INTRODUCTION: Otitis media is the inammation of the middle ear cleft and the tympanum with otorrhoea lasting from 2 weeks to more than 3 months, with permanent perforation mainly caused by 1,2bacteria . Ear infection may be acute or chronic purulent 3type . About 65–330 million people suffer from ear infection 4worldwide and 60 % of them had signicant hearing loss . Even though ear infection is primarily a disease of infants and 5young children, it can also affect adults . The disease may begin in childhood or as a complication of untreated or inadequately treated acute suppurative otitis media or may 6be chronic from onset . The microorganisms may gain entry to the middle ear through a chronic perforation. Children tend to have higher predisposition to ear infection than adults because anatomy of the eustachian tube in children permits easier access of organism through the nasopharynx. 5,7Moreover, the incidence is higher in males than females . AOM is the most frequent reason of medical consultation and 8,9the main indication of antibiotic therapy in childhood . It usually occurs between the age of 3 months and 3 years, with a peak of incidence from 6 to 11 months. By the age of 3 years, up 10,11to 80% of all children have suffered at least once from AOM . About 40% have had six or more AOMs by their seventh year of 12life . The global incidence has doubled from 1970 to 1990 and was recently calculated to be 10.85% or 709 million per year, varying from 3.64% in central Europe to 43.37% in central 8,12Africa . CSOM usually develops in the rst years of life but can persist during adulthood. The disease affects 65–330 million people worldwide, mainly in developing countries. It has been estimated that there are 31 million new cases of CSOM per 12year, with 22.6�% in children less than 5 years old . A cross- sectional study of bacterial microbiota in middle ear, adenoid and tonsil specimens from a paediatric patient with chronic serous OM utilizing 16S rRNA gene-based pyrosequencing analysis revealed Pseudomonas spp. as the most common pathogen present in the middle ear, whereas Streptococcus spp. dominated the tonsil microbiota at relative abundance 13rates of 82.7 and 69.2� %, respectively . Bacteroides spp., Clostridium spp., Peptococcus spp., Peptostreptococcus spp., Prevetolla melaninogenica and Fusobacterium spp. are 14,15anaerobic pathogens that can cause CSOM . MATERIALS AND METHOD: Patients with ear problems coming to regional hospital Bilaspur from surrounding rural areas of Bilaspur, Solan, Hamirpur and Mandi Districts, constituted the study subjects. A total of 40 subjects with otitis media infection were included in the study. According to the age, the patients were grouped into 1–17 years and 19–30 years. The specimens collected from patients with ear exudates by using sterile cotton swabs under strict aseptic precautions and assist of aural speculum then processed immediately in the Lab. of microbiology. Age and sex proles and results of bacterial isolates and drug susceptibility of patients who had ear infection were retrieved. Ear discharge samples were inoculated on MacConkey agar, Blood agar, Mannitol Salt agar and Chocolate agar. All of the inoculated media were incubated at 37 °C for 18–24 h. Bacterial species were identied by standard microbiological methods manually. Susceptibility testing was done on Mueller–Hinton agar using 16disk diffusion technique according to Kirby–Bauer Method . The antimicrobial agents tested were: benzyl penicillin, ampicillin, tetracyclin, erythro, gentamicin, clindamycin, tmp/smx, amoxyclav, ciproox, levoox, pip/taz, cefuroxime, ceftriaxone, cefoperazone/sulb, amikacin, ertapenem, imipenem, l inezolid and cefepime. The antibiotic susceptibility proles were interpreted based on Clinical and Laboratory Standards Institute (CLSI 2014) guidelines. RESULTS: A total of 40 patients from clinically suspected patients of otitis media were tested and analyzed. Of them, 18 were children with age group 1-17 yrs and 22 were adult with 19-30 yrs of age. Out of 18 children 9(50%) were male and 9 (50%) were female. Out of 22 adult patients 8(36.4%) male and 14(63.6%). Out of 18 children 17 (94.4%) had microbial growth (no growth was present in 1 male patient), and all 22 (100%) adult patients had microbial growth (Table 1). In children (Figure-1), The most frequent bacterial isolates were staphylococcus aureus 10 (55.5%), followed by escherichia coli in 2(11%), pseudomonas aeruginosa 1(5%) and proteus mirabilis 1(5%). In adults (Figure-2), The most frequent bacterial isolates were staphylococcus aureus in 6(27.2%), followed by pseudomonas aeruginosa in 5(22.7%), klebsiella pneumonia in 3(13.6%), staphylococcus epidermidis in 3(13.6%), and staphylococcus saprophyticus in 1(4.5%). In children out of 10 S. aureus isolates, 9 (90%) were resistant to benzyl penicillin, 8 (80%) each for erythromycin, INFECTIVE PROFILE OF EAR INFECTIONS IN PEDIATRIC VS ADULTS Original Research Paper Dr Ankur Dharmani MD Pediatrics Regional Hospital, Bilaspur, Himachal Pradesh, India Medicine Introduction: Even though ear infection is primarily a disease of infants and young children, it can also affect adults. Materials and method: A total of 40 subjects with otitis media infection were included in the study. Patients were grouped into 1–17 years and 19–30 years. Bacterial species were identied by standard microbiological methods manually. Results: The most frequent bacterial isolates were staphylococcus aureus in children 10 (55.5%) and adults 6(27.2%). Conclusion: Predominant bacterial isolate was S. aureus in both adults and children, however there were more S. aureus in children than adults. ABSTRACT KEYWORDS : VOLUME-9, ISSUE-1, JANUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Dr Sonia Kashyap MD Internal Medicine DDU Hospital, Shimla, Himachal Pradesh, India Dr Manjeet Singh* MS ENT Regional Hospital Bilaspur Himachal Pradesh, India *Corresponding Author 44 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS clindamycin, ciproox, and levoox, 4(40%) for TMP/ SMX, and 1(10%) for teracyclin. Out of 2 escherichia coli isolates, 1(50%) each was resistant to ampicillin, ciproox, levoox, cefuroxime, and cefuroxime. Out of 2 isolates of staphylococcus epidermidis 2(100%) were resistant to benzyl penicillin, erythromycin, and ciproox. 1(50%) were resistant to teracyclin, clindamycin, TMP/ SMX and levoox. There were no resistant in pseudomonas aeruginosa isolates. 1 isolate of proteus mirabilis were showing resistant in ampicillin, PIP/TAZ, cefuroxime, ceftriaxone, imipenem, and cefepime (Table-3). In adult patients, out of 6 S. aureus isolates, 6(100%) each were resistant for ciproox and levoox, 5(83.3%) for erythromycin, 4(66.6%) for clindamycin and benzyl penicillin, 3 (50%) for TMP/CMX, 2(33.3%) each for ampicillin and amoxyclav, and 1(16.6%) for cefuroxime. Out of 5 pseudomonas aeruginosa isolates 1(20%) each were resistant for benzyl penicillin, erythromycin, clindamycin, ciproox, levoox. Out of 3 klebsiella pneumonia isolates 3(100%) each were resistant for ampicillin, and cefuroxime. 1(33.3%) each of TMP/ CMX and ceftriaxone. Out of 3 staphylococcus epidermidis isolates 2(66.6%) each were resistant to benzyl penicillin, erythromycin and TMP/ CMX. 1 isolate of staphylococcus saprophyticus were 1(100%) resistant to benzyl penicillin and TMP/CMX (Table-4). DISCUSSION: A total of 40 patients from clinically suspected patients of otitis media were included in our study with 18 were children with age group 1-17 yrs and 22 adult patients with 19-30 yrs of age. Out of 18 children 9(50%) were male and 9 (50%) were female. Out of 22 adult patients 8(36.4%) male and 14(63.6%) (Table- 171). In the study by Derese Hailu et al ., in 2016, 368 patients were included in the study with age range from 1-72 years. Of them, 205 (55.7 %) were males and 163 (44.3 %) female 3patients. Araya Gebereyesus Wasihun et al ., in 2015, total 162 patients were included in the study with age range 3 months to 69 years, 105 (64.8 %) of them were males and 57 19(35.2 %) females. In the Chandima P. Karunanayake, et al ., in 2016, There were 2082 Caucasian children who participated in the study, with age range 6–17 years, 1025 (49.2%) male and 1057 (50.8%) female. In the study by Kasahun Gorems et 20al ., in 2018, Among 173 otitis media patients participated in the study; majority, 102(63%) were pediatrics Out of 18 children 17 (94.4%) had microbial growth (no growth was present in 1 male patient), and all 22 (100%) adult patients had microbial growth. According to the study by Derese Hailu 17et al ., in 2016 Overall, 296 (80.4 %) of otitis media had microbial isolates. In the study by Araya Gebereyesus 3Wasihun et al ., in 2015, pathogens were isolated from 157 20(98.2 %), Kasahun Gorems et al ., in 2018, Pathogens were isolated from 160 (92.5%) of the patients. According to our study in children (Figure-1), The most frequent bacterial isolates were staphylococcus aureus 10 (55.5%), followed by escherichia coli in 2(11%), pseudomonas aeruginosa 1(5%) and proteus mirabilis 1(5%). In adults (Figure-2), The most frequent bacterial isolates were staphylococcus aureus in 6(27.2%), followed by pseudomonas aeruginosa in 5(22.7%), klebsiella pneumonia in 3(13.6%), staphylococcus epidermidis in 3(13.6%), and staphylococcus saprophyticus in 1(4.5%). In the study by Kasahun Gorems et 20al ., in 2018 (Figure-3), The predominant isolate was Staphylococcus aureus (30.72%) followed by Proteus spp. 17(17.89%). According to the study by Derese Hailu et al ., in 2016 (Figure-4) The most frequent bacterial isolates were P. aeruginosa 88 (30.4 %) followed by S. aureus 78 (26.9 %) and Proteus spp. 65 (22.3 %). In our study in children out of 10 (45.5%) S. aureus isolates, 9 (90%) were resistant to benzyl penicillin, 8 (80%) each for erythromycin, clindamycin, ciproox, and levoox, 4(40%) for TMP/ SMX, and 1(10%) for teracyclin. Out of 2 escherichia coli isolates, 1(50%) each was resistant to ampicillin, ciproox, levoox, cefuroxime, and cefuroxime. Out of 2 isolates of staphylococcus epidermidis 2(100%) were resistant to benzyl penicillin, erythromycin, and ciproox. 1(50%) were resistant to teracyclin, clindamycin, TMP/ SMX and levoox. There were no resistant in pseudomonas aeruginosa isolates. 1 isolate of proteus mirabilis were showing resistant in ampicillin, PIP/TAZ, cefuroxime, ceftriaxone, imipenem, and cefepime. As per our study In adult patients, out of 6 S. aureus isolates, 6(100%) each were resistant for ciproox and levoox, 5(83.3%) for erythromycin, 4(66.6%) for clindamycin and benzyl penicillin, 3 (50%) for TMP/CMX, 2(33.3%) each for ampicillin and amoxyclav, and 1(16.6%) for cefuroxime. Out of 5 pseudomonas aeruginosa isolates 1(20%) each were resistant for benzyl penicillin, erythromycin, clindamycin, ciproox, levoox. Out of 3 klebsiella pneumonia isolates 3(100%) each were resistant for ampicillin, and cefuroxime. 1(33.3%) each of TMP/ CMX and ceftriaxone. Out of 3 staphylococcus epidermidis isolates 2(66.6%) each were resistant to benzyl penicillin, erythromycin and TMP/ CMX. 1 isolate of staphylococcus saprophyticus were 1(100%) resistant to benzyl penicillin and TMP/CMX. 3According to Araya Gebereyesus Wasihun et al ., in 2015, The highest number of bacteria 98 (45.3 %) were isolated in the age group of 0–5 years (p = 0.02). S. aureus, P. mirabilis, P. aeruginosa, S. pyogenes, S. pneumoniae and H. inuenzae were the dominant bacterial isolates in this age group. Of 46 S. aureus isolates, 100 % were resistant to ampicillin, tetracycline and penicillin (100 % each), (67.4 %) to ceftriaxone and (63 %) to doxycycline. Less resistance was observed to ciprooxacin, gentamicin, erythromycin and noroxacin. P. aeruginosa was resistant to tetracycline, ampicillin, nitrofurantonin (100 % each), 96.3 % to penicillin and amoxicillin clavulanic acid (88.9 %). Similarly, E. coli showed 50 % resistance to doxycycline, and ampicillin and nitrofurantonin (83.3 % each). In our study there are more s. aureus isolates specially in children, Findlay and Janz showed that, among children aged 0 to 3 years, 46% of First Nations children living off reserve had an ear infection compared to 40% of all Canadian children 20within the same age range . These results are similar to ndings from other studies reporting that most children will 21,22have had an ear infection by their third birthday . CONCLUSION: In conclusion, bacterial ear infection is a major health problem in the study area. Predominant bacterial isolate was S. aureus in both adults and children, however there were more S. aureus in children than adults. The bacteria which have been isolated from otitis media have shown high level of antibiotics resistance in the study area. Majority of the bacterial isolates had multiple antibiotic resistant patterns. Hence antibiotics susceptibility test is mandatory before prescribing any antibiotics. Akhnowledgement: First authors: Dr Ankur Dharmani, Dr Sonia Kashyap Table 1: Socio-demographic characteristics and clinical manifestations of patients VOLUME-9, ISSUE-1, JANUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Children (n=18) Adult (n=22) Sex (male) 9(50%) 8(36.4%) Age 1-17 yrs 19-30 yrs ASOM 11 (61%) 8(36.4%) CSOM 6(33.3%) 14(63.6%) EAC FURUNCULOSIS 1 0 X 45GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Fig 1 bacterial isolates in children Figure:2 bacterial isolates in adult Figure:3 predominant bacterial isolates in the study by Kasahun Gorems et al., in 2018 Figure:4 predominant bacterial isolates in the study by Derese Hailu et al., in 2016 VOLUME-9, ISSUE-1, JANUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Table 2 Resistance pattern of antimicrobial agents (%) in children BP AMP TC ERY CM TMP/ SMX CF LF PIP/TAZ CFU CFX CFP/ SULB IMI CFP pseudomonas aeruginosa (n=1) 0 0 0 0 0 0 escherichia coli (n=2) - 1(50%) - - - 0 1(50%) 1(50%) 0 1(50%) 1(50%) 0 0 0 staphylococc us aureus (n=10) 9 (90%) - 1(10%) 8 (80%) 8(80%) 4(40%) 8(80%) 8(80%) - - - - - - proteus mirabilis (n=1) 1(100%) 0 0 1(100%) 1(100%) 1(100%) 1(100%) 1(100%) 1(100%) staphylococc us epidermidis (n=2) 2(100%) 1(50%) 2(100%) 1(50%) 1(50%) 2(100%) 1(50%) BP: benzyl penicillin, AMP: ampicillin, TC: teracyclin, ERY: erythromycin, CM: clindamycin, CF : ciproox, LF: levoox, CFU : cefuroxime, CFX : ceftriaxone, IMI : imipenem, CFP: cefepime Table 3 : Resistance pattern of antimicrobial agents (%) in adults BP AMP ERY CM TMP/ CMX AMXC CF LF CFU CFX pseudomonas aeruginosa (n=5) 1(20%) - 1(20%) 1(20%) 0 1(20%) 1(20%) - - staphylococcus aureus (n=6) 4(66.6%) 2(33.3%) 5(83.3%) 4(66.6%) 3 (50%) 2(33.3%) 6(100%) 6(100%) 1(16.6%) 0 staphylococcus saprophyticus (n=1) 1(100%) - 0 0 1(100%) - 0 0 - - klebsiella pneumonia (n=3) - 3(100%) - - 1(33.3%) 0 0 - 3(100%) 1(33.3%) staphylococcus epidermidis(n=3) 2(66.6%) - 2(66.6%) 3(100%) 2(66.6%) - 1(33.3%) 1(33.3%) - - BP: benzyl penicillin, AMP: ampicillin, TC: teracyclin, ERY: erythromycin, CM: clindamycin, AMXC: amoxyclav, CF : ciproox, LF: levoox, CFU : cefuroxime, CFX : ceftriaxone REFERENCES: 1. 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