Bacterial otitis media in sub-Saharan Africa: a systematic review and meta-analysis

Abstract

Background: Otitis media is inflammation of the middle ear, comprising a spectrum of diseases. It is the commonest episode of infection in children, which often occurs after an acute upper respiratory tract infection. Otitis media is ranked as the second most important cause of hearing loss and the fifth global burden of disease with a higher incidence in developing worlds like Sub-Saharan Africa and South Asia. Therefore, this systematic review is aimed to quantitatively estimate the current status of bacterial otitis media, bacterial etiology and their susceptibility profile in sub-Saharan Africa. Methods: A literature search was conducted from major databases and indexing services including EMBASE (Ovid interface), PubMed/MEDLINE, Google Scholar, ScienceDirect, Cochrane Library, WHO African Index-Medicus and others. All studies (published and unpublished) addressing the prevalence of otitis media and clinical isolates conducted in sub-Saharan Africa were included. Format prepared in Microsoft Excel was used to extract the data and data was exported to Stata version 15 software for the analyses. Der-Simonian-Laird random-effects model at a 95% confidence level was used for pooled estimation of outcomes. The degree of heterogeneity was presented with I 2 statistics. Publication bias was presented with funnel plots of standard error supplemented by Begg's and Egger's tests. The study protocol is registered on PROSPERO with reference number ID: CRD42018102485 and the published methodology is available from http://www.crd.york.ac.uk/CRD42018102485. Results: A total of 33 studies with 6034 patients were included in this study. All studies have collected ear swab/ discharge samples for bacterial isolation. The pooled isolation rate of bacterial agents from the CSOM subgroup was 98%, patients with otitis media subgroup 87% and pediatric otitis media 86%. A univariate meta-regression analysis indicated the type of otitis media was a possible source of heterogeneity (p-value = 0.001). The commonest isolates were P. aeruginosa (23-25%), S. aureus (18-27%), Proteus species (11-19%) and Klebsiella species. High level of resistance was observed against Ampicillin, Amoxicillin-clavulanate, Cotrimoxazole, Amoxicillin, and Cefuroxime. Conclusion: The analysis revealed that bacterial pathogens like P. aeruginosa and S. aureus are majorly responsible for otitis media in sub-Saharan Africa. The isolates have a high level of resistance to commonly used drugs for the management of otitis media.

Antibiotic Susceptibility Patterns of Bacterial Isolates from Routine Clinical Specimens from Referral Hospitals in Tanzania: A Prospective Hospital-Based Observational Study

“…are the most cited causative agents for otitis in sub-Sharan Africa and are reported to exhibit a high level of resistance to multiple antibiotics. 20 On the other hand, the majority of the participants were women of reproductive age, which explains the high number of urine specimens and E. coli processed in this study.…”

“…19 Ear pus, urine, wound pus, stool, and blood specimens were the most frequent clinical specimens analyzed. The presence of a large number of ear pus specimen points toward suppurative otitis diseases which are common in children and adolescents below 15 years especially in sub-Saharan Africa, 20 and their transmission is linked to poor hygienic conditions. P. aeruginosa, S. aureus, Proteus spp., and Klebsiella spp.…”

Microbiology of Chronic Suppurative Otitis Media: An update from a Tertiary Care Hospital in Bangladesh

“…2 , 7 Although P. aeruginosa has been reported to be the leading cause of CSOM followed by S. aureus by many investigators but variation in bacterial profile and frequency is well documented. 10 , 11 , 20 The conducive environment of middle ear cavity may favour the growth of P. aeruginosa but etiological agents of CSOM differs substantially with regards to time and place and also factors like variation in climate, socioeconomic status and patient’s self-hygiene play important role. 11 We observed polymicrobial infections in 7.3% cases, which is a very common occurrence in CSOM and many studies have reported mixed pathogens including bacteria and fungus.…”

“…reported high level of resistance against Ampicillin, Amoxicillin/Clavulanate, Cotrimoxazole, Amoxicillin, and Cefuroxime and our finding is in concordance with this report and also in agreement with another recent study. 10 , 20 Moderate to high resistance observed against different classes of antibiotics indicates prevalence of MDR bacteria and is a matter of great concern because antibiotics from these classes are being prescribed frequently for empirical treatment of CSOM. Unethical prescription of antibiotic for trivial causes, easy availability over the counter, lack of culture facilities and absence of good governess are all contributing factors in the development of high antimicrobial resistance (AMR) in the developing countries including Bangladesh.…”

“…High level of antimicrobial resistance against commonly used antibiotics like Ampicillin, Amoxicillin, Cotrimoxazole, Amoxicillin/Clavulanate, Cephalosporins, Quinolones and Macrolides has been a challenge leading to unsatisfactory treatment outcomes in the recent years. 2 , 5 , 10 , 11 …”