Predicting bacteria causing acute bacterial rhinosinusitis by clinical features
Dussawan SuwannawongKachorn SeresirikachornSongklot AeumjaturapatSupinda ChusakulJesada KanjanaumpornWirach ChitsuthipakornWinyu RuksakulKornkiat Snidvongs
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Clinicians rely on clinical presentations to select therapeutic agents for acute bacterial rhinosinusitis. Streptococcus pneumoniae and Haemophilus influenzae are common in acute bacterial rhinosinusitis. Drug resistant Streptococcus pneumoniae and Haemophilus influenzae require different antibiotics.This study aimed to evaluate the associations between clinical features of acute bacterial rhinosinusitis and pathogenic bacteria.Sixty-four patients with acute bacterial rhinosinusitis were enrolled. Clinical features including nasal obstruction, discolored discharge, facial pain, smell disturbance, fever and laboratory findings of patients with acute bacterial rhinosinusitis were collected. The bacterial cultures of endoscopic middle meatal swabs were used as a reference.Serum C-reactive protein level elevation correlated with the bacterial species (p=0.03), by which was increased in 80.0% of Haemophilus influenzae rhinosinusitis and 57.1% of Streptococcus pneumoniae rhinosinusitis. The elevated C-reactive protein was the significant predictor for Haemophilus influenzae rhinosinusitis with the Odds Ratio of 18.06 (95% CI 2.36-138.20). The sensitivity of serum C-reactive protein level elevation for diagnosing Haemophilus influenzae rhinosinusitis was 0.80 (95% CI 0.49-0.94).Elevation of serum C-reactive protein level was associated with and predicted acute bacterial rhinosinusitis caused by Haemophilus influenzae.Of 368 acute otitis media (AOM) cases among 7-valent pneumococcal conjugate-vaccinated children, 43.5% were colonized by multiple otopathogens in the nasopharynx but only 7.1% experienced polymicrobial AOM. When co-colonization occurred, Haemophilus influenzae predominated over all Streptococcus pneumoniae strains except 19A strains to cause AOM. Haemophilus influenzae and Streptococcus pneumoniae both predominated over Moraxella catarrhalis to cause AOM.
Moraxella (Branhamella) catarrhalis
Acute Otitis Media
Pneumococcal infections
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ABSTRACT Streptococcus pneumoniae and Haemophilus influenzae carriage is a useful index for measuring the emergence of resistance and outcome in vaccination trials. We performed a study to determine which sampling site, nasopharynx (NP) or oropharynx (OP), yields the highest rate of S. pneumoniae and H. influenzae isolation at different ages. Both NP and OP cultures were obtained from 216 children aged <60 months and their mothers. The total S. pneumoniae carriage rate was 68% among children and 15% among mothers ( P < 0.001). Using NP alone for the isolation of S. pneumoniae would have missed 2, 2, and 42% and using OP alone would have missed 77, 66, and 45% of S. pneumoniae in children aged 0 to 23 months, 24 to 59 months, and mothers, respectively. Using NP cultures alone for H. influenzae would have missed 23, 24, and 81% of the isolates, respectively. The respective figures for H. influenzae isolation from OP alone are 38, 29, and 9%. In children, S. pneumoniae was carried mainly in the NP while H. influenzae was equally carried in the NP and OP. In mothers, S. pneumoniae was carried equally in the NP and OP while H. influenzae was carried significantly more often in the OP. In children, H. influenzae colonization increased during illness, mainly in the NP. Culturing only one site significantly reduced the recovery of H. influenzae at all ages. NP cultures for S. pneumoniae detected close to 100% of isolates in children but only 58% of isolates in mothers.
Carriage
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Abstract Viable and non-viable B. catarrhalis were mixed together with S. pneumoniae and H. influenzae and injected into non-bacterial mucoid effusion material collected from the middle ear of patients with a present secretory otitis media. The samples were incubated at 37°C. Presence of viable B. catarrhalis could evidently prolong the survival of both S. pneumoniae and H. influenzae . Presence of non-viable B. catarrhalis could also enhance the growth of S. pneumoniae , but not H. influenzae . In contrast both S. pneumoniae and H. influenzae suppressed the growth of B. catarrhalis .
Moraxella (Branhamella) catarrhalis
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Acute Otitis Media
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Recent development of resistance of Streptococcus pneumoniae to antimicrobial agents, including penicillin, has raised concerns that this bacterium will eventually become resistant to vancomycin. During screening for vancomycin resistance, we have occasionally found S. pneumoniae isolates that
Pneumococcal infections
Penicillin resistance
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Moraxella (Branhamella) catarrhalis
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The present study was performed in order to study development of myringosclerosis during acute otitis media caused by different bacteria in myringotomized and non-myringotomized ears.A rat model of acute otitis media caused by Streptococcus pneumoniae type 3 and non-typeable Haemophilus influenzae was used. A sample consisted of 42 animals. Four days following middle ear inoculation, a myringotomy was performed in 10 animals from the Streptococcus pneumoniae group and 6 from the non-typeable Haemophilus influenzae group. Another group of 24 animals was inoculated only. On day 4, 7, 14 and 28 after inoculation the status of the drum was inspected under the otomicroscope for vascular reaction, effusion, perforation, myringosclerosis and scarring.On day 4 after inoculation all infected ears had typical signs of acute otitis media. Tympanic membranes healed with scar formation in most cases of myringotomized Streptococcus pneumoniae type 3 infection and deposition of sclerotic plaques was observed by day 14. Otomicroscopically visible myringosclerosis was not found after non-typeable Haemophilus influenzae induced acute otitis media neither in myringotomized nor in non-myringotomized animals. We conclude that Streptococcus pneumoniae type 3 provokes a severe clinical course of acute otitis media that healed with scarring and myringosclerosis formation in the tympanic membrane. Clinically visible myringosclerosis develops after middle ear infection caused by Streptococcus pneumoniae type 3, but not in cases caused by non-typeable Haemophilus influenzae.
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To establish a method for rapid molecular detection of Streptococcus pneumoniae and Haemophilus influenzae in the early stage of infection.Specific DNA probes for Streptococcus pneumoniae and Haemophilus influenzae and 16 S rRNA universal probe of bacteria were synthesized by polymerase chain reaction (PCR) and labeled with biotin. The DNA of the bacteria, virus and fungi were hybridized with these probes respectively prior to application for examination of the clinical samples.The DNA probes of 263, 351, and 370 bp were amplified by PCR. Streptococcus pneumoniae and Haemophilus influenzae reacted only with their corresponding probes, and no cross reaction of the bacterial universal probe with virus and fungi was noted. The method could detect bacterial DNA in as small amount as 1 ng. Of the 100 sputum specimens, 11 were found to be positive for Streptococcus pneumoniae and 8 for Haemophilus influenzae, with a positivity rate greater than that by sputum culture.DNA probe detection is simple, rapid, and specific for clinical examination of Streptococcus pneumoniae and Haemophilus influenzae.
Haemophilus parainfluenzae
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Objective Investigate isolation rate and analyze resistance of Haemophilus mfluenzae and parainfluenzae during 2000～2001 in our hospital. Methods Samples were inoculated in the Chocolatc Haemophilus Agar, the strains were identified and β-lactamase and resistance test were carried out. Results In 974 samples from respiratory tract we found 8 strains of Haemophilus influcnzae, with β-lactamase(+) strains being 0, and 13 strains of Haemophilus parainfluenzae β-lactamases 7.69 in 2000. In 845 samples we found 25 strains of Haemophilus influenzae, and with β lxctamase(+) strans 24 and Haemophilus parain fluenzae 120 strains with β-lactamase 17.5 and were found 1 strain β-lactamase negative in 2001. Conclusion Haemophilus is a very important infectious agent in respiratory tract, and the culture medium quality is a key factor to isolation rate of Haemophilus. In 2001 Haemophilus infuenzae β-lactamases(+) stain was 24, but it was unusual to find multi-resistance. Haemophilus parainfluenzae resistance is more complex than that of Haemophilus influenzae, it occurs by other mechanisms and is more difficult in terms of treatment. The correct use of antibiotics is the best way to decrease drug resistance.
Haemophilus parainfluenzae
Chocolate agar
Isolation
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Solithromycin (CEM-101) is a "fourth-generation" macrolide, as it has three binding site and is acid stable. The three binding sites confer activity against bacteria resistant to the older macrolides and ketolides, including multidrug-resistant Streptococcus pneumoniae and nontypeable Haemophilus influenzae (NTHi). The objective of this study was to evaluate solithromycin pharmacokinetics (PK), middle ear fluid (MEF) concentrations, and microbiologic efficacy in a chinchilla model of experimental otitis media (EOM) due to strains of S. pneumoniae or NTHi. Plasma PK (maximum concentration of drug in serum [Cmax] and area under the concentration-time curve from 0 to 24 h [AUC0-24]) and middle ear fluid (MEF) concentrations were determined. Isolates with specified antimicrobial susceptibility patterns were inoculated directly into the middle ear (ME). Plasma and MEF were collected for PK and MEF cultures performed to determine efficacy. Solithromycin administered at 150 mg/kg of body weight/day resulted in Cmax and AUC0-24 values of 2.2 μg/ml and 27.4 μg · h/ml in plasma and 1.7 μg/ml and 28.2 μg · h/ml in extracellular MEF on day 1. By day 3, Cmax and AUC0-24 values had increased to 4.5 μg/ml and 54 μg · h/ml in plasma and 4.8 μg/ml and 98.6 μg · h/ml in extracellular MEF. For NTHi EOM, three isolates with MIC/minimal bactericidal concentration (MBC) ratios of 0.5/1 μg/ml (isolate BCH1), 2/2 μg/ml (isolate BMC1247C), and 4/4 μg/ml (isolate BMC1213C) were selected. The MEF of >85% of animals infected with BCH1 and BMC1247C was sterilized. For NTHi BMC1213, >85% of MEF cultures remained positive. For S. pneumoniae EOM, 3 isolates with MIC/MBC ratios of 0.06/0.125 μg/ml (S. pneumoniae 331), 0.125/1 μg/ml (S. pneumoniae CP-645 [MLSB phenotype]), and 0.5/2 μg/ml (CP-712 [mefA subclass mefA resistance]) were selected. Solithromycin sterilized MEF in 100% of animals infected with S. pneumoniae 331 and S. pneumoniae CP-645. ME infection persisted in 60% of animals infected with CP-712. In a model of EOM, solithromycin sterilized MEF in >85% of animals challenged with NTHi with an MIC of ≤2 μg/ml and 100% of ME infected with S. pneumoniae with an MIC of ≤0.125 μg/ml.
Ketolide
Minimum bactericidal concentration
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