Is Multidrug Resistance in Acute Otitis Media with Streptococcus pneumoniae Associated with a More Severe Disease?

Abstract

<b><i>Objectives:</i></b> <i>Streptococcus pneumoniae</i> is the leading bacterial etiologic agent in acute otitis media (AOM), and it produces a more severe inflammatory response than other otopathogens. Additionally, the presence of multidrug-resistant (MDR) <i>S. pneumoniae</i> is an important issue in the management of AOM. The present pilot study aimed to ascertain whether MDR <i>S. pneumoniae</i> is associated with a higher inflammatory response and/or a more severe disease. <b><i>Methods:</i></b> This was a prospective, single-center study on nonpneumococcal conjugate vaccine-immunized pediatric patients with severe AOM. Demographic and clinical characteristics were recorded. Middle ear fluid was obtained and cultured for each patient; antibiotic-resistance profiling was tested for <i>S. pneumoniae</i> isolates. The C-reactive protein (CRP) level and complete blood count were determined. Patients with positive middle ear fluid culture for <i>S. pneumoniae</i> were divided into 2 groups according to antibiotic resistance profile: MDR and non-MDR. <b><i>Results:</i></b> MDR <i>S. pneumoniae</i> was identified in 15 (35.7%) of the 42 eligible patients. Children in this group had significantly higher CRP levels (72.23 ± 62.92 vs. 14.96 ± 15.57 mg/L, <i>p</i> &#x3c; 0.001), higher absolute neutrophil count (8.46 ± 3.97 vs. 5.22 ± 4.5 × 10³/mm³, <i>p</i> = 0.004), higher percentage of neutrophils (52.85 ± 13.49% vs. 38.34 ± 16.16%, <i>p</i> = 0.004), and were more prone to develop acute mastoiditis (<i>p</i> = 0.01). Receiver operating characteristic analysis identified CRP as the best biomarker to discriminate between the 2 groups of patients (AUC = 0.891). <b><i>Conclusion:</i></b> MDR <i>S. pneumoniae</i> was associated with a more severe inflammatory response and a higher incidence of mastoiditis.