BACTERIOLOGY OF ACUTE OTITIS-MEDIA IN WES TERN FRANCE

Aim. - A prospective study on bacteriological epidemiology in acute ot its media was conducted in a pediatric hospital emergency service from January 1993 to October 1995. Patients. - One hundred and fifty-eight children, aged 6 months to 6 years, with an acute otitis media were i ncluded. Culturing and cleansing of the ear canal and tympanocentesis for aspiration and culture of the secretions were performed in 118 chi ldren (46 of whom had received antibiotics before for 48 hours). Main results. - Middle ear aspirates were sterile in 35% of the children wh o had not received antibiotics and in 64% of those already treated. Ba cteria in middle ear were predominantly Haemophilus influenzae and Str eptococcus pneumoniae. Fifty-nine percent of S pneumoniae strains were penicillin-resistant; however, they were responsible for clinical fai lure in only 8% of cases. No Staphylococcus strains, commensal of the ear canal, could be considered as pathogenic for the middle ear. Concl usion. - The preciseness with which secretions of middle ear are aspir ated reduces the risk of contamination and comparison of ear canal and middle ear cultures allows to identify them. The high ratio of steril e middle ear aspirates after antibiotic treatment raises the question if other factors are responsible for persistent symptoms. The existenc e of penicillin-resistant S pneumoniae must be known to adjust treatme nt.