TY - JOUR
T1 - Bacterial Reservoirs in the Middle Ear of Otitis-prone Children Are Associated with Repeat Ventilation Tube Insertion
AU - Seppanen, Elke J.
AU - Thornton, Ruth B.
AU - North, Hannah J.D.
AU - Corscadden, Karli J.
AU - Wiertsema, Selma P.
AU - Vijayasekaran, Shyan
AU - Coates, Harvey L.
AU - Jacoby, Peter
AU - Richmond, Peter C.
AU - Kirkham, Lea Ann S.
PY - 2020/2/1
Y1 - 2020/2/1
N2 - Background: Repeat ventilation tube insertion (VTI) is common in children with recurrent acute otitis media (rAOM). Identifying risk factors associated with repeat surgery will improve clinical management and prevent repeat VTI. Methods: Surgical records were assessed at 8 years following VTI surgery for rAOM in children 6-36 months of age. Children were grouped according to detection of bacterial otopathogen in their middle ear effusion (MEE) at the time of VTI, and outcomes for future otorhinolaryngology surgery compared. Results: Age, gender, pneumococcal vaccination status, antibiotic usage, day-care attendance, number of siblings and number of AOM episodes were similar between groups. Of the 63 children who had PCR +ve MEE, 58.7% required repeat VTI compared with 31.4% of the 51 children with no otopathogen detected in their MEE (odds ratio = 3.1, 95% confidence interval [1.4-6.8]; P = 0.004). Nontypeable Haemophilus influenzae (NTHi) was the predominant otopathogen in MEE (79% of all PCR +ve MEE). Respiratory virus detection was not associated with repeat VTI. Conclusions: Presence of bacterial otopathogen, specifically nontypeable H. influenzae, in the middle ear during VTI was a predictor of children at-risk of repeat VTI. Here, we identify a modifiable microbiologic factor for repeat VTI that can be targeted to improve clinical management of rAOM.
AB - Background: Repeat ventilation tube insertion (VTI) is common in children with recurrent acute otitis media (rAOM). Identifying risk factors associated with repeat surgery will improve clinical management and prevent repeat VTI. Methods: Surgical records were assessed at 8 years following VTI surgery for rAOM in children 6-36 months of age. Children were grouped according to detection of bacterial otopathogen in their middle ear effusion (MEE) at the time of VTI, and outcomes for future otorhinolaryngology surgery compared. Results: Age, gender, pneumococcal vaccination status, antibiotic usage, day-care attendance, number of siblings and number of AOM episodes were similar between groups. Of the 63 children who had PCR +ve MEE, 58.7% required repeat VTI compared with 31.4% of the 51 children with no otopathogen detected in their MEE (odds ratio = 3.1, 95% confidence interval [1.4-6.8]; P = 0.004). Nontypeable Haemophilus influenzae (NTHi) was the predominant otopathogen in MEE (79% of all PCR +ve MEE). Respiratory virus detection was not associated with repeat VTI. Conclusions: Presence of bacterial otopathogen, specifically nontypeable H. influenzae, in the middle ear during VTI was a predictor of children at-risk of repeat VTI. Here, we identify a modifiable microbiologic factor for repeat VTI that can be targeted to improve clinical management of rAOM.
KW - acute otitis media
KW - non-typeable Haemophilus influenzae
KW - otopathogen
KW - repeat surgery
KW - repeat ventilation tube insertion
KW - ventilation tube insertion
UR - http://www.scopus.com/inward/record.url?scp=85077798546&partnerID=8YFLogxK
U2 - 10.1097/INF.0000000000002541
DO - 10.1097/INF.0000000000002541
M3 - Article
C2 - 31725550
AN - SCOPUS:85077798546
SN - 0891-3668
VL - 39
SP - 91
EP - 96
JO - Pediatric Infectious Disease Journal
JF - Pediatric Infectious Disease Journal
IS - 2
ER -
