Chronic Suppurative Otitis Media: A Case Report

Author(s): M.M. Karimi Yazdi, Zohreh Ghalavand, Alireza K. Yazdi, Mansoor Kodori, Marzieh Taheri, Mahboobeh S. Tabriz, Gita Eslami*

Journal Name: Infectious Disorders - Drug Targets
Formerly Current Drug Targets - Infectious Disorders

Volume 20 , Issue 2 , 2020

Become EABM
Become Reviewer
Call for Editor


Background Context: Chronic Suppurative Otitis Media (CSOM) is a common cause of hearing impairment and disability. CSOM caused by Pseudomonas aeruginosa is usually treated with topical ciprofloxacin and resistance to ciprofloxacin in CSOM isolates has rarely been reported.

Case Presentation: A 24-year-old male patient with CSOM due to p. aeruginosa was reported. CSOM was prolonged for ten years and physician prescribed topical ciprofloxacin drops, pus suctioning and ear pH alteration. The treatment wasn’t effective and the patient came back to the clinic with relapse of suppurative otitis media. P. aeruginosa was isolated as the cause of CSOM and the isolate was resistant to ciprofloxacin, aztreonam, imipenem, gentamicin, doripenem, cefepime, levofloxacin, amikacin and susceptible to colistin and ceftazidime. There were two mutations in gyrA and eight mutations were observed in nfxB genes. Finally, tympanomastoidectomy was done.

Conclusion: Usually topical antibiotics, especially ciprofloxacin, is effective against ear infections but our case was different and the P. aeruginosa isolated from CSOM was resistant to most of the antibiotics. One reason for CSOM recurrence might be surgery failure. The routine and primary treatment for CSOM did not seem sufficient and tympanomastoidectomy is suggested to be the best treatment approach for these patients.

Keywords: Pseudomonas aeruginosa, fluoroquinolones resistance, suppurative otitis media, tympanomastoidectomy, CSOM, chronic.

Shyamala, R.; Reddy, P.S. The study of bacteriological agents of chronic suppurative otitis media-aerobic culture and evaluation. J. Microbiol. Biotech. Res., 2017, 2(1), 152-162.
Schilder, A.G.; Chonmaitree, T.; Cripps, A.W.; Rosenfeld, R.M.; Casselbrant, M.L.; Haggard, M.P.; Venekamp, R.P. Otitis media. Nat. Rev. Dis. Primers, 2016, 2, 16063.
[] [PMID: 27604644]
Chong, LY.; Head, K.; Richmond, P.; Snelling, T.; Schilder, AG.; Burton, MJ. Systemic antibiotics for chronic suppurative otitis media. Cochrane Database Syst. Rev., 2018, 2018(6)CD013052
Monasta, L.; Ronfani, L.; Marchetti, F.; Montico, M.; Vecchi Brumatti, L.; Bavcar, A.; Grasso, D.; Barbiero, C.; Tamburlini, G. Burden of disease caused by otitis media: systematic review and global estimates. PLoS One, 2012, 7(4)e36226
[] [PMID: 22558393]
Mittal, R.; Lisi, C.V.; Gerring, R.; Mittal, J.; Mathee, K.; Narasimhan, G.; Azad, R.K.; Yao, Q.; Grati, M.; Yan, D.; Eshraghi, A.A.; Angeli, S.I.; Telischi, F.F.; Liu, X.Z. Current concepts in the pathogenesis and treatment of chronic suppurative otitis media. J. Med. Microbiol., 2015, 64(10), 1103-1116.
[] [PMID: 26248613]
Yorgancılar, E.; Yildirim, M.; Gun, R.; Bakir, S.; Tekin, R.; Gocmez, C.; Meric, F.; Topcu, I. Complications of chronic suppurative otitis media: a retrospective review. Eur. Arch. Otorhinolaryngol., 2013, 270(1), 69-76.
[] [PMID: 22249835]
Madana, J.; Yolmo, D.; Kalaiarasi, R.; Gopalakrishnan, S.; Sujatha, S. Microbiological profile with antibiotic sensitivity pattern of cholesteatomatous chronic suppurative otitis media among children. Int. J. Pediatr. Otorhinolaryngol., 2011, 75(9), 1104-1108.
[] [PMID: 21715027]
Pealskulrat, B. Bacteriology of Chronic Suppurative Otitis Media., 2011.
Vishwanath, S.; Mukhopadhyay, C.; Prakash, R.; Pillai, S.; Pujary, K.; Pujary, P. Chronic suppurative otitis media: optimizing initial antibiotic therapy in a tertiary care setup. Indian J. Otolaryngol. Head Neck Surg., 2012, 64(3), 285-289.
[] [PMID: 23998037]
Nguyen, K.V.; Nguyen, T.V.; Nguyen, H.T.T.; Le, D.V. Mutations in the gyrA, parC, and mexR genes provide functional insights into the fluoroquinolone-resistant Pseudomonas aeruginosa isolated in Vietnam. Infect. Drug Resist., 2018, 11, 275-282.
[] [PMID: 29535543]
Sonmezer, MC; Ertem, G; Erdinc, FS; Kaya Kilic, E; Tulek, N; Adiloglu, A Evaluation of risk factors for antibiotic resistance in patients with nosocomial infections caused by Pseudomonas aeruginosa. Can. J. Infect. Dis. Med. Microbiol., 2016.
Prakash, R.; Juyal, D.; Negi, V.; Pal, S.; Adekhandi, S.; Sharma, M.; Sharma, N. Microbiology of chronic suppurative otitis media in a tertiary care setup of uttarakhand state, India. N. Am. J. Med. Sci., 2013, 5(4), 282-287.
[] [PMID: 23724403]
Lasisi, A.O.; Olaniyan, F.A.; Muibi, S.A.; Azeez, I.A.; Abdulwasiu, K.G.; Lasisi, T.J.; Imam, Z.O.; Yekinni, T.O.; Olayemi, O. Clinical and demographic risk factors associated with chronic suppurative otitis media. Int. J. Pediatr. Otorhinolaryngol., 2007, 71(10), 1549-1554.
[] [PMID: 17643499]
Yang, X.; Xing, B.; Liang, C.; Ye, Z.; Zhang, Y. Prevalence and fluoroquinolone resistance of pseudomonas aeruginosa in a hospital of South China. Int. J. Clin. Exp. Med., 2015, 8(1), 1386-1390.
[PMID: 25785142]
Nouri, R; Ahangarzadeh Rezaee, M; Hasani, A; Aghazadeh, M; Asgharzadeh, M. The role of gyrA and parC mutations in fluoroquinolones-resistant Pseudomonas aeruginosa isolates from Iran. brazilian journal of microbiology.,, 2016, 47(4), 925-30.
Febriana, R; Hasmono, D Genetic mutation profile of gyrA and parC gene in ciprofloxacin-resistance Pseudomonas aeruginosa. Folia Medica Indonesiana, 2014, 50(1)
Kobayashi, H.; Isozaki, M.; Fukuda, T.; Anzai, Y.; Kato, F. Surveillance of fluoroquinolone-resistant clinical isolates of Pseudomonas aeruginosa. Open J. Med. Microbiol., 2013, 3(2), 144.
Vaez, H.; Faghri, J.; Isfahani, B.N.; Moghim, S.; Yadegari, S.; Fazeli, H.; Moghofeei, M.; Safaei, H.G. Efflux pump regulatory genes mutations in multidrug resistance Pseudomonas aeruginosa isolated from wound infections in Isfahan hospitals. Adv. Biomed. Res., 2014, 3, 117.
[] [PMID: 24949288]

Rights & PermissionsPrintExport Cite as

Article Details

Year: 2020
Published on: 13 May, 2020
Page: [244 - 246]
Pages: 3
DOI: 10.2174/1871526519666190228162001
Price: $65

Article Metrics

PDF: 35