Bacterial Acute Otitis Media Complicated with Otorrhea in a Children’s Hospital in the Era of Pneumococcal Conjugate Vaccines

Acute otitis media (AOM) is a common disease among children and can be complicated by otorrhea (AOMO). In 2010, the 13-valent Pneumococcal Conjugate Vaccine (PCV13) replaced the 7-valent vaccine (PCV7) in Greece. We aimed to describe the microbiological profile of bacterial ΑOMO among children young...

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Main Authors: Irene Tzovara, Anastasios Doudoulakakis, Georgios Kalogeras, Emmanouil Koutouzis, Charilaos Dellis, Sophia Pasparakis, Marietta Charakida, Evangelia Lebessi, Elisavet Bozavoutoglou, Michael Tsakanikos, Vassiliki Syriopoulou, Maria Tsolia
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Language:English
Published: MDPI AG 2025-05-01
Series:Pathogens
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Online Access:https://www.mdpi.com/2076-0817/14/5/494
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author Irene Tzovara
Anastasios Doudoulakakis
Georgios Kalogeras
Emmanouil Koutouzis
Charilaos Dellis
Sophia Pasparakis
Marietta Charakida
Evangelia Lebessi
Elisavet Bozavoutoglou
Michael Tsakanikos
Vassiliki Syriopoulou
Maria Tsolia
author_facet Irene Tzovara
Anastasios Doudoulakakis
Georgios Kalogeras
Emmanouil Koutouzis
Charilaos Dellis
Sophia Pasparakis
Marietta Charakida
Evangelia Lebessi
Elisavet Bozavoutoglou
Michael Tsakanikos
Vassiliki Syriopoulou
Maria Tsolia
author_sort Irene Tzovara
collection DOAJ
description Acute otitis media (AOM) is a common disease among children and can be complicated by otorrhea (AOMO). In 2010, the 13-valent Pneumococcal Conjugate Vaccine (PCV13) replaced the 7-valent vaccine (PCV7) in Greece. We aimed to describe the microbiological profile of bacterial ΑOMO among children younger than 16 years across the two PCV periods in a tertiary children’s hospital. Middle ear fluid cultures from 2418 children with AOMO were collected from 2007 to 2022. Otopathogens were isolated and tested for antimicrobial susceptibility. Data were compared between the PCV7- (2007–2011) and PCV13-period (2012–2019). The most common otopathogen over the 16-year period was <i>S. pyogenes</i> (35.4%), followed by <i>H. influenzae</i> (33.8%), <i>S. pneumoniae</i> (26.6%), and <i>M. catarrhalis</i> (4.1%). Pneumococcal resistance to cefotaxime and clindamycin significantly increased from 2% to 4.5% (<i>p</i> = 0.019) and 16.1% to 22.8% (<i>p</i> = 0.039), respectively. Resistance of <i>H. influenzae</i> to ampicillin increased from 6.3% to 13.9% (<i>p</i> < 0.001). A significant reduction in cotrimoxazole-resistant <i>S. pneumoniae</i> from 31% to 22.4% (<i>p</i> = 0.012), and in clindamycin-resistant and erythromycin-resistant <i>S pyogenes</i>, from 17.4% to 9.3% and 21.4% to 10.8%, respectively (<i>p</i> ≤ 0.001), was observed. During 2013–2022, 38 <i>S. pneumoniae</i> serotypes were identified among 250 isolates. Serotype 3 (27.2%) and 19A (13.2%) prevailed, followed by 19F (7%). The most common causes after the shift to PCV13 are <i>S. pyogenes</i> and <i>H. influenzae</i>. However, <i>S. pneumoniae</i> remains an important otopathogen with significant antimicrobial resistance. Serotype 3 was mostly detected, followed by 19A.
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spelling doaj-art-10f4bdc6c68947d5a0adcec8a62d612b2025-08-20T03:47:54ZengMDPI AGPathogens2076-08172025-05-0114549410.3390/pathogens14050494Bacterial Acute Otitis Media Complicated with Otorrhea in a Children’s Hospital in the Era of Pneumococcal Conjugate VaccinesIrene Tzovara0Anastasios Doudoulakakis1Georgios Kalogeras2Emmanouil Koutouzis3Charilaos Dellis4Sophia Pasparakis5Marietta Charakida6Evangelia Lebessi7Elisavet Bozavoutoglou8Michael Tsakanikos9Vassiliki Syriopoulou10Maria Tsolia11First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, GreeceDepartment of Microbiology, “P. & A. Kyriakou” Children’s Hospital, 11527 Athens, GreeceDepartment of Microbiology, “P. & A. Kyriakou” Children’s Hospital, 11527 Athens, GreeceInfectious Diseases and Chemotherapy Research Laboratory, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, GreeceInfectious Diseases and Chemotherapy Research Laboratory, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, GreeceSecond Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “P. & A. Kyriakou” Children’s Hospital, 11527 Athens, GreeceSecond Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “P. & A. Kyriakou” Children’s Hospital, 11527 Athens, GreeceDepartment of Microbiology, “P. & A. Kyriakou” Children’s Hospital, 11527 Athens, GreeceDepartment of Microbiology, “P. & A. Kyriakou” Children’s Hospital, 11527 Athens, GreeceEar Nose and Throat Department, “P. & A. Kyriakou” Children’s Hospital, 11527 Athens, GreeceInfectious Diseases and Chemotherapy Research Laboratory, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, 11527 Athens, GreeceSecond Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “P. & A. Kyriakou” Children’s Hospital, 11527 Athens, GreeceAcute otitis media (AOM) is a common disease among children and can be complicated by otorrhea (AOMO). In 2010, the 13-valent Pneumococcal Conjugate Vaccine (PCV13) replaced the 7-valent vaccine (PCV7) in Greece. We aimed to describe the microbiological profile of bacterial ΑOMO among children younger than 16 years across the two PCV periods in a tertiary children’s hospital. Middle ear fluid cultures from 2418 children with AOMO were collected from 2007 to 2022. Otopathogens were isolated and tested for antimicrobial susceptibility. Data were compared between the PCV7- (2007–2011) and PCV13-period (2012–2019). The most common otopathogen over the 16-year period was <i>S. pyogenes</i> (35.4%), followed by <i>H. influenzae</i> (33.8%), <i>S. pneumoniae</i> (26.6%), and <i>M. catarrhalis</i> (4.1%). Pneumococcal resistance to cefotaxime and clindamycin significantly increased from 2% to 4.5% (<i>p</i> = 0.019) and 16.1% to 22.8% (<i>p</i> = 0.039), respectively. Resistance of <i>H. influenzae</i> to ampicillin increased from 6.3% to 13.9% (<i>p</i> < 0.001). A significant reduction in cotrimoxazole-resistant <i>S. pneumoniae</i> from 31% to 22.4% (<i>p</i> = 0.012), and in clindamycin-resistant and erythromycin-resistant <i>S pyogenes</i>, from 17.4% to 9.3% and 21.4% to 10.8%, respectively (<i>p</i> ≤ 0.001), was observed. During 2013–2022, 38 <i>S. pneumoniae</i> serotypes were identified among 250 isolates. Serotype 3 (27.2%) and 19A (13.2%) prevailed, followed by 19F (7%). The most common causes after the shift to PCV13 are <i>S. pyogenes</i> and <i>H. influenzae</i>. However, <i>S. pneumoniae</i> remains an important otopathogen with significant antimicrobial resistance. Serotype 3 was mostly detected, followed by 19A.https://www.mdpi.com/2076-0817/14/5/494acute otitis mediaotorrheapneumococcal conjugate vaccinepneumococcal serotypessurveillanceantibiotic resistance
spellingShingle Irene Tzovara
Anastasios Doudoulakakis
Georgios Kalogeras
Emmanouil Koutouzis
Charilaos Dellis
Sophia Pasparakis
Marietta Charakida
Evangelia Lebessi
Elisavet Bozavoutoglou
Michael Tsakanikos
Vassiliki Syriopoulou
Maria Tsolia
Bacterial Acute Otitis Media Complicated with Otorrhea in a Children’s Hospital in the Era of Pneumococcal Conjugate Vaccines
Pathogens
acute otitis media
otorrhea
pneumococcal conjugate vaccine
pneumococcal serotypes
surveillance
antibiotic resistance
title Bacterial Acute Otitis Media Complicated with Otorrhea in a Children’s Hospital in the Era of Pneumococcal Conjugate Vaccines
title_full Bacterial Acute Otitis Media Complicated with Otorrhea in a Children’s Hospital in the Era of Pneumococcal Conjugate Vaccines
title_fullStr Bacterial Acute Otitis Media Complicated with Otorrhea in a Children’s Hospital in the Era of Pneumococcal Conjugate Vaccines
title_full_unstemmed Bacterial Acute Otitis Media Complicated with Otorrhea in a Children’s Hospital in the Era of Pneumococcal Conjugate Vaccines
title_short Bacterial Acute Otitis Media Complicated with Otorrhea in a Children’s Hospital in the Era of Pneumococcal Conjugate Vaccines
title_sort bacterial acute otitis media complicated with otorrhea in a children s hospital in the era of pneumococcal conjugate vaccines
topic acute otitis media
otorrhea
pneumococcal conjugate vaccine
pneumococcal serotypes
surveillance
antibiotic resistance
url https://www.mdpi.com/2076-0817/14/5/494
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