Mujahid Zaaraasmat Ahesannawaz, Palal Shilpa Saji, Gopan Gopika, Ramabhadraiah Anil Kumar
Department of Otorhinolaryngology, Bangalore Medical College and Research Institute, Bangalore, Karnataka India.
Indian J Otolaryngol Head Neck Surg. 2024 Oct;76(5):3886-3894. doi: 10.1007/s12070-024-04737-1. Epub 2024 May 27.
Chronic Suppurative Otitis Media (CSOM) is an inflammation of the mucoperiosteal lining of the middle ear cleft. Recently, biofilms have been discovered to play a pivotal role in the pathogenesis of CSOM. A biofilm is a bacterial aggregation that adheres to the mucosal surfaces and is connected with an extracellular matrix. Biofilms enhance antibiotic resistance, facilitate genetic alterations and amplify competence to combat host immunity. This study aims to identify the spectrum of biofilm-producers in CSOM and investigate their antibiotic sensitivity. Samples (648) were obtained from the deeper part of external auditory meatus of patients with CSOM. Pus samples were collected and processed for culture sensitivity. Biofilms detected. The findings were compiled and statistically analyzed. Out of 500 culture-positive samples, most commonly isolated bacteria was Pseudomonas (62.6%), followed by MRSA (13.8%). Biofilm-producers were 350, with 119 being strong, 167 moderate, and 64 weak. Biofilms were produced by 70% of the isolates, with Pseudomonas producing the most (74.6%), followed by MRSA. Gentamicin was the most effective antibiotic against biofilm-producers. Amoxicillin-Clavulanic Acid, Ceftriaxone, Cefuroxime, and Minocyclin were resistant. Pseudomonas had the highest sensitivity to Levofloxacin (96.6%), followed by Ceftazidime and Ciprofloxacin. Pseudomonas was resistant to Cefuroxime, Amoxicillin-Clavulanic acid and Linezolid. Multi-drug resistance has been widespread among CSOM causal species, particularly in biofilm producers. Thus, screening for biofilm formation, in addition to the standard antibiogram, must be undertaken as part of CSOM protocol. This will address the multi-drug resistance and select an appropriate treatment modality.
慢性化脓性中耳炎（CSOM）是中耳裂黏膜骨膜衬里的一种炎症。最近，生物膜已被发现在CSOM的发病机制中起关键作用。生物膜是一种细菌聚集体，附着于黏膜表面并与细胞外基质相连。生物膜增强抗生素耐药性，促进基因改变并增强对抗宿主免疫的能力。本研究旨在确定CSOM中生物膜产生菌的种类，并调查它们的抗生素敏感性。从CSOM患者外耳道深部获取样本（648份）。收集脓液样本并进行培养敏感性检测，检测生物膜。对结果进行汇总并统计分析。在500份培养阳性样本中，最常分离出的细菌是铜绿假单胞菌（62.6%），其次是耐甲氧西林金黄色葡萄球菌（MRSA，13.8%）。产生生物膜的菌株有350株，其中强生物膜产生菌119株，中度生物膜产生菌167株，弱生物膜产生菌64株。70%的分离株产生生物膜，其中铜绿假单胞菌产生生物膜的比例最高（74.6%），其次是MRSA。庆大霉素是对抗生物膜产生菌最有效的抗生素。阿莫西林-克拉维酸、头孢曲松、头孢呋辛和米诺环素耐药。铜绿假单胞菌对左氧氟沙星的敏感性最高（96.6%），其次是头孢他啶和环丙沙星。铜绿假单胞菌对头孢呋辛、阿莫西林-克拉维酸和利奈唑胺耐药。多重耐药在CSOM致病菌种中广泛存在，尤其是在生物膜产生菌中。因此，除了标准的药敏试验外，作为CSOM诊疗方案的一部分，必须进行生物膜形成的筛查。这将解决多重耐药问题并选择合适的治疗方式。
