than older children, they were and suffering from complex acute otitis media (AOM) (27.9%) and conjunctivitis (13.1%). In children under 3 years of age, NT Haemophilus influenzae (49.7%) was the main otopathogen isolated, particularly in those with complex AOM (57.1%). In children over 3 years of age, Group A Streptococcus accounted for 57%. In pneumococcal cases (25.1%), serotype 3 was the main serotype isolated (16.2%), followed by 23B (15.2%). CONCLUSION Our data from 2015 to 2023 represent a robust baseline preceding the widespread utilization of next-generation PCVs.
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Affiliation(s)
- Corinne Levy
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France; Université Paris Est, IMRB-GRC GEMINI, Créteil, France; AFPA, Association Française de Pédiatrie Ambulatoire, Orléans, France.
| | - Emmanuelle Varon
- Service de microbiologie, Hôpital Intercommunal de Créteil, Créteil, France
| | - Philippe Bidet
- Université Paris Cité, IAME, INSERM, F-75018 Paris, France; Service de microbiologie, Hôpital Robert-Debré, AP-HP, Paris, France
| | - Stéphane Béchet
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; AFPA, Association Française de Pédiatrie Ambulatoire, Orléans, France
| | - Christophe Batard
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; AFPA, Association Française de Pédiatrie Ambulatoire, Orléans, France
| | - Alain Wollner
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; AFPA, Association Française de Pédiatrie Ambulatoire, Orléans, France
| | - Franck Thollot
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; AFPA, Association Française de Pédiatrie Ambulatoire, Orléans, France
| | - Stéphane Bonacorsi
- Université Paris Cité, IAME, INSERM, F-75018 Paris, France; Service de microbiologie, Hôpital Robert-Debré, AP-HP, Paris, France
| | - Robert Cohen
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France; Université Paris Est, IMRB-GRC GEMINI, Créteil, France; AFPA, Association Française de Pédiatrie Ambulatoire, Orléans, France
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Shaikh N, Hoberman A, Paradise JL, Rockette HE, Kurs-Lasky M, Martin JM. Association Between Nasopharyngeal Colonization and Clinical Outcome in Children With Acute Otitis Media. Pediatr Infect Dis J 2023; 42:e274-e277. [PMID: 37171965 PMCID: PMC10523893 DOI: 10.1097/inf.0000000000003956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Young children with acute otitis media (AOM) frequently exhibit nasopharyngeal colonization with either Streptococcus pneumoniae, Haemophilus influenzae or both pathogens. We aimed to determine if antibiotics could be spared or shortened in those without nasopharyngeal colonization with either pathogen. METHODS In 2 separate randomized clinical trials in children aged 6-23 months with stringently-diagnosed AOM, we performed bacterial cultures on nasopharyngeal specimens collected at the time of diagnosis. In the first trial, we compared the efficacy of amoxicillin/clavulanate (amox/clav) administered for 10 days vs. that of placebo, and in the second trial, we compared the efficacy of amox/clav administered for 10 days vs. 5 days. In each trial, we classified children as being colonized with both S. pneumoniae and H. influenzae, S. pneumoniae alone, H. influenzae alone, or neither pathogen, and as experiencing either clinical success or clinical failure at the end-of-therapy visit, based on previously reported a priori criteria. RESULTS We evaluated 796 children. Among children randomized to amox/clav, those colonized with either S. pneumoniae or H. influenzae or both were approximately twice as likely to experience clinical failure as children not colonized with either pathogen (odds ratio: 1.8; confidence intervals: 1.2-2.9). In contrast, among children randomized to placebo, clinical failure at the end-of-therapy visit was not associated with nasopharyngeal culture results at the time of diagnosis. CONCLUSIONS Children colonized with either S. pneumoniae or H. influenzae or both have a greater chance of treatment failure than children colonized with neither pathogen.
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Affiliation(s)
- Nader Shaikh
- Department of Pediatrics, University of Pittsburgh School of Medicine and Children’s Hospital of Pittsburgh of UPMC, Divisions of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alejandro Hoberman
- Department of Pediatrics, University of Pittsburgh School of Medicine and Children’s Hospital of Pittsburgh of UPMC, Divisions of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jack L. Paradise
- Department of Pediatrics, University of Pittsburgh School of Medicine and Children’s Hospital of Pittsburgh of UPMC, Divisions of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Howard E. Rockette
- Department of Biostatistics, Graduate School of Public Heath, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marcia Kurs-Lasky
- Department of Pediatrics, University of Pittsburgh School of Medicine and Children’s Hospital of Pittsburgh of UPMC, Divisions of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Judith M. Martin
- Department of Pediatrics, University of Pittsburgh School of Medicine and Children’s Hospital of Pittsburgh of UPMC, Divisions of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
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12
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El Feghaly RE, Nedved A, Katz SE, Frost HM. New insights into the treatment of acute otitis media. Expert Rev Anti Infect Ther 2023; 21:523-534. [PMID: 37097281 PMCID: PMC10231305 DOI: 10.1080/14787210.2023.2206565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/20/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION Acute otitis media (AOM) affects most (80%) children by 5 years of age and is the most common reason children are prescribed antibiotics. The epidemiology of AOM has changed considerably since the widespread use of pneumococcal conjugate vaccines, which has broad-reaching implications for management. AREAS COVERED In this narrative review, we cover the epidemiology of AOM, best practices for diagnosis and management, new diagnostic technology, effective stewardship interventions, and future directions of the field. Literature review was performed using PubMed and ClinicalTrials.gov. EXPERT OPINION Inaccurate diagnoses, unnecessary antibiotic use, and increasing antimicrobial resistance remain major challenges in AOM management. Fortunately, effective tools and interventions to improve diagnostic accuracy, de-implement unnecessary antibiotic use, and individualize care are on the horizon. Successful scaling of these tools and interventions will be critical to improving overall care for children.
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Affiliation(s)
- Rana E. El Feghaly
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Amanda Nedved
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Sophie E. Katz
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Holly M. Frost
- Department of Pediatrics, Denver Health and Hospital Authority, Denver, CO, USA
- Center for Health Systems Research, Denver Health and Hospital Authority, Denver, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
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13
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Sebastian T, Toseef MU, Kurtz M, Frost HM. Nasopharyngeal rapid diagnostic testing to reduce unnecessary antibiotic use and individualize management of acute otitis media. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e49. [PMID: 36970427 PMCID: PMC10031585 DOI: 10.1017/ash.2023.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 03/17/2023]
Abstract
Background Acute otitis media (AOM) is the most common indication for antibiotics in children. The associated organism can influence the likelihood of antibiotic benefit and optimal treatment. Nasopharyngeal polymerase chain reaction can effectively exclude the presence of organisms in middle-ear fluid. We explored the potential cost-effectiveness and reduction in antibiotics with nasopharyngeal rapid diagnostic testing (RDT) to direct AOM management. Methods We developed 2 algorithms for AOM management based on nasopharyngeal bacterial otopathogens. The algorithms provide recommendations on prescribing strategy (ie, immediate, delayed, or observation) and antimicrobial agent. The primary outcome was the incremental cost-effectiveness ratio (ICER) expressed as cost per quality-adjusted life day (QALD) gained. We used a decision-analytic model to evaluate the cost-effectiveness of the RDT algorithms compared to usual care from a societal perspective and the potential reduction in annual antibiotics used. Results An RDT algorithm that used immediate prescribing, delayed prescribing, and observation based on pathogen (RDT-DP) had an ICER of $1,336.15 per QALD compared with usual care. At an RDT cost of $278.56, the ICER for RDT-DP exceeded the willingness to pay threshold; however, if the RDT cost was <$212.10, the ICER was below the threshold. The use of RDT was estimated to reduced annual antibiotic use, including broad-spectrum antimicrobial use, by 55.7% ($4.7 million for RDT vs $10.5 million for usual care). Conclusion The use of a nasopharyngeal RDT for AOM could be cost-effective and substantially reduce unnecessary antibiotic use. These iterative algorithms could be modified to guide management of AOM as pathogen epidemiology and resistance evolve.
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Affiliation(s)
- Thresia Sebastian
- Department of Pediatrics, Denver Health and Hospital Authority, Denver, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
- Department of Pediatrics, Alameda Health Systems, Oakland, California
| | - Mohammad Usama Toseef
- Public Health Institute at Denver Health, Denver, Colorado
- Beaumont Research Institute, Beaumont Health, Royal Oak, Michigan
| | - Melanie Kurtz
- Center for Health Systems Research, Denver Health and Hospital Authority, Denver, Colorado
| | - Holly M. Frost
- Department of Pediatrics, Denver Health and Hospital Authority, Denver, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
- Center for Health Systems Research, Denver Health and Hospital Authority, Denver, Colorado
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14
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Pichichero M, Malley R, Kaur R, Zagursky R, Anderson P. Acute otitis media pneumococcal disease burden and nasopharyngeal colonization in children due to serotypes included and not included in current and new pneumococcal conjugate vaccines. Expert Rev Vaccines 2023; 22:118-138. [PMID: 36565291 DOI: 10.1080/14760584.2023.2162506] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Despite the introduction of effective pneumococcal conjugate vaccines (PCV), Streptococcus pneumoniae remains a major cause of acute otitis media (AOM) worldwide. New, higher valency vaccines that offer broader serotype coverage have been recently developed and others are in development. However, given the capsular serotypes expressed by pneumococci causing AOM, it is unclear to what extent differing or higher valency PCVs will provide additional protection. AREAS COVERED We conducted a systematic literature search of the MEDLINE database to identify articles published from January 2016 to September 2021 in 4 low and middle income and 10 high-income countries. We searched PubMed with terms: (Streptococcus pneumoniae) OR pneumococcal AND serotype AND (conjugate vaccine). We evaluated serotype distribution and the actual or projected coverage of pneumococcal serotypes by PCV10 (GlaxoSmithKline), PCV13 (Pfizer), PCV10SII (Serum Institute of India) PCV15 (Merck) and PCV20 (Pfizer). EXPERT OPINION Our review highlights the important epidemiological differences in serotype distribution and coverage by existing and higher valency vaccines to protect against AOM in children. These data provide support for further evaluation of serotype-independent vaccines for optimal control of pneumococcal AOM disease worldwide.
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Affiliation(s)
- Michael Pichichero
- Rochester General Hospital Research Institute, Center for Infectious Diseases, Rochester, NY, USA
| | - Richard Malley
- Boston Children's Hospital, Division of Infectious Diseases, Boston Massachusetts, USA
| | - Ravinder Kaur
- Rochester General Hospital Research Institute, Center for Infectious Diseases, Rochester, NY, USA
| | - Robert Zagursky
- Rochester General Hospital Research Institute, Center for Infectious Diseases, Rochester, NY, USA
| | - Porter Anderson
- Boston Children's Hospital, Division of Infectious Diseases, Boston Massachusetts, USA
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15
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Safari D, Wahyono DJ, Tafroji W, Darmawan AB, Winarti Y, Kusdaryanto WD, Paramaiswari WT, Pramono H, Pratiwi M, Chamadi MR. Serotype Distribution and Antimicrobial Resistance Profile of Haemophilus influenzae Isolated from School Children with Acute Otitis Media. Int J Microbiol 2022; 2022:5391291. [PMID: 35655653 PMCID: PMC9152372 DOI: 10.1155/2022/5391291] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 11/02/2021] [Accepted: 05/06/2022] [Indexed: 11/17/2022] Open
Abstract
Haemophilus influenzae is a Gram-negative opportunistic bacterial pathogen of the human respiratory tract. This study describes the prevalence, serotype distribution, and susceptibility profiles of H. influenzae strains isolated from the nasopharynx of school children with acute otitis media (AOM) in Banyumas Regency, Central Java, Indonesia. H. influenzae was isolated from nasopharyngeal swab specimens using chocolate agar plates supplemented with IsoVitaleX and bacitracin. Serotyping was performed using quantitative polymerase chain reaction. Antimicrobial susceptibility profiles were determined using a microdilution broth assay. H. influenzae was present in 69.7% of samples (85/122). Nontypeable H. influenzae (NHTi) was the most common serotype (95.3%), followed by H. influenzae type b (3.5%) and H. influenzae type f (1.2%). All the H. influenzae isolates were susceptible to levofloxacin, ceftriaxone, imipenem, meropenem, cefuroxime, and cefixime. Most isolates were susceptible to sparfloxacin (99%), cefepime (99%), amoxicillin/clavulanic acid 2 : 1 (99%), ampicillin/sulbactam 2 : 1 (96%), chloramphenicol (94%), tetracycline (93%), ampicillin (87%), and clarithromycin (82%). Nineteen percent of the isolates were resistant to cotrimoxazole, and 11% of the isolates were resistant to ampicillin. This study showed that H. influenzae carriage among samples was dominated by NTHi and less susceptible to cotrimoxazole.
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Affiliation(s)
- Dodi Safari
- Eijkman Institute for Molecular Biology/Pusat Riset Biologi Molekuler Eijkman, Cibinong, West Java, Indonesia
| | | | - Wisnu Tafroji
- Eijkman Institute for Molecular Biology/Pusat Riset Biologi Molekuler Eijkman, Cibinong, West Java, Indonesia
| | - Anton Budhi Darmawan
- Department of Otorhinolaryngology, Head and Neck Surgery, Jenderal Soedirman University, Purwokerto, Indonesia
| | - Yayah Winarti
- Eijkman Institute for Molecular Biology/Pusat Riset Biologi Molekuler Eijkman, Cibinong, West Java, Indonesia
| | - Wahyu Dwi Kusdaryanto
- Department of Otorhinolaryngology, Head and Neck Surgery, Jenderal Soedirman University, Purwokerto, Indonesia
| | | | | | - Meyta Pratiwi
- Jenderal Soedirman University, Purwokerto, Indonesia
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16
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Frost HM, Sebastian T, Keith A, Kurtz M, Dominguez SR, Parker SK, Jenkins TC. COVID-19 and Acute Otitis Media in Children: A Case Series. J Prim Care Community Health 2022; 13:21501319221082351. [PMID: 35289210 PMCID: PMC8928385 DOI: 10.1177/21501319221082351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: The association of SARS-CoV-2 with acute otitis media (AOM) in children is poorly understood. Methods: Cases were identified as a subpopulation within the NO TEARS prospective AOM study in Denver, CO from March to December 2020. Children enrolled were 6 to 35 months of age with uncomplicated AOM; those with AOM and SARS-CoV-2 were included. Data was obtained from electronic medical records and research case report forms. Results: A total of 108 patients enrolled in the NO TEARS study from May 2019 through December 2020 (all subsequently tested for SARS CoV-2). During the COVID-19 pandemic study period (March-December 2020), 16 patients enrolled, and 7 (43.6%) were identified with AOM/COVID-19 co-infection. Fever was present in 3 of 7 children (29%). Four children (57%) attended daycare. Only 2 children (29%) had SARS CoV-2 testing as part of their clinical workup. Mean AOM-SOS© scores were similar among SARS CoV-2 positive and negative patients with no statistical significance with two-sided t-tests: 13.6 (±4.5) versus 14.2 (±4.9) at enrollment, 1.4 (±1.8) versus 4.2 (±4.9) on Day 5, and 0.6 (±0.9) versus 2.5 (±6.1) on Day 14. Among the 7 cases, no child had an AOM treatment failure or recurrence within 3 to 14 or 15 to 30 days respectively. Of the 6 patients with completed bacterial and viral testing, a bacterial pathogen was identified in all 6, and a viral pathogen in 3 (50%). Conclusions: COVID-19 and AOM can co-exist. Providers should maintain a high index of suspicion for COVID-19 even in patients with clinical AOM and should not use a diagnosis of AOM to exclude COVID-19.
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Affiliation(s)
- Holly M Frost
- Denver Health and Hospital Authority, Denver, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA
| | - Thresia Sebastian
- Denver Health and Hospital Authority, Denver, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA
| | - Amy Keith
- Denver Health and Hospital Authority, Denver, CO, USA
| | - Melanie Kurtz
- Denver Health and Hospital Authority, Denver, CO, USA
| | - Samuel R Dominguez
- University of Colorado School of Medicine, Aurora, CO, USA.,Children's Hospital Colorado, Aurora, CO, USA
| | - Sarah K Parker
- University of Colorado School of Medicine, Aurora, CO, USA.,Children's Hospital Colorado, Aurora, CO, USA
| | - Timothy C Jenkins
- Denver Health and Hospital Authority, Denver, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA
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17
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Jinhage M, Hermansson A, Gisselsson-Solén M. Nasopharyngeal cultures in children with AOM - A retrospective study on bacteriological findings and impact on management. Int J Pediatr Otorhinolaryngol 2021; 149:110848. [PMID: 34304116 DOI: 10.1016/j.ijporl.2021.110848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 06/09/2021] [Accepted: 07/18/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite a far from perfect correlation with middle ear growth, nasopharyngeal cultures are sometimes used in children with acute otitis media (AOM) in order to have some idea of the causative pathogen. How these cultures are used in clinical practice and to what extent they influence clinical management has not previously been studied. The objective with this study was to investigate in what circumstances nasopharyngeal cultures are performed in children with AOM, what the bacteriological results are and to what extent cultures influence clinical management. METHODS All nasopharyngeal cultures taken in clinical practice from children with AOM in the county of Skåne, Sweden, during 2017-2018 were retrieved together with details from the medical charts two months prior to and one month after the culture. Information about the reason for culturing, the bacteriological result, and whether this result changed the management of the child, was retrieved from the charts. RESULTS During the 2 years, 978 nasopharyngeal cultures were taken in children with AOM. The most common reasons for obtaining a culture was a recurrence of AOM (40%) or treatment failure (22%). Many of the children had ongoing or recent antibiotic treatment. M. catarrhalis was the most commonly identified pathogen (53%), followed by H. influenzae (30%) and S. pneumoniae (14%). Resistance rates were low, and the most commonly identified resistant pathogen was betalactamase-negative ampicillin-resistant H. influenzae. One in five cultures led to a change in management, such as a change of antibiotics or an additional check-up. This was most commonly seen in association with H. influenzae, reflecting clinical practice in Sweden, where AOM is primarily treated with penicillin V. CONCLUSION Despite not having a perfect correlation with middle ear growth, nasopharyngeal cultures can provide clues about suitable alternative antibiotics in cases of treatment failure, and they can help monitoring nasopharyngeal carriage and resistance rates.
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Affiliation(s)
- Malin Jinhage
- Skåne University Hospital, Sweden; Department of Otorhinolaryngology, Head and Neck Surgery, Lund University Hospital, 22185, Lund, Sweden.
| | - Ann Hermansson
- Department of Otorhinolaryngology, Head and Neck Surgery, Lund University Hospital, 22185, Lund, Sweden
| | - Marie Gisselsson-Solén
- Department of Otorhinolaryngology, Head and Neck Surgery, Lund University Hospital, 22185, Lund, Sweden
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18
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Fuji N, Pichichero M, Kaur R. Haemophilus influenzae Prevalence, Proportion of Capsulated Strains and Antibiotic Susceptibility During Colonization and Acute Otitis Media in Children, 2019-2020. Pediatr Infect Dis J 2021; 40:792-796. [PMID: 34321442 DOI: 10.1097/inf.0000000000003171] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The objective of this study was to determine the prevalence, proportion of encapsulated strains and antibiotic susceptibility of Haemophilus influenzae isolated from young children. METHODS Children, 6 months to 30 months old, were prospectively enrolled from September 2019 to September 2020 at Rochester, NY, pediatric clinics. H. influenzae isolates from nasopharynx (NP) at healthy visits and disease isolates from NP and middle ear fluid (MEF) at onset of acute otitis media (AOM) were characterized by capsular typing, β-lactamase production and antibiotic susceptibility. RESULTS Samples from 565 healthy visits and 130 AOM visits were collected. H. influenzae was detected 5.9% and 27% in the NP from healthy and AOM visits, respectively. In the MEF, H. influenzae was isolated in 43% of samples. Eight percent of H. influenzae isolates were encapsulated, 88% type f. Overall 39.7% of isolates were β-lactamase producing; 43% for MEF isolates. Ampicillin, trimethoprim/sulfamethoxazole, erythromycin and clarithromycin nonsusceptibility were found in more than 25% of isolates. None of the encapsulated H. influenzae isolates were positive for β-lactamase production or ampicillin nonsusceptibility. 9.2% of isolates were β-lactamase negative, ampicillin resistant (β-lactamase negative, ampicillin resistant + β-lactamase negative, ampicillin intermediate). CONCLUSIONS The prevalence of H. influenzae in the NP of young children is very low at times of health, but H. influenzae is highly prevalent in MEF at onset of AOM. Nontypeable H. influenzae accounts for >90% of all H. influenzae isolates. Type f predominated among encapsulated strains. β-lactamase production and antibiotic nonsusceptibility among H. influenzae strains isolated from the NP and MEF are common.
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Affiliation(s)
- Naoko Fuji
- From the Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, New York
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19
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Dynamic changes in otopathogens colonizing the nasopharynx and causing acute otitis media in children after 13-valent (PCV13) pneumococcal conjugate vaccination during 2015-2019. Eur J Clin Microbiol Infect Dis 2021; 41:37-44. [PMID: 34432166 DOI: 10.1007/s10096-021-04324-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
The otopathogens colonizing the nasopharynx (NP) and causing acute otitis media (AOM) have shown dynamic changes following introduction of pneumococcal conjugate vaccines. Five hundred eighty-nine children were prospectively enrolled, 2015-2019. Two thousand fifty-nine visits (1528 healthy, 393 AOM, and 138 AOM follow-up) were studied. Two thousand forty-two NP and 495 middle ear fluid (MEF) samples by tympanocentesis from 319 AOM cases were cultured for bacterial identification and antibiotic susceptibility. Streptococcus pneumoniae (Spn) isolates were serotyped by Quellung, and multi-locus sequence type (ST) determined by genomic analysis. Haemophilus influenzae (Hi) was the most common otopathogen cultured from MEF during AOM (34% in MEF) followed by Spn (24% in MEF), then Moraxella catarrhalis (Mcat) (15% in MEF). NP isolates during healthy visit were Mcat (39%), Spn (32%), Hi (12%). 48.6% of Hi isolates from MEF were beta-lactamase-producing. Spn non-susceptibility to penicillin and other antibiotics was high. The most common Spn serotypes associated with AOM (and colonizing the NP during healthy visits) were 35B, 23B, and 15B/C. ST558 and ST199 were the most common sequence types. During 2015-2019, Hi was the most common otopathogen cultured from MEF during AOM among young children. Pneumococcal AOM was most commonly caused by non-PCV13 serotypes of Spn, predominantly 35B, 23B, and 15B/C. Resistance to common antibiotics among Spn strains showed an increasing trend.
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20
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Phillips M, Finelli L, Saiman L, Wang C, Choi Y, Patel J. Respiratory Syncytial Virus-associated Acute Otitis Media in Infants and Children. J Pediatric Infect Dis Soc 2020; 9:544-550. [PMID: 32886769 DOI: 10.1093/jpids/piaa094] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022]
Abstract
Despite recent declines in the incidence of acute otitis media (AOM), more than 5 million cases and 5-6 million primary AOM visits still occur in young children in the United States, resulting in $4.4 billion direct medical costs annually. Our aims in this review are to describe the role of respiratory syncytial virus (RSV) in the etiology of AOM, discuss the prospect of prevention of RSV-associated AOM through immunization, and suggest future research strategies to assess the impact of immunization on RSV-associated AOM.
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Affiliation(s)
- Matthew Phillips
- Center for Observational and Real-World Evidence, Merck & Co, Inc, Kenilworth, New Jersey, USA
| | - Lyn Finelli
- Center for Observational and Real-World Evidence, Merck & Co, Inc, Kenilworth, New Jersey, USA
| | - Lisa Saiman
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA.,Department of Infection Prevention & Control, New York-Presbyterian Hospital, New York, New York, USA
| | - Chengbin Wang
- Center for Observational and Real-World Evidence, Merck & Co, Inc, Kenilworth, New Jersey, USA
| | - Yoonyoung Choi
- Center for Observational and Real-World Evidence, Merck & Co, Inc, Kenilworth, New Jersey, USA
| | - Janak Patel
- Department of Pediatrics, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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21
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Mather MW, Drinnan M, Perry JD, Powell S, Wilson JA, Powell J. A systematic review and meta-analysis of antimicrobial resistance in paediatric acute otitis media. Int J Pediatr Otorhinolaryngol 2019; 123:102-109. [PMID: 31085462 DOI: 10.1016/j.ijporl.2019.04.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/16/2019] [Accepted: 04/30/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE OF REVIEW Acute otitis media (AOM) is the largest cause of antimicrobial prescriptions amongst children in developed countries. Excessive and inappropriate prescribing is known to drive antimicrobial resistance, but less is known of antimicrobial resistance in AOM-associated bacteria. TYPE OF REVIEW & SEARCH STRATEGY We conducted a systematic review and meta-analysis of bacterial prevalence and antimicrobial resistance in studies of paediatric AOM identified from Ovid Medline, Embase and the Cochrane library. RESULTS From 48 unique studies, 15,871 samples were included. Only 0.67 (CI 0.63-0.71) of all ear samples grew a bacterial pathogen. The most common bacterial causes of AOM in children were Streptococcus pneumoniae 0.30 (CI 0.27-0.32), Haemophilus influenza 0.23 (CI 0.20-0.26), and Moraxella catarrhalis 0.05 (CI 0.04-0.06). Resistance patterns varied amongst organisms and antimicrobial agents. The pooled proportion of bacterial culture-positive episodes of AOM that could be effectively treated with amoxicillin was 0.85 (CI 0.76-0.94), erythromycin was 0.64 (0.48-0.78) and amoxicillin-clavulanate was 0.95 (CI 0.85-0.98). CONCLUSION We have demonstrated the bacteriology and antimicrobial resistance patterns of AOM. Of samples which grew bacteria, on average approximately 15% of isolates demonstrated resistance to amoxicillin; a typical first-line agent. Greater understanding of local bacteriology and resistance patterns is needed to enable improved antimicrobial stewardship.
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Affiliation(s)
- Michael W Mather
- Institute of Cellular Medicine, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK; Department of Otolaryngology, Freeman Hospital, Freeman Road, Newcastle Upon Tyne, NE7 7DN, UK
| | - Michael Drinnan
- Institute of Cellular Medicine, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK
| | - John D Perry
- Department of Microbiology, Freeman Hospital, Freeman Road, Newcastle Upon Tyne, NE7 7DN, UK
| | - Steven Powell
- Department of Otolaryngology, Freeman Hospital, Freeman Road, Newcastle Upon Tyne, NE7 7DN, UK
| | - Janet A Wilson
- Department of Otolaryngology, Freeman Hospital, Freeman Road, Newcastle Upon Tyne, NE7 7DN, UK; Institute of Health and Society, Newcastle University, Richardson Road, Newcastle Upon Tyne, NE2 4AX, UK
| | - Jason Powell
- Institute of Cellular Medicine, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK; Department of Otolaryngology, Freeman Hospital, Freeman Road, Newcastle Upon Tyne, NE7 7DN, UK.
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22
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Brugger SD, Kraemer JG, Qi W, Bomar L, Oppliger A, Hilty M. Age-Dependent Dissimilarity of the Nasopharyngeal and Middle Ear Microbiota in Children With Acute Otitis Media. Front Genet 2019; 10:555. [PMID: 31275355 PMCID: PMC6593076 DOI: 10.3389/fgene.2019.00555] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/24/2019] [Indexed: 12/16/2022] Open
Abstract
Acute bacterial otitis media is usually caused by otopathogens ascending to the middle ear from the nasopharynx (NP). However, it is unknown if the nasopharyngeal microbiota of children with acute otitis media (AOM) can serve as an age-dependent or independent proxy for the microbial communities of the middle ear fluid (MEF) as there is a lack of 16S rRNA amplicon sequencing studies simultaneously analyzing the microbial communities of the two sites. Within this study, we performed 16S rRNA next generation sequencing on a total of 286 nasopharyngeal swabs (NPSs) collected between 2004 and 2013 within a Swiss national AOM surveillance program from children (0-6 years) with AOM. In addition, 42/286 children had spontaneous tympanic membrane perforation and, therefore, those MEF could also be analyzed. We found that alpha [Richness, Shannon diversity index (SDI) and Evenness] and beta diversity measurements of the nasopharyngeal bacterial microbiota showed a clear dependency of the increasing age of the children. In more detail, bacterial richness and personalized profiles (measured by beta dispersion) were higher and more frequent in older children, respectively. Dissimilarity values based on the binary distance matrix of the microbiota patterns of the NP and the MEF also correlated with increasing age. In general, positive (PPV) and negative predictive values (NPV) of the most abundant operational taxonomic units (OTUs) in the NP were moderately and well predictive for their presence in the MEF, respectively. This data is crucial to better understand polymicrobial infections and therefore AOM pathogenesis.
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Affiliation(s)
- Silvio D Brugger
- Institute for Infectious Diseases, Faculty of Medicine, University of Bern, Bern, Switzerland.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, United States.,Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich - University of Zurich, Zurich, Switzerland
| | - Julia G Kraemer
- Institute for Infectious Diseases, Faculty of Medicine, University of Bern, Bern, Switzerland.,Institute for Work and Health, University of Lausanne, University of Geneva, Épalinges, Switzerland
| | - Weihong Qi
- Functional Genomics Center Zurich, Swiss Federal Institute of Technology Zurich, University of Zurich, Zurich, Switzerland
| | - Lindsey Bomar
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, United States.,Department of Microbiology, The Forsyth Institute, Cambridge, MA, United States
| | - Anne Oppliger
- Institute for Work and Health, University of Lausanne, University of Geneva, Épalinges, Switzerland
| | - Markus Hilty
- Institute for Infectious Diseases, Faculty of Medicine, University of Bern, Bern, Switzerland
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23
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Levy C, Varon E, Ouldali N, Wollner A, Thollot F, Corrard F, Werner A, Béchet S, Bonacorsi S, Cohen R. Bacterial causes of otitis media with spontaneous perforation of the tympanic membrane in the era of 13 valent pneumococcal conjugate vaccine. PLoS One 2019; 14:e0211712. [PMID: 30707730 PMCID: PMC6358092 DOI: 10.1371/journal.pone.0211712] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 01/18/2019] [Indexed: 11/19/2022] Open
Abstract
After pneumococcal conjugate vaccine (PCV) implementation, the number of acute otitis media (AOM) episodes has decreased, but AOM still remains among the most common diagnoses in childhood. From 2% to 17% of cases of AOM feature spontaneous perforation of the tympanic membrane (SPTM). The aim of this study was to describe the bacteriological causes of SPTM 5 to 8 years years after PCV13 implementation, in 2010. From 2015 to 2018, children with SPTM were prospectively enrolled by 41 pediatricians. Middle ear fluid was obtained by sampling spontaneous discharge. Among the 470 children with SPTM (median age 20.8 months), no otopathogen was isolated for 251 (53.4% [95% CI 48.8%;58.0%]): 47.1% of infants and toddlers, 68.3% older children (p<0.001). Among children with isolated bacterial otopathogens (n = 219), non-typable Haemophilus influenzae (NTHi) was the most frequent otopathogen isolated (n = 106, 48.4% [95% CI 41.6%;55.2%]), followed by Streptoccocus pyogenes (group A streptococcus [GAS]) (n = 76, 34.7% [95% CI 28.4%;41.4%]) and Streptococcus pneumoniae (Sp) (n = 61, 27.9% [95% Ci 22.0%;34.3%]). NTHi was frequently isolated in infants and toddlers (53.1%), whereas the main otopathogen in older children was GAS (52.3%). In cases of co-infection with at least two otopathogens (16.9%, n = 37/219), NTHi was frequently involved (78.4%, n = 29/37). When Sp was isolated, PCV13 serotypes accounted for 32.1% of cases, with serotype 3 the main serotype (16.1%). Among Sp strains, 29.5% were penicillin-intermediate and among NTHi strains, 16.0% were β-lactamase-producers. More than 5 years after PCV13 implementation, the leading bacterial species recovered from AOM with SPTM was NTHi for infants and toddlers and GAS for older children. In both age groups, Sp was the third most frequent pathogen and vaccine serotypes still played an important role. No resistant Sp strains were isolated, and the frequency of β-lactamase-producing NTHi did not exceed 16%.
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Affiliation(s)
- Corinne Levy
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés, France
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France
- AFPA, Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France
- Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Emmanuelle Varon
- National Reference Center for Pneumococci, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Naim Ouldali
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés, France
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France
- Unité d’épidémiologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, ECEVE INSERM UMR 1123, Paris, France
| | - Alain Wollner
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés, France
| | - Franck Thollot
- AFPA, Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France
| | - François Corrard
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés, France
| | - Andreas Werner
- AFPA, Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France
| | - Stéphane Béchet
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés, France
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France
| | - Stéphane Bonacorsi
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- Service de Microbiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Robert-Debré, 75019 Paris, France
| | - Robert Cohen
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés, France
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France
- Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Unité Court Séjour, Petits nourrissons, Service de Néonatalogie, Centre Hospitalier Intercommunal de Créteil, Créteil, France
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24
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Pichichero M, Kaur R, Scott DA, Gruber WC, Trammel J, Almudevar A, Center KJ. Effectiveness of 13-valent pneumococcal conjugate vaccination for protection against acute otitis media caused by Streptococcus pneumoniae in healthy young children: a prospective observational study. THE LANCET CHILD & ADOLESCENT HEALTH 2018; 2:561-568. [PMID: 30119715 DOI: 10.1016/s2352-4642(18)30168-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/04/2018] [Accepted: 05/09/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND With wide use of the seven-valent pneumococcal conjugate vaccine (PCV7) for protection against acute otitis media caused by Streptococcus pneumoniae serotypes included in the vaccine, efficacy testing for the 13-valent vaccine (PCV13) was not feasible. We aimed to assess the effectiveness of PCV13 in preventing acute otitis media caused by the six serotypes in PCV13 that were not in PCV7. METHODS We did a longitudinal observational study in healthy children seen as outpatients in a private paediatric practice in Rochester, NY, USA. Children aged up to 30 months who had received the full primary series of PCV13 with other recommended vaccines were eligible to participate and were followed up to age 30-36 months to identify episodes of acute otitis media, during which we collected middle-ear fluid (MEF) by tympanocentesis. We assessed MEF for the serotypes common to PCV7 and PCV13 (4, 6B, 9V, 14, 18C, 19F, and 23F) and the six additional serotypes specific to PCV13 (1, 3, 5, 6A, 7F, and 19A). As controls, we included children enrolled in a longitudinal study in the study centre from Oct 1, 2007, to Sept 30, 2009, who had been vaccinated with PCV7, had MEF prospectively collected at the onset of acute otitis media, and been followed up until age 30 months. The primary outcome was the effectiveness of PCV13 to prevent acute otitis media caused by pneumococci expressing the six capsular serotypes not included in PCV7 (1, 3, 5, 6A, 7F, and 19A). This study is registered with ClinicalTrials.gov, number NCT01199016. FINDINGS From Sept 28, 2010, to Sept 30, 2013, we enrolled 239 children (123 [51%] boys and 116 [49%] girls; median age 6·3 months [IQR 6·1-8·6]) in the PCV13 cohort, and 162 completed the study. Of 348 children (184 [53%] boys and 164 [47%] girls; 6·5 months [6·1-9·1]) included in the PCV7 cohort, 248 completed follow-up. 223 MEF samples were obtained at onset of acute otitis media from 90 children in the PCV13 cohort. 53 (24%) of 223 samples were culture positive for S pneumoniae, compared with 89 (31%) of 284 samples in the PCV7 cohort (p=0·06). Four (8%) of 53 samples in the PCV13 cohort contained pneumococci expressing one of the additional PCV13 capsular serotypes, compared with 46 (52%) of 89 samples in the PCV7 cohort, giving a relative reduction of 86% (95% CI 61-94, p=0·0010). The greatest reduction in MEF samples was in serotype 19A (two [4%] in the PCV13 cohort vs 46 [52%] in the PCV7 cohort; relative reduction 91% [58-97, p=0·0010]). INTERPRETATION PCV13 prevents acute otitis media caused by S pneumoniae expressing serotypes included in the vaccine. FUNDING Pfizer.
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Affiliation(s)
- Michael Pichichero
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, NY, USA.
| | - Ravinder Kaur
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, NY, USA
| | - Daniel A Scott
- Pfizer Vaccines Clinical Research and Development, Collegeville, PA, USA
| | - William C Gruber
- Pfizer Vaccines Clinical Research and Development, Pearl River, NY, USA
| | | | - Anthony Almudevar
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Kimberly J Center
- Pfizer Vaccines Clinical Research and Development, Collegeville, PA, USA
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25
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Antibiotic Resistance of Potential Otopathogens Isolated From Nasopharyngeal Flora of Children With Acute Otitis Media Before, During and After Pneumococcal Conjugate Vaccines Implementation. Pediatr Infect Dis J 2018; 37:e72-e78. [PMID: 29227464 DOI: 10.1097/inf.0000000000001862] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND To re-evaluate antibiotic strategies for acute otitis media (AOM) in young children, we analyzed the trends of nasopharyngeal carriage and antibiotic resistance of Streptococcus pneumoniae (Sp), Haemophilus influenzae (Hi) and Moraxella catarrhalis (Mc) isolated from young children with AOM during a 16-year period. METHODS This cross-sectional study analyzed from 2001 to 2016 the nasopharyngeal carriage of Sp, Hi and Mc of young children with AOM. Medical history and physical findings were reported. Periods were defined by pneumococcal conjugate vaccine (PCV) introduction. We separately analyzed the 13-valent PCV (PCV13) period, which started after 2013. RESULTS During the study, 12,973 children with AOM were enrolled by 138 pediatricians. By comparing the first and last PCV periods, the proportion of children in day care centers and that of AOM with conjunctivitis significantly increased. The proportion of penicillin nonsusceptible Sp carriage significantly decreased during the study, with 0.8% of penicillin-resistant strains isolated in the PCV13 period, but that of β-lactamase-producing Hi continually increased to 23.6% in 2016. The level of Mc β-lactamase-producing strains remained high (>97%). In the PCV13 period, the main predictors of β-lactamase-producing Hi carriage were conjunctivitis (adjusted odds ratio = 6.0, 95% confidence interval [4.7-7.7]) and attending a day care center (2.4 [1.7-3.5]). CONCLUSIONS In the PCV13 period, the proportion of penicillin-resistant Sp carriage was very low and that of β-lactamase-producing Hi carriage did not exceed 20% among children with AOM and without conjunctivitis. Our results suggest that amoxicillin may remain the first-line antibiotic treatment for AOM in young children except for those with conjunctivitis, for which amoxicillin-clavulanate is still the best antibiotic.
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26
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Lappan R, Imbrogno K, Sikazwe C, Anderson D, Mok D, Coates H, Vijayasekaran S, Bumbak P, Blyth CC, Jamieson SE, Peacock CS. A microbiome case-control study of recurrent acute otitis media identified potentially protective bacterial genera. BMC Microbiol 2018; 18:13. [PMID: 29458340 PMCID: PMC5819196 DOI: 10.1186/s12866-018-1154-3] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 02/08/2018] [Indexed: 12/15/2022] Open
Abstract
Background Recurrent acute otitis media (rAOM, recurrent ear infection) is a common childhood disease caused by bacteria termed otopathogens, for which current treatments have limited effectiveness. Generic probiotic therapies have shown promise, but seem to lack specificity. We hypothesised that healthy children with no history of AOM carry protective commensal bacteria that could be translated into a specific probiotic therapy to break the cycle of re-infection. We characterised the nasopharyngeal microbiome of these children (controls) in comparison to children with rAOM (cases) to identify potentially protective bacteria. As some children with rAOM do not appear to carry any of the known otopathogens, we also hypothesised that characterisation of the middle ear microbiome could identify novel otopathogens, which may also guide the development of more effective therapies. Results Middle ear fluids, middle ear rinses and ear canal swabs from the cases and nasopharyngeal swabs from both groups underwent 16S rRNA gene sequencing. The nasopharyngeal microbiomes of cases and controls were distinct. We observed a significantly higher abundance of Corynebacterium and Dolosigranulum in the nasopharynx of controls. Alloiococcus, Staphylococcus and Turicella were abundant in the middle ear and ear canal of cases, but were uncommon in the nasopharynx of both groups. Gemella and Neisseria were characteristic of the case nasopharynx, but were not prevalent in the middle ear. Conclusions Corynebacterium and Dolosigranulum are characteristic of a healthy nasopharyngeal microbiome. Alloiococcus, Staphylococcus and Turicella are possible novel otopathogens, though their rarity in the nasopharynx and prevalence in the ear canal means that their role as normal aural flora cannot be ruled out. Gemella and Neisseria are unlikely to be novel otopathogens as they do not appear to colonise the middle ear in children with rAOM. Electronic supplementary material The online version of this article (10.1186/s12866-018-1154-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rachael Lappan
- The Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia. .,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.
| | - Kara Imbrogno
- The Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Chisha Sikazwe
- Department of Microbiology, PathWest, Perth, WA, Australia
| | - Denise Anderson
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Danny Mok
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Harvey Coates
- School of Medicine, The University of Western Australia, Perth, WA, Australia
| | - Shyan Vijayasekaran
- School of Medicine, The University of Western Australia, Perth, WA, Australia.,Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Paul Bumbak
- School of Medicine, The University of Western Australia, Perth, WA, Australia.,Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,Department of Microbiology, PathWest, Perth, WA, Australia.,School of Medicine, The University of Western Australia, Perth, WA, Australia.,Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Sarra E Jamieson
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Christopher S Peacock
- The Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia. .,Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.
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27
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Martin JM, Hoberman A, Shaikh N, Shope T, onika Bhatnagar S, Block SL, Haralam MA, Kurs-Lasky M, Green M. Changes Over Time in Nasopharyngeal Colonization in Children Under 2 Years of Age at the Time of Diagnosis of Acute Otitis Media (1999-2014). Open Forum Infect Dis 2018; 5:ofy036. [PMID: 29588912 PMCID: PMC5842555 DOI: 10.1093/ofid/ofy036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 02/15/2018] [Indexed: 11/14/2022] Open
Abstract
Background In children with acute otitis media (AOM), a decrease in nasopharyngeal (NP) colonization with vaccine serotypes of Streptococcus pneumoniae has been noted since the introduction of pneumococcal conjugate vaccines (PCVs). The purpose of this study is to describe corresponding changes in colonization with Haemophilus influenzae. Methods In 4 separate studies, we obtained NP cultures from children aged 6-23 months presenting with AOM. Cohort 1 was recruited before routine use of PCV7 (1999-2000); 93% of children in cohort 2 (2003-2005) and 100% in cohort 3 (2006-2009) received ≥2 doses of PCV7. All children in cohort 4 (2012-2014) received ≥2 doses of PCV13. Isolates of H. influenzae were tested for ß-lactamase production; ß-lactamase negative isolates from cohorts 3 and 4 underwent susceptibility testing. Results A total of 899 children were evaluated. NP colonization with H. influenzae was found in 26% of children in cohort 1 (n = 175), 41% in cohort 2 (n = 87), 33% in cohort 3 (n = 282), and 29% in cohort 4 (n = 355). Colonization with H. influenzae increased initially from cohort 1 to cohort 2 (P = .01), then decreased across cohorts 2, 3, and 4 (P = .03, test for trend). The prevalence rates of ß-lactamase production were 27%, 42%, 33%, and 30% in each of the 4 cohorts, respectively (P = .50). Conclusions Although an initial increase in H. influenzae colonization was observed, suggesting an impact of PCVs, the most recent prevalence rates of NP colonization with H. influenzae and ß-lactamase production were like those observed before universal administration of PCV7. This knowledge is critical to guide appropriate treatment recommendations for children with AOM.
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Affiliation(s)
- Judith M Martin
- Divisions of General Academic Pediatrics and Pediatric Infectious Diseases, Department of Pediatrics, University of Pittsburgh School of Medicine and Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
- Correspondence: J. M. Martin, MD, Division of General Academic Pediatrics, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, 3414 Fifth Ave, CHOB 3rd Floor Room 305, Pittsburgh, PA 15213 ()
| | - Alejandro Hoberman
- Divisions of General Academic Pediatrics and Pediatric Infectious Diseases, Department of Pediatrics, University of Pittsburgh School of Medicine and Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nader Shaikh
- Divisions of General Academic Pediatrics and Pediatric Infectious Diseases, Department of Pediatrics, University of Pittsburgh School of Medicine and Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Timothy Shope
- Divisions of General Academic Pediatrics and Pediatric Infectious Diseases, Department of Pediatrics, University of Pittsburgh School of Medicine and Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - S onika Bhatnagar
- Divisions of General Academic Pediatrics and Pediatric Infectious Diseases, Department of Pediatrics, University of Pittsburgh School of Medicine and Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stan L Block
- Kentucky Pediatric Research, Inc., Bardstown, Kentucky
| | - Mary Ann Haralam
- Divisions of General Academic Pediatrics and Pediatric Infectious Diseases, Department of Pediatrics, University of Pittsburgh School of Medicine and Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Marcia Kurs-Lasky
- Divisions of General Academic Pediatrics and Pediatric Infectious Diseases, Department of Pediatrics, University of Pittsburgh School of Medicine and Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael Green
- Divisions of General Academic Pediatrics and Pediatric Infectious Diseases, Department of Pediatrics, University of Pittsburgh School of Medicine and Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania
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28
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Zhang XH, Leeuwenkamp O, Oh KB, Lee YE, Kim CM. Cost-effectiveness analysis of infant pneumococcal vaccination with PHiD-CV in Korea. Hum Vaccin Immunother 2017; 14:85-94. [PMID: 29115905 PMCID: PMC5791581 DOI: 10.1080/21645515.2017.1362513] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Streptococcus pneumoniae and non-typeable Haemophilus influenzae (NTHi) can cause invasive pneumococcal diseases (IPD), pneumonia, and acute otitis media (AOM). Both the 10-valent pneumococcal NTHi protein D conjugate vaccine (PHiD-CV) and the 13-valent pneumococcal conjugate vaccine (PCV-13) are included in the National Immunization Program for infants in Korea. This study aimed to evaluate the cost-effectiveness of the 3+1 schedule of PHiD-CV versus that of PCV-13 for National Immunization Program in Korea. Methods: A published Markov model was adapted to evaluate the cost-effectiveness of vaccinating the 2012 birth cohort with PHiD-CV vs. PCV-13 from the Korean government perspective over 10 y. Best available published data were used for epidemiology, vaccine efficacy and disutilities. Data on incidence and direct medical costs were taken from the national insurance claims database. Sensitivity analyses were conducted to explore the robustness of the results. Results: PHiD-CV was projected to prevent an additional 195,262 cases of pneumococcal diseases and NTHi-related diseases vs. PCV-13, with a substantially greater reduction in NTHi-related AOM and a comparable reduction in IPD and community-acquired pneumonia. Parity-priced PHiD-CV generated a health gain of about 844 quality-adjusted life years and a total cost-saving of approximately 4 million United States Dollars (USD) over 10 y. 93% of probabilistic simulations found PHiD-CV 3+1 to be the dominant vaccine option. Conclusion: Compared to PCV-13, PHiD-CV was projected to provide similar prevention against IPD and community-acquired pneumonia but would prevent more cases of AOM. Parity-priced PHiD-CV was anticipated to generate substantial cost-savings and health benefits vs. PCV-13 in Korea.
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Affiliation(s)
| | | | | | | | - Chul-Min Kim
- e Department of Family Medicine , The Catholic University, Seoul St. Mary Hospital , Seoul , Korea
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29
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Kaur R, Wischmeyer J, Morris M, Pichichero ME. Comparison of direct-plating and broth-enrichment culture methods for detection of potential bacterial pathogens in respiratory secretions. J Med Microbiol 2017; 66:1539-1544. [PMID: 29034852 DOI: 10.1099/jmm.0.000587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE We compared the recovery of potential respiratory bacterial pathogens and normal flora from nasopharyngeal specimens collected from children during health and at the onset of acute otitis media (AOM) by selective direct-plating and overnight broth-enrichment. METHODS Overall, 3442 nasal wash (NW) samples collected from young children were analysed from a 10-year prospective study. NWs were cultured by (1) direct-plating to TSAII/5 % sheep blood agar and chocolate agar plates and (2) overnight broth-enrichment in BacT/ALERT SA-broth followed by plating. Standard microbiology techniques were applied to identify three dominant respiratory bacterial pathogens: Streptococcus pneumoniae (Spn), Haemophilus influenzae (Hflu) and Moraxella catarrhalis (Mcat) as well as two common nasal flora, Staphylococcus aureus (SA) and alpha-haemolytic Streptococci (AHS).Results/Key findings. Direct-plating of NW resulted in isolation of Spn from 37.8 %, Hflu from 13.6 % and Mcat from 33.2 % of samples. In comparison, overnight broth-enrichment isolated fewer Spn (30.1 %), Hflu (6.2 %) and Mcat (16.2 %) (P<0.001-0.0001). Broth-enrichment resulted in significant increased isolation of SA (6.0 %) and AHS (30.1 %) (P<0.0001). Competition between bacterial species in broth when both species were detected by direct-plating was assessed, and it was found that SA and AHS out-competed other species during broth-enrichment when samples were collected from healthy children but not during AOM. In middle ear fluids (MEF) at the onset of AOM, broth-enrichment resulted in higher recovery of Spn (+10.4 %, P<0.001), Hflu (+4.4 %, P=0.39) and Mcat (+13.5 %, <0.001). CONCLUSION Broth-enrichment significantly reduces the accurate detection of bacterial respiratory pathogens and increases identification of SA and AHS in NW. Broth-enrichment improves detection of bacterial respiratory pathogens in MEF samples.
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Affiliation(s)
- Ravinder Kaur
- Rochester General Hospital Research Institute, Center for Infectious Diseases and Immunology, 1425 Portland Avenue, Rochester, NY 14621, USA
| | - Jareth Wischmeyer
- Rochester General Hospital Research Institute, Center for Infectious Diseases and Immunology, 1425 Portland Avenue, Rochester, NY 14621, USA
| | - Matthew Morris
- Rochester General Hospital Research Institute, Center for Infectious Diseases and Immunology, 1425 Portland Avenue, Rochester, NY 14621, USA
| | - Michael E Pichichero
- Rochester General Hospital Research Institute, Center for Infectious Diseases and Immunology, 1425 Portland Avenue, Rochester, NY 14621, USA
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Perez AC, Murphy TF. A Moraxella catarrhalis vaccine to protect against otitis media and exacerbations of COPD: An update on current progress and challenges. Hum Vaccin Immunother 2017; 13:2322-2331. [PMID: 28853985 PMCID: PMC5647992 DOI: 10.1080/21645515.2017.1356951] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/16/2017] [Accepted: 07/12/2017] [Indexed: 01/03/2023] Open
Abstract
Moraxella catarrhalis is a major cause of morbidity and mortality worldwide, especially causing otitis media in young children and exacerbations of chronic obstructive pulmonary disease in adults. This pathogen uses several virulence mechanisms to colonize and survive in its host, including adherence and invasion of host cells, formation of polymicrobial biofilms with other bacterial pathogens, and production of β-lactamase. Given the global impact of otitis media and COPD, an effective vaccine to prevent M. catarrhalis infection would have a huge impact on the quality of life in both patient populations by preventing disease, thus reducing morbidity and health care costs. A number of promising vaccine antigens have been identified for M. catarrhalis. The development of improved animal models of M. catarrhalis disease and identification of a correlate of protection are needed to accelerate vaccine development. This review will discuss the current state of M. catarrhalis vaccine development, and the challenges that must be addressed to succeed.
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Affiliation(s)
- Antonia C. Perez
- Clinical and Translational Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA
- Division of Infectious Diseases, Department of Medicine, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Timothy F. Murphy
- Clinical and Translational Research Center, University at Buffalo, The State University of New York, Buffalo, NY, USA
- Division of Infectious Diseases, Department of Medicine, University at Buffalo, The State University of New York, Buffalo, NY, USA
- Department of Microbiology, University at Buffalo, The State University of New York, Buffalo, NY, USA
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Pettigrew MM, Alderson MR, Bakaletz LO, Barenkamp SJ, Hakansson AP, Mason KM, Nokso-Koivisto J, Patel J, Pelton SI, Murphy TF. Panel 6: Vaccines. Otolaryngol Head Neck Surg 2017; 156:S76-S87. [PMID: 28372533 DOI: 10.1177/0194599816632178] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective To review the literature on progress regarding (1) effectiveness of vaccines for prevention of otitis media (OM) and (2) development of vaccine antigens for OM bacterial and viral pathogens. Data Sources PubMed database of the National Library of Science. Review Methods We performed literature searches in PubMed for OM pathogens and candidate vaccine antigens, and we restricted the searches to articles in English that were published between July 2011 and June 2015. Panel members reviewed literature in their area of expertise. Conclusions Pneumococcal conjugate vaccines (PCVs) are somewhat effective for the prevention of pneumococcal OM, recurrent OM, OM visits, and tympanostomy tube insertions. Widespread use of PCVs has been associated with shifts in pneumococcal serotypes and bacterial pathogens associated with OM, diminishing PCV effectiveness against AOM. The 10-valent pneumococcal vaccine containing Haemophilus influenzae protein D (PHiD-CV) is effective for pneumococcal OM, but results from studies describing the potential impact on OM due to H influenzae have been inconsistent. Progress in vaccine development for H influenzae, Moraxella catarrhalis, and OM-associated respiratory viruses has been limited. Additional research is needed to extend vaccine protection to additional pneumococcal serotypes and other otopathogens. There are likely to be licensure challenges for protein-based vaccines, and data on correlates of protection for OM vaccine antigens are urgently needed. Implications for Practice OM continues to be a significant health care burden globally. Prevention is preferable to treatment, and vaccine development remains an important goal. As a polymicrobial disease, OM poses significant but not insurmountable challenges for vaccine development.
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Affiliation(s)
- Melinda M Pettigrew
- 1 Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven Connecticut, USA
| | | | - Lauren O Bakaletz
- 3 Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, and Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | | | | | - Kevin M Mason
- 3 Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, and Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | | | - Janak Patel
- 7 University of Texas Medical Branch, Galveston, Texas, USA
| | - Stephen I Pelton
- 8 Boston University School of Medicine, Boston, Massachusetts, USA
| | - Timothy F Murphy
- 9 University at Buffalo, The State University of New York, Buffalo, New York, USA
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Decrease in Pneumococcal Otitis Media Cultures With Concomitant Increased Antibiotic Susceptibility in the Pneumococcal Conjugate Vaccines Era. Otol Neurotol 2017; 38:853-859. [DOI: 10.1097/mao.0000000000001419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Kyd JM, Hotomi M, Kono M, Kurabi A, Pichichero M, Ryan A, Swords WE, Thornton R. Panel 5: Immunology. Otolaryngol Head Neck Surg 2017; 156:S63-S75. [DOI: 10.1177/0194599816663886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective To perform a state-of-the-art review of the literature from January 2012 through May 2015 on studies that advanced our knowledge of the innate and adaptive immunology related to otitis media. This review also proposes future directions for research in this area. Data Sources PubMed database of the National Library of Medicine. Review Methods Three subpanels comprising experts in the field focused on sections relevant to cytokines, innate immunity, and adaptive immunity. The review focused on animal, cell line, and human studies and was critical in relation to the recommendations from the previous publication and for determination of the proposed goals and priorities. The panel met at the 18th International Symposium on Recent Advances in Otitis Media in June 2015 to consolidate its prior search results and discuss, plan, and refine the review. The panel approved the final draft. Conclusion From 2012 to 2014, tremendous progresses in immunology of otitis media were established—especially in the areas of innate immunity associated with the pathogenesis of otitis media. Implications for Practice The advances of the past 4 years formed the basis for a series of short- and long-term research goals in an effort to guide the field. Accomplishing these goals will provide opportunities for the development of novel interventions, including new ways to better treat and prevent otitis media, especially for recurrent otitis media.
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Affiliation(s)
| | | | | | - Arwa Kurabi
- University of California, San Diego, California, USA
| | | | - Allen Ryan
- University of California, San Diego, California, USA
| | - W. Edward Swords
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Cilveti R, Olmo M, Pérez-Jove J, Picazo JJ, Arimany JL, Mora E, Pérez-Porcuna TM, Aguilar I, Alonso A, Molina F, del Amo M, Mendez C. Epidemiology of Otitis Media with Spontaneous Perforation of the Tympanic Membrane in Young Children and Association with Bacterial Nasopharyngeal Carriage, Recurrences and Pneumococcal Vaccination in Catalonia, Spain - The Prospective HERMES Study. PLoS One 2017; 12:e0170316. [PMID: 28146590 PMCID: PMC5287464 DOI: 10.1371/journal.pone.0170316] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/03/2017] [Indexed: 01/26/2023] Open
Abstract
The Epidemiology of otitis media with spontaneous perforation of the tympanic membrane and associated nasopharyngeal carriage of bacterial otopathogens was analysed in a county in Catalonia (Spain) with pneumococcal conjugate vaccines (PCVs) not included in the immunization programme at study time. A prospective, multicentre study was performed in 10 primary care centres and 2 hospitals (June 2011-June 2014), including all otherwise healthy children ≥2 months ≤8 years with otitis media presenting spontaneous tympanic perforation within 48h. Up to 521 otitis episodes in 487 children were included, showing by culture/PCR in middle ear fluid (MEF): Haemophilus influenzae [24.2%], both Streptococcus pneumoniae and H. influenzae [24.0%], S. pneumoniae [15.9%], Streptococcus pyogenes [13.6%], and Staphylococcus aureus [6.7%]. Culture-negative/PCR-positive otitis accounted for 31.3% (S. pneumoniae), 30.2% (H. influenzae) and 89.6% (mixed S. pneumoniae/H. influenzae infections). Overall, incidence decreased over the 3-year study period, with significant decreases in otitis by S. pneumoniae and by H. influenzae, but no decreases for mixed S. pneumoniae/H. influenzae infections. Concordance between species in nasopharynx and MEF was found in 58.3% of cases, with maximal rates for S. pyogenes (71.8%), and with identical pneumococcal serotype in 40.5% of cases. Most patients (66.6%) had past episodes. PCV13 serotypes were significantly more frequent in first episodes, in otitis by S. pneumoniae as single agent, and among MEF than nasopharyngeal isolates. All non-PCV13 serotypes separately accounted for <5% in MEF. Up to 73.9% children had received ≥1 dose of PCV, with lower carriage of PCV13 serotypes than among non-vaccinated children. Pooling pneumococcal isolates from MEF and nasopharynx, 30% were multidrug resistant, primarily belonging to serotypes 19A [29.8%], 24A [14.3%], 19F [8.3%] and 15A [6.0%]. Our results suggest that increasing PCV13 vaccination would further reduce transmission of PCV13 serotypes with special benefits for youngest children (with none or uncompleted vaccine schedules), preventing first otitis episodes and subsequent recurrences.
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Affiliation(s)
- Robert Cilveti
- Department of Paediatrics, H. Universitari Mútua Terrassa, Barcelona, Spain
- * E-mail:
| | - Montserrat Olmo
- Department of Paediatrics, H. Universitari Mútua Terrassa, Barcelona, Spain
| | | | | | | | - Emiliano Mora
- Department of Paediatrics, H. Universitari Mútua Terrassa, Barcelona, Spain
| | | | - Ignacio Aguilar
- CAP Turó de Can Mates, San Cugat del Vallés, Barcelona, Spain
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Timby N, Domellöf M, Holgerson PL, West CE, Lönnerdal B, Hernell O, Johansson I. Oral Microbiota in Infants Fed a Formula Supplemented with Bovine Milk Fat Globule Membranes - A Randomized Controlled Trial. PLoS One 2017; 12:e0169831. [PMID: 28099499 PMCID: PMC5242539 DOI: 10.1371/journal.pone.0169831] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/21/2016] [Indexed: 01/10/2023] Open
Abstract
Background In a recent study, supplementation of infant formula with milk fat globule membranes (MFGM) decreased the incidence of otitis media in infants <6 months of age. Objectives The aim of the present study was to characterize the oral microbiota in infants fed MFGM-supplemented formula and compare it to that of infants fed standard formula or breast milk. Methods In a prospective double-blinded randomized controlled trial, exclusively formula-fed infants <2 months of age were randomized to be fed experimental formula (EF, n = 80) with reduced energy and protein and supplemented with a bovine MFGM concentrate, or standard formula (SF, n = 80) until 6 months of age. A breast-fed reference (BFR, n = 80) group was also recruited. The oral microbiota was analyzed at 4 (n = 124) and 12 (n = 166) months of age using Illumina MiSeq multiplex sequencing and taxonomic resolution against the HOMD 16S rDNA database of oral bacteria. Results Species richness in the oral samples did not differ between the EF and SF groups, but partial least square modeling identified a few taxa that were significantly associated with being in either group, e.g. lower level of Moraxella catarrhalis in the EF group. Infants in the BFR group had significantly lower species richness at 4 months of age and their microbiota pattern differed markedly from the formula-fed groups. Conclusions Supplementation of infant formula with MFGM yielded moderate effects on the oral microbiome. Moraxella catarrhalis was less prevalent in infants fed EF than in those fed SF and may be associated with the decrease in otitis media seen in the same group.
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Affiliation(s)
- Niklas Timby
- Department of Clinical Sciences/Unit of Pediatrics, Umeå University, Umeå, Sweden
- * E-mail:
| | - Magnus Domellöf
- Department of Clinical Sciences/Unit of Pediatrics, Umeå University, Umeå, Sweden
| | | | - Christina E. West
- Department of Clinical Sciences/Unit of Pediatrics, Umeå University, Umeå, Sweden
| | - Bo Lönnerdal
- Department of Nutrition, University of California, Davis, United States of America
| | - Olle Hernell
- Department of Clinical Sciences/Unit of Pediatrics, Umeå University, Umeå, Sweden
| | - Ingegerd Johansson
- Department of Odontology/Unit of Cariology, Umeå University, Umeå, Sweden
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Han SB, Kim JH, Kang JH, Ma SH, Kim CS, Kim KH, Kim HM, Choi YY. Recent epidemiology of Streptococcus pneumoniae in nasopharynxes of Korean children with acute otitis media. J Infect Chemother 2016; 23:136-141. [PMID: 28024738 DOI: 10.1016/j.jiac.2016.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/18/2016] [Accepted: 10/22/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND This prospective study was performed to evaluate serotype distribution, multilocus sequence typing, and antibiotic susceptibility of Streptococcus pneumoniae identified in Korean children with acute otitis media (AOM) after the introduction of a 7-valent pneumococcal conjugate vaccine (PCV7). METHODS Nasopharyngeal aspirates were collected from children diagnosed with AOM in seven hospitals in Korea. The bacteria identified in these samples and the serotypes, sequence types (STs), and antibiotic susceptibilities of S. pneumoniae isolates were evaluated. RESULTS A total of 390 children were enrolled, and bacteria were identified in 376 (96.4%) children. S. pneumoniae, Haemophilus influenzae and Moraxella catarrhalis were identified in 155 (39.7%), 127 (32.6%) and 86 (22.1%) children, respectively. Serotype 19A (22.4%) was the most common S. pneumoniae serotype, with serogroups 11 (14.7%) and 15 (13.5%) following. ST320 (23.5%) was the most common ST; ST166 (17.0%) and ST83 (8.5%) followed. The overall susceptibility rates of S. pneumoniae to oral penicillin V and amoxicillin/clavulanate were 2.6% and 53.2%, respectively. The susceptibility rate to cefditoren was 91.0%; however, the rates for other cephalosporins were less than 10.0%. Compared with other serogroups, S. pneumoniae serogroups 19, 11, and 15 showed significantly lower susceptibility rates to all the antibiotics tested. CONCLUSION S. pneumoniae serotype 19A, serogroups 11 and 15 were the major nasopharyngeal-colonizing bacteria in Korean children with AOM after the introduction of PCV7. These relatively prevalent serotype/serogroups showed lower antibiotic susceptibility rates.
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Affiliation(s)
- Seung Beom Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Hyun Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Han Kang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Sang Hyuk Ma
- Department of Pediatrics, Fatima Hospital, Changwon, Republic of Korea
| | - Chun Soo Kim
- Department of Pediatrics, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Kyung-Hyo Kim
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Republic of Korea; Center for Vaccine Evaluation and Study, Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Hwang Min Kim
- Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Young Youn Choi
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Republic of Korea
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Kono M, Zafar MA, Zuniga M, Roche AM, Hamaguchi S, Weiser JN. Single Cell Bottlenecks in the Pathogenesis of Streptococcus pneumoniae. PLoS Pathog 2016; 12:e1005887. [PMID: 27732665 PMCID: PMC5061371 DOI: 10.1371/journal.ppat.1005887] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 08/22/2016] [Indexed: 12/18/2022] Open
Abstract
Herein, we studied a virulent isolate of the leading bacterial pathogen Streptococcus pneumoniae in an infant mouse model of colonization, disease and transmission, both with and without influenza A (IAV) co-infection. To identify vulnerable points in the multiple steps involved in pneumococcal pathogenesis, this model was utilized for a comprehensive analysis of population bottlenecks. Our findings reveal that in the setting of IAV co-infection the organism must pass through single cell bottlenecks during bloodstream invasion from the nasopharynx within the host and in transmission between hosts. Passage through these bottlenecks was not associated with genetic adaptation by the pathogen. The bottleneck in transmission occurred between bacterial exit from one host and establishment in another explaining why the number of shed organisms in secretions is critical to overcoming it. These observations demonstrate how viral infection, and TLR-dependent innate immune responses it stimulates and that are required to control it, drive bacterial contagion. Many discrete steps are involved in the progression of infectious diseases. Bottlenecks represent key points where the population size/genetic diversity is at a minimum and the pathogen is most vulnerable to intervention strategies. Our study used an infant mouse model for a comprehensive analysis of bottlenecks in infection by the major pathogen Streptococcus pneumoniae. In our model, we also considered influenza A virus, a clinically important and common co-infection. The main findings reveal i) a single cell bottleneck during host-to-host transmission and ii) the bottleneck in transmission occurs during events between bacterial exit from one host and establishment in another host. We manipulated innate immune responses involved in viral control and inflammation to show that viral co-infection allows the bottleneck in transmission to be overcome by increasing bacterial exit. Finally, we demonstrate that a specific host response stimulated by influenza A is sufficient to recapitulate effects of viral co-infection. Thus, our study identifies key vulnerable stages during S. pneumoniae infection and provides mechanistic understanding for how viral infection promotes bacterial contagion.
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Affiliation(s)
- Masamitsu Kono
- Department of Microbiology, New York University, New York, New York, United States of America
- Department of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama, Japan
| | - M. Ammar Zafar
- Department of Microbiology, New York University, New York, New York, United States of America
| | - Marisol Zuniga
- Department of Microbiology, New York University, New York, New York, United States of America
| | - Aoife M. Roche
- Department of Microbiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Shigeto Hamaguchi
- Department of Microbiology, New York University, New York, New York, United States of America
| | - Jeffrey N. Weiser
- Department of Microbiology, New York University, New York, New York, United States of America
- * E-mail:
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Abstract
This review summarizes a prospective, longitudinal 10-year study in Rochester, NY, involving 760 children where virtually all clinically diagnosed acute otitis media (AOM) was confirmed by bacterial culture of middle ear fluid. This review describes detection of otopathogens in middle ear fluid, nasopharyngeal (NP) otopathogen colonization patterns, AOM risk factor analysis, biomarkers of AOM and antibody responses to NP colonization by otopathogens. After licensure of PCV13, there was an immediate drop in AOM caused by Streptococcus pneumoniae (Spn) vaccine serotypes and shortly thereafer an increase in nonvaccine types 16, 21 and 35B. When NP co-colonization occurred, nontypeable Haemophilus influenzae (NTHi) predominated over Spn to cause AOM, and NTHi and Spn both predominated over Moraxella catarrhalis. Transcriptome analysis of peripheral blood mononuclear cells identified unique signatures for NTHi AOM compared with Spn AOM. Elevation of 3 cytokines in serum (S100A12, intercellular adhesion molecule 1 and interleukin 10) accurately predicted the presence and recovery from AOM and the likely otopathogen. NP colonization was an immunizing event.
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Kaur R, Casey JR, Pichichero ME. Emerging Streptococcus pneumoniae Strains Colonizing the Nasopharynx in Children After 13-valent Pneumococcal Conjugate Vaccination in Comparison to the 7-valent Era, 2006-2015. Pediatr Infect Dis J 2016; 35:901-6. [PMID: 27420806 PMCID: PMC4948952 DOI: 10.1097/inf.0000000000001206] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND After introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in the United States in 2000, emergence of replacement serotypes occurred, leading to the introduction of a 13-valent pneumococcal conjugate vaccine (PCV13) in 2010 that contained all PCV7 serotypes plus 6 additional serotypes (1, 3, 5, 6A, 7F and 19A). Here, we describe a 9-year prospective, longitudinal study characterizing Streptococcus pneumoniae strains colonizing the nasopharynx (NP) of young children based on serotype, sequence type (ST) and antibiotic susceptibility during the PCV7 and PCV13 eras. METHODS NP samples were obtained for pneumococcal identification from prospectively followed children at 6, 9, 12, 15, 18, 24 and 30 months of age. A total of 1072 visits during the PCV7 era (June 2006 to September 2010) and 2044 visits during the PCV13 era (October 2010 to September 2015) were included from 665 children. Serotyping and multilocus sequence typing types of Streptococcus pneumoniae isolates were evaluated along with their antibiotic resistance pattern. RESULTS A total of 1045 Streptococcus pneumoniae were isolated; 350 during the PCV7 era and 685 during the PCV13 era. The most common serotypes identified during the PCV7 era were 19A and 23B compared with 35B, 23B and 21 in PCV13 era. Serotypes 15A/B/C emerged in equal proportion during the PCV13 era. Serotypes 16 and 20 were only observed in the PCV13 era. NP carriage of 19A persisted 5 years after PCV13 introduction (5% of all isolates). Multilocus ST 199 remained a dominant ST during both the PCV7 and PCV13 eras, and ST558 and ST62 emerged after PCV13. Antibiotic resistance to penicillin, ceftriaxone, cefotaxime, erythromycin, tetracycline and trimethoprim/sulfamethoxazole significantly decreased from the PCV7 to the PCV13 era. CONCLUSIONS Serotypes 35B, 23B, 21 and 15A/B/C rapidly emerged as NP colonizers in the early PCV13 era. Genetically divergent strains with ST558 and ST62 emerged. Resistance to common antibiotics declined after the introduction of PCV13.
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Affiliation(s)
- Ravinder Kaur
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, NY
| | | | - Michael E. Pichichero
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, NY
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Jervis-Bardy J, Rogers GB, Morris PS, Smith-Vaughan HC, Nosworthy E, Leong LEX, Smith RJ, Weyrich LS, De Haan J, Carney AS, Leach AJ, O'Leary S, Marsh RL. The microbiome of otitis media with effusion in Indigenous Australian children. Int J Pediatr Otorhinolaryngol 2015; 79:1548-55. [PMID: 26228497 DOI: 10.1016/j.ijporl.2015.07.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 07/06/2015] [Accepted: 07/09/2015] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Indigenous Australian children have a high prevalence of otitis media with effusion (OME) and associated conductive hearing loss. Only three microbiological studies of middle ear fluid (MEF) from Indigenous Australian children with OME have been reported. All of these were reliant on culture or species-specific PCR assays. The aim of this study was to characterise the middle ear fluid (MEF), adenoid and nasopharyngeal (NP) microbiomes of Indigenous Australian children, using culture-independent 16S rRNA gene sequencing. METHODS MEF, NP swabs and adenoid specimens were collected from 11 children in the Alice Springs region of Central Australia. Bacterial communities in these specimens were characterised using 16S rRNA gene sequencing. RESULTS The microbiota in MEF samples were dominated (>50% relative abundance) by operational taxonomic units (OTUs) consistent with Alloiococcus otitidis (6/11), Haemophilus influenzae (3/11) or Streptococcus sp. (specifically, Mitis group streptococci which includes Streptococcus pneumoniae) (1/11). Anatomical site selectivity was indicated by the presence of a single conserved Haemophilus OTU in 7/11 MEF samples. In comparison, there were ten distinct Haemophilus OTUs observed across the NP and adenoid samples. Despite significant differences between the MEF and NP/adenoid microbiomes, Streptococcus sp., H. influenzae and Moraxella catarrhalis OTUs were common to all sample types. Co-occurrence of classical otopathogens in paired MEF and NP/Adenoid samples is consistent with earlier culture-based studies. CONCLUSION These data highlight the need to further assess H. influenzae traits important in otitis media and to understand the role of canal flora, especially A. otitidis, in populations with a high prevalence of tympanic membrane perforation.
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Affiliation(s)
- Jake Jervis-Bardy
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Geraint B Rogers
- Infection and Immunity Theme, South Australia Health and Medical Research Institute, Adelaide, SA, Australia
| | - Peter S Morris
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Heidi C Smith-Vaughan
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Elizabeth Nosworthy
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Lex E X Leong
- Infection and Immunity Theme, South Australia Health and Medical Research Institute, Adelaide, SA, Australia
| | - Renee J Smith
- Infection and Immunity Theme, South Australia Health and Medical Research Institute, Adelaide, SA, Australia; School of Biological Sciences, Flinders University, Adelaide, SA, Australia
| | - Laura S Weyrich
- Australian Centre for Ancient DNA, University of Adelaide, Adelaide, SA, Australia
| | - Jacques De Haan
- Department of Otolaryngology, Alice Springs Hospital, Alice Springs, NT, Australia
| | - A Simon Carney
- Department of Otolaryngology-Head & Neck Surgery, Flinders University, Adelaide, SA, Australia
| | - Amanda J Leach
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Stephen O'Leary
- Department of Otolaryngology, University of Melbourne, Melbourne, VIC, Australia
| | - Robyn L Marsh
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
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Sun R, Wang X, Li X. Correlation Analysis of Nasopharyngeal Carcinoma TNM Staging with Serum EA IgA and VCA IgA in EBV and VEGF-C and -D. Med Sci Monit 2015; 21:2105-9. [PMID: 26191775 PMCID: PMC4514295 DOI: 10.12659/msm.893415] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Nasopharyngeal carcinoma often occurs in humans in the nasopharyngeal epithelium area. Ebstein-Barr (EB) virus plays a key role in the process of nasopharyngeal carcinoma lesions. Early antigen antibody (EA-IgA) and viral capsid antigen IgA (VCA-IgA) of EB virus detection in serum can effectively monitor the process of nasopharyngeal carcinoma lesions. Serum vascular endothelial growth factor (VEGF) -C and VEGF-D expression detection can reflect the distant metastases ability of human tumor cells. MATERIAL AND METHODS 153 cases of nasopharyngeal carcinoma patients in our hospital were enrolled, while 148 cases of healthy adults were selected as control. ELISA was used to detect serum EA-IgA, VCA-IgA, VEGF-C and -D expression levels. Spearman rank correlation analysis was applied to test the correlation of nasopharyngeal carcinoma TNM clinical stage and different indexes. RESULTS Serum EA-IgA, VCA-IgA, VEGF-C and -D expression in nasopharyngeal carcinoma patients was 43.74±2.6 U•mL^-1, 62.5±2.7 U·mL^-1, 473.25±3.4 pg•mL^-1, and 498.36±2.3 pg•mL^-1, respectively, which was significantly higher than in the control group as 18.65±3.7 U•mL^-1, 23.74±1.5 U•mL^-1, 225.42±2.3 pg•mL^-1, and 257.24±3.5 pg•mL^-1 (P<0.05). Nasopharyngeal carcinoma TNM clinical staging was obviously correlated with serum EA-IgA, VCA-IgA, and VEGF-C (P<0.05), but not VEGF-D (P>0.05). CONCLUSIONS Nasopharyngeal carcinoma patient serum EA-IgA and VCA-IgA expression levels were significantly correlated with TNM staging. The high levels of these 3 indicators suggest advanced nasopharyngeal carcinoma TNM staging and serious lesions.
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Affiliation(s)
- Ruimei Sun
- Department of Head and Neck Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China (mainland)
| | - Xiaoli Wang
- Department of Head and Neck Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China (mainland)
| | - Xiaojiang Li
- Department of Head and Neck Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China (mainland)
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