Background: CSOM is the most common notorious infection seen in developing countries which has led to a number of serious life threatening complications. The most common organism isolated in CSOM is Pseudomonas aeruginosa. Early and effective treatment based on the causing organism and its antibiotic sensitivity has helped in prevention of complications. The main objective of this study is to identify the prevalence of Pseudomonas aeruginosa in CSOM and to know their sensitivity pattern against the commonly prescribed antibiotics.

Material and Methods: A total of 130 patients with unilateral and bilateral CSOM were enrolled in the study. Samples were processed and organisms were identified by standard bacteriological methods. Antibiotic sensitivity testing was done according to CLSI guidelines. Sensitivity was tested for 11 different antibiotics by dividing into 6 classes.

Results: Of the total 130 samples collected, 40 (30.7%) showed growth of Pseudomonas aeruginosa. Sensitivity pattern of Pseudomonas aeruginosa showed that piperacillin was active against 90% of isolates followed by piperacillin+tazobactum 82.5% and meropenem 70%.

Conclusion: Pseudomonas aeruginosa was the most common bacteria isolated from CSOM followed by Staphylococcus aureus. Penicillin group of drugs were found to be most effective followed by carbapenem group. Pseudomonas aeruginosa showed high resistance to tobramycin. Continuous surveillance is hence necessary to monitor antimicrobial resistance and to guide in empirical treatment. 

Keywords: Chronic Suppurative Otitis Media, Pseudomonas aeruginosa Antibiogram.

1. Gates GA, Klein JO, Lim DJ, Mogi G, Ogra PL, Pararella MM, et al. Recent advances in otitis media. 1. Definitions, terminology, and classification of otitis media. Ann Otol Rhinol Laryngol Suppl 2002; 188: 8-18.
2. Morris PS, Leach AJ. Prevention and management of chronic suppurative otitis media in aboriginal children: A practical approach. Community Ear Hear Health. 2007;4:22-5.
3. Hart CA, Kariuki S. Antimicrobial resistance in developing countries. BMJ 1998;317:647–50.
4. Rout MR, Mohanty D, Vijaylaxmi Y, Kamalesh B, Chakradhar M. Prevalence of cholesteatoma in chronic suppurative otitis media with central perforation. Indian J Otol. 2012;18:7‑
5. Poorey VK, Thakur P. Clinicomicrobi-ological evaluation and antibiotic susceptibility in cases of chronic suppurative otitis media. Indian J Otol 2015;21:107-10.
6. Taneja M, Taneja MK. CSOM - A bacteriological study. Indian J Otol. 2009;15:3-7.
7. Poorey VK, Arati Iyer. Study of bacterial flora in CSOM and its clinical significance. Indian J Otolaryngol Head Neck Surg. 2002;54:91-5.
8. Loy AH, Tan AL, Lu PK. Microbiology of chronic suppurative otitis media in Singapore. Singapore Med J 2002;43:296-9.
9. Prakash R, Juyal D, Negi V, Pal S, Adekhandi S, Sharma M, et al. Microbiology of chronic suppurative otitis media in a tertiary care setup of uttarakhand state, India. N Am J Med Sci 2013;5:282-7.
10. Shazia Parveen SJ. Aerobic bacteriology of CSOM in a teaching  Microbiol Biotech Res.2012;2(4):1306-10.
11. Aduda DS, Macharia IM, Mugwe P, Oburra H, Farragher B, Brabin B, et al. Bacteriology of chronic suppurative otitis media (CSOM) in children in Garissa district, Kenya: A point prevalence study. Int J Pediatr Otorhinolaryngol 2013;77:1107-11.
12. Anwar-us-Salam, Abid SH, Abdulla EM. Suppurative Otitis in Karachi: An Audit of 510 Cases. Pak J Otolaryn 1997;13:66–9.
13. Asish J, Amar M, Vinay H, Sreekantha, Avinash SS, Amareshar M. To study the bacteriological and mycological profile of chronic suppurative otitis media patients and their antibiotic sensitivity pattern. Int J Pharma Bio Sci 2013;4:186-99.
14. Prakash M, Lakshmi K, Anuradha S, Swathi GN. Bacteriological profile and their antibiotic susceptibility pattern of cases of CSOM. Asian J Pharm Clin Res 2013;6:210-2.
15. Kumar H, Seth S. Bacterial and fungal study of 100 cases of chronic suppurative otitis media. J Clin Diagn Res 2011;5:1224-7.
16. Orji FT, Dike BO. Observations on the current bacteriological profile of chronic suppurative otitis media in Southeastern Nigeria. Ann Med Health Sci Res 2015;5:124-8.
17. Brook, S.M.Finegold, JAMA. 1979,2,241,5,487.
18. Shyamala R, Reddy SP. Incidence and sensitivity pattern of Pseudomonas aeruginosa in chronic suppurative otitis media in South Indian rural population. J Microbiol Biotech Res 2012;2:346-50.
19. Atanu Nandy,P.S Mllya,K.Sivarajan, Indian Journal of Otolaryngology and Head&Neck surgery, 1991,43,3,136.
20. Maninder Pal Singh, Harminder Prabhakar, Satya Arora India. J.Med.Microbiol,1985,3,177.
21. Ayyagiri, Pancholi, V.K.Pandhi, et al. Indian J Med Res,1981,73,860.
22. J .Gulati, P.L.Tandon, Waryan Singh,Indian Journal of Otolaryngology and Head & Neck surgery,1969,21,4,198.
23. Rao, C.S. Baskaran, Indian J Pathol Microl;1984,27,4,341.
24. A.Campos,J Chemother;1995,7,5,427.
25. Altuntas.Eur Arch Otorhinolaryngol 1996,253,6,364.
26. Collee JG, Miles RS, Watt B. Tests for identification of bacteria. In: Collee JG, Fraser AG, Marmion BP, Simmons A, Eds. Mackie & McCartney Practical Medical Microbiology, 14th edition. New York & London: Churchill Livingstone; 1996: 131-149.
27. Bailey, Scotts. Non fermentative gram negative Bacilli and coccobacilli. Diagnostic microbiology. 12 th edition. St. Louis, Missouri (US): Mosby Elsevier; 1990: 386-407.
28. Franklin R and Cockerill. Performance Standards for AST. CLSI 2012; 31 (1) 22nd Informational Suppl; M100-S22 .
29. National Committee for Clinical Laboratory Standards. Performance standards for antimicrobial disk susceptibility tests. 7th ed. Approved standard M2-A7. Wayne, Pa: The Committee; 2000.
30. Falagas ME, Koletsi PK, Bliziotis IA. The diversity of definitions of multidrug-resistant (MDR) and pandrug-resistant (PDR) Acinetobacter baumannii and Pseudomonas aeruginosa. J Med Microbiol 2006;55(Pt 12):1619-29.
31. Livermore DM. Multiple mechanisms of antimicrobial resistance in Pseudomonas aeruginosa: Our worst nightmare? Clin Infect Dis 2002;34:634-40.
32. Juyal D, Sharma M, Negi V, Prakash R, Sharma N. Pseudomonas aeruginosa and its sensitivity spectrum in chronic suppurative otitis media: A study from Garhwal hills of Uttarakhand State, India. Indian J Otol 2017;23:180-4.
33. Deshmukh KA, Manthale D. Prevalence and antibiotic susceptibility of Pseudomonas aeruginosa isolated from chronic suppurative otitis media. Int J Otorhinolaryngol Head Neck Surg 2017;3:56-60.
34. Kumar S, Sharma R, Saxena A, Pandey A, Gautam P, Taneja V. Bacterial flora of infected unsafe CSOM. Indian J Otol. 2012;18:208-11.
35. Nwokoye NN, Egwari LO, Coker AO, Olubi OO, Ugoji EO, Nwachukwu SC. Predisposing and bacteriological features of otitis media. Afr J Microbiol Res 2012;6:5205.
36. Attallah M. Microbiology of chronic Suppurative otitis media with cholesteatoma. Saudi Med J 2000; 21 : 924-7.
37. Osazuwa F, Osazuwa E, Osime C, Igharo EA, Imade PE, Lofor P, et al. Etiologic agents of otitis media in Benin city, Nigeria. N Am J Med Sci 2011;3:95-8.
38. Bairy I, Pradhan D, Yenigalla BM. Microbiology of chronic suppurative otitis media. lnt J Otol 2007;13:21-4.
39. Maji PK, Chatterjee TK, Chatterjee S, et al. The investigation of bacteriology of chronic suppurative otitis media in patients attending a tertiary care hospital with special emphasis on seasonal variation. Ind J Otolaryngol Head Neck Surg 2007;59(2):128-31.
40. Indudharan R, Haq JA, Aiyar S. Antibiotics in chronic suppurative otitis media: a bacteriologic study. Ann Otol Rhinol Laryngol 1999;108(5):440-5.
41. Ettehad GH, Refahi S, Nemmati A, Pirzadeh A, Daryani A. Microbial and antimicrobial susceptibility patterns from patients with chronic otitis media in Ardebil. Int J Trop Med 2006;1:62-5.
42. Nikakhlagh S, Khosravi AD, Fazlopour A, Safarzadeh M, Rashidi N. Microbiologic findings in patients with chronic suppurative otitis media. J Med Sci 2008;8:503-6.
43. Ajay K, Namrata K, Shailesh K, et al. Prevalence and antimicrobial sensitivity pattern of Pseudomonas aeruginosa from chronic suppurative otitis media (CSOM) cases in a tertiary care hospital of Bihar. J. Evolution Med. Dent. Sci. 2017;6(70): 5000-5003
44. Kim SH, Kim MG, Kim SS, Cha SH, Yeo SG. Change in detection rate of methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa and their antibiotic sensitivities in patients with chronic suppurative otitis media. J Int Adv Otol 2015;11:151-6.
45. Gellatly SL, Hancock RE. Pseudomonas aeruginosa: New insights into pathogenesis and host defenses. Pathog Dis 2013;67:159-73.
46. Iqbal SM, Udaipurwala IH, Hasan A, Shafiq M, Mughal S. Chronic suppurative otitis media: Disease pattern and drug sensitivity. J Surg Pak 2006;11:17–9.
47. Ahmed S, Iqbal MA, Hassan Z, Khurshid T, Ali L, Pervez Q. Spectrum and bacterial isolates in chronic suppurative otitis media in Khuzdar. Pak J Otolaryngol 2006;22:34–6.
48. Gul AA, Ali L, Rahim E, Ahmed S. Chronic suppurative otitis media; frequency of Pseudomonas aeruginosa in patients and its sensitivity to various antibiotics. Professional Med J 2007;14:411–5.
49. Ahmed A, Usman J, Hashim R. Isolates from chronic suppurative otitis media and their antimicrobial sensitivity. Pak Armed Forces Med J 1999;49:82–5.
50. Ayson AN, Lopez JEG, Llanes EGD. Chronic suppurative otitis media: bacteriology and drug sensitivity patterns at the Quirino memorial medical centre (2004-05): a preliminary study. Phillip J Otolaryngol Head Neck Surg 2006;21(1,2):20-3.
51. Somekh E, Cordova Z. Ceftazidime versus aztreonam in the treatment of pseudomonal chronic suppurative otitis media in children. Scand J Infect Dis 2000;32:197–9.

Dr. S. Soumya

Assistant Professor, Department of Microbiology, Jawaharlal Nehru Medical College,

KAHER University, Belgaum-590010, Karnataka, India

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