Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
Department of Otolaryngology Head and Neck Surgery, Addenbrooke's Hospital, Cambridge, UK.
Clin Otolaryngol. 2023 Sep;48(5):740-747. doi: 10.1111/coa.14071. Epub 2023 May 14.
Acute otitis media (AOM) and otitis externa (OE) are common ear infections which may warrant antibiotic therapy. For many infections, there is a rise in antimicrobial resistance, which is associated with treatment failure, morbidity, prolonged hospitalisation and mortality. This study aimed to identify longitudinal changes in microbiology and antimicrobial resistance in aural swabs taken from patients with AOM or OE.
Retrospective observational analysis.
Aural samples processed at Manchester Medical Microbiology Partnership Laboratories between January 2008 and December 2018 were analysed to record organism isolated and antimicrobial sensitivity.
Individual aural swabs from 7200 patients.
Changes in the incidence of organisms and antimicrobial resistance between two time periods (2008-2012 and 2013-2018) were compared using the chi-squared test (alpha = 0.05).
From 7200 swabs, 2879 (40%) were from children. The most frequently isolated organisms were Staphylococcus aureus (25%), Pseudomonas aeruginosa (24.4%), yeast (9.1%), mixed anaerobes (7.9%) and Haemophilus influenzae (6.1%). In children aged 0-4 years, H. influenzae had particularly high incidence (25%). Overall, the incidence of P. aeruginosa decreased significantly with time (p = 0.05). Isolates displaying resistance to one or more antimicrobial agents increased significantly in number in the second time period for P. aeruginosa (p = 0.04) and H. influenzae (p = 0.03). There was increased resistance to amoxicillin for P. aeruginosa (p = 0.01) and to erythromycin for H. influenzae (p < 0.01).
Variations in type and frequency of organisms with increasing age likely result from differences in the preponderance of AOM compared to OE in children versus adults. We found increasing antimicrobial resistance for two organisms commonly isolated from AOM and OE infections, suggesting that aspects of current UK treatment practices and national recommendations may need to be revised.
急性中耳炎（AOM）和外耳炎（OE）是常见的耳部感染，可能需要抗生素治疗。对于许多感染，抗菌药物耐药性呈上升趋势，这与治疗失败、发病率、住院时间延长和死亡率有关。本研究旨在确定从患有 AOM 或 OE 的患者的耳拭子中分离出的微生物和抗菌药物耐药性的纵向变化。
回顾性观察分析。
2008 年 1 月至 2018 年 12 月在曼彻斯特医学微生物学合作实验室处理的耳样被分析，以记录分离出的病原体和抗菌药物敏感性。
7200 名患者的单个耳拭子。
使用卡方检验（alpha = 0.05）比较两个时间段（2008-2012 年和 2013-2018 年）之间病原体和抗菌药物耐药性的发生率变化。
7200 个拭子中，2879 个（40%）来自儿童。最常分离出的病原体是金黄色葡萄球菌（25%）、铜绿假单胞菌（24.4%）、酵母（9.1%）、混合厌氧菌（7.9%）和流感嗜血杆菌（6.1%）。在 0-4 岁的儿童中，流感嗜血杆菌的发病率特别高（25%）。总体而言，铜绿假单胞菌的发病率随时间显著下降（p = 0.05）。第二个时间段内，对一种或多种抗菌药物显示耐药性的分离株数量显著增加，铜绿假单胞菌（p = 0.04）和流感嗜血杆菌（p = 0.03）。铜绿假单胞菌对阿莫西林的耐药性（p = 0.01）和流感嗜血杆菌对红霉素的耐药性（p < 0.01）增加。
随着年龄的增长，病原体的类型和频率发生变化，这可能是由于儿童 AOM 与成人 OE 的发病率不同所致。我们发现两种常见于 AOM 和 OE 感染的病原体的抗菌药物耐药性增加，这表明英国目前的治疗实践和国家推荐可能需要修订。
