Nonsusceptible Streptococcus pneumoniae in children with chronic otitis media with effusion and recurrent otitis media undergoing ventilating tube placement

Context. Children with chronic otitis media are at risk for nonsusceptible Streptococcus pneumoniae (NSP) infection. If these children undergo ventila ting tube placement, there is an opportunity to culture middle ear fluid an d the nasopharynx to determine carriage of NSP. Objective. To determine the incidence of NSP carriage, NSP antibiotic susce ptibility and risk factors for NSP carriage in children with chronic otitis media undergoing tube placement. Design and setting. Prospective cohort study in an academic medical center with recruitment of patients from an otolaryngology private practice and cl inic. Patients. Children <18 years of age undergoing tube placement for chronic o titis media. Interventions. Myringotomy and tube placement, with culture of middle ear f luid and nasopharynx. Main outcome measures. The incidence of NSP cultured from the middle ears a nd nasopharynx of recruited subjects with the use of the minimum inhibitory concentration break points for penicillin susceptibility recommended by th e National Committee for Clinical Laboratory Standards. Results. S. pneumoniae was identified in at least 1 site from 23 of 300 stu dy subjects (7.6%); of these 23, 12 case subjects (52.2%) harbored NSP. Of the risk factors assessed by preoperative questionnaire, only younger age w as associated with NSP colonization (P < 0.0001). Of the six oral cephalosp orins studied, cefpodoxime and cefuroxime showed good in vitro activity aga inst S. pneumoniae isolates with intermediate penicillin resistance. Conclusions. Children with chronic otitis media undergoing tube placement m ay carry NSP and provide a means of monitoring the incidence of NSP and ant ibiotic susceptibilities for children with ear infections in their communit ies. Younger age is a risk factor for NSP carriage in this population.