Three Innate Cytokine Biomarkers Predict Presence of Acute Otitis Media and Relevant Otopathogens

Abstract

Background: Diagnosis of Acute Otitis Media (AOM) is challenging, resulting in frequent over diagnosis and improper prescription of antibiotics. A serum biomarker of AOM would significantly improve pediatric care for this common illness.Methods: Serum samples were studied from 197 children 6-36 months old during health, during viral Upper Respiratory Infection (URI) without middle ear involvement, and at the onset of AOM (confirmed by tympanocentesis). Serum concentrations of S100A12, IL-10, and ICAM-1 were measured by ELISA. Otopathogens were identified by culture of middle ear fluid. A predictive model for infection and causative otopathogen was developed based on density distributions of the measured cytokines. Results:A biomarker score derived from subject age and serum concentrations of S100A12, IL-10, and ICAM-1 was significantly able to distinguish both between health and disease and between upper respiratory infections with and without middle ear involvement (AOM vs URI), and further predicted the specific causative bacterial pathogen. This biomarker could also identify recurrent OM-prone children. Conclusions:For the first time we show that a biomarker risk score derived from serum cytokine levels can predict the presence of bacterial AOM, the likely Otopathogen, and the recurrent OM-prone child. Clinical significance:(1) AOM is a widespread pediatric infection with a substantial economic burden. (2) Three serum cytokines can discriminate between URI and AOM, reducing over diagnosis. (3) Prediction of responsible pathogen enables targeted antibiotic prescription.

Nasopharyngeal rapid diagnostic testing to reduce unnecessary antibiotic use and individualize management of acute otitis media

“…51 In addition, serum biomarkers have been suggested as a potential option for pathogen-directed therapy for AOM. 52 However, this would likely require capital investments from health systems, and it is not clear how antimicrobial resistance would be determined, though it is necessary to choose the appropriate agent, particularly for H. influenzae.…”

Development and Validation of an Automated Classifier to Diagnose Acute Otitis Media in Children

“…Training programs, such as the Enhancing Proficiency in Otitis Media curriculum, were developed to improve practitioners’ skills in diagnosing otitis media. Other clinical tools have included pneumatic otoscopy, tympanometry, smartphone-based otoscope attachments, serum biomarkers, and novel imaging technologies such as a light field otoscope and optical coherence tomography . Despite these efforts, diagnostic accuracy remains low and, accordingly, further innovation is warranted.…”