Mushi Martha F, Mwalutende Alfred E, Gilyoma Japhet M, Chalya Phillipo L, Seni Jeremiah, Mirambo Mariam M, Mshana Stephen E
Department of Surgery, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. BOX 1464, Mwanza, Tanzania.
BMC Ear Nose Throat Disord. 2016 Jan 7;16:1. doi: 10.1186/s12901-015-0021-1. eCollection 2016.
Chronic suppurative otitis media (CSOM) is a major health problem in developing countries causing hearing loss and life threatening complications. Early and effective treatment based on the knowledge of causative micro-organisms and predictors of outcome are crucial in preventing these associated complications. This study was conducted to determine the predictors of CSOM complications, treatment outcome and antimicrobial susceptibility of pathogens, thus providing essential evidence to formulate a policy for management of CSOM.
This was a prospective hospital based cross sectional study involving 301 patients attending Ear Nose and Throat (ENT) clinics at Bugando Medical Centre (BMC) between October 2013 and March 2014. A standardized data collection tool was used to collect demographics and clinical characteristics of patients with CSOM. Ear swabs were collected using sterile cotton swabs and transported to the laboratory for culture and antibiotic susceptibility testing.
Out of 301 patients with CSOM; 187 (62.1 %) had positive aerobic culture within 48 h of incubation. Disease complications and poor treatment outcome were observed in 114 (37.8 %, 95 % CI; 32.2-43.3) and 46 (15.3 %, 95 % CI; 11.2-19.3) respectively. On multivariate logistic regression analysis factors found independently to predict both disease complications and poor treatment outcome were otalgia, being infected by multi drug resistant bacteria and being HIV positive. Prolonged illness duration before seeking medical attention was also found to be associated with disease complications (OR 1.029, 95 % CI 1.007-1.05, p = 0.01). A total of 116 (61 %) of gram negative bacteria were isolated. Of 34 Staphylococcus aureus, 14 (41 %) were found to be methicillin resistant Staphylococcus aureus (MRSA) while of 116 g negative enteric bacteria, 49 (42 %) were extended spectrum beta lactamases producers (ESBL).
Findings of this study suggest that positive HIV status, infection due to multidrug resistant pathogens and otalgia are significantly associated with disease complications and poor treatment outcome. Of great importance this study confirms that prolonged illness duration without seeking medical attention significantly predicts disease complications. Urgent preventive measures and laboratory guided early treatment are necessary to reduce complications associated with CSOM.
慢性化脓性中耳炎（CSOM）是发展中国家的一个主要健康问题，可导致听力丧失和危及生命的并发症。基于对致病微生物的了解和预后预测因素进行早期有效治疗对于预防这些相关并发症至关重要。本研究旨在确定CSOM并发症的预测因素、治疗结果及病原体的抗菌药敏性，从而为制定CSOM管理策略提供重要依据。
这是一项基于医院的前瞻性横断面研究，研究对象为2013年10月至2014年3月期间在布甘多医疗中心（BMC）耳鼻喉科门诊就诊的301例患者。使用标准化数据收集工具收集CSOM患者的人口统计学和临床特征。用无菌棉拭子采集耳拭子并送至实验室进行培养和抗生素药敏试验。
在301例CSOM患者中，187例（62.1%）在培养48小时内有氧培养呈阳性。分别有114例（37.8%，95%CI；32.2 - 43.3）和46例（15.3%，95%CI；11.2 - 19.3）观察到疾病并发症和治疗效果不佳。多因素逻辑回归分析发现，独立预测疾病并发症和治疗效果不佳的因素为耳痛、感染多重耐药菌和HIV阳性。就医前病程延长也与疾病并发症相关（OR 1.029，95%CI 1.007 - 1.05，p = 0.01）。共分离出116株（61%）革兰阴性菌。在34株金黄色葡萄球菌中，14株（41%）为耐甲氧西林金黄色葡萄球菌（MRSA），而在116株革兰阴性肠道菌中，49株（42%）为超广谱β-内酰胺酶产生菌（ESBL）。
本研究结果表明，HIV阳性、多重耐药病原体感染和耳痛与疾病并发症及治疗效果不佳显著相关。本研究非常重要地证实，病程延长而未就医是疾病并发症的显著预测因素。采取紧急预防措施和实验室指导下的早期治疗对于减少与CSOM相关的并发症是必要的。
