Treatment of Multi-Drug Resistant Microorganisms in Chronic Suppurative Otitis Media

Objective: The aim of the study was to investigate the bacterial profile of patients who have resistant otorrhea despite the administration of topical antibiotics, antiseptics, and ear cleaning (aural toilet) and to discuss the topical and systemic therapy used for the eradication of treatment-resistant bacteria. Methods: A swab culture was obtained from the external ear canal in 544 patients with resistant otorrhea. All bacterial isolates were identified by conventional microbiological methods. Multidrug-resistant microorganisms were identified, and a systemic or topical antibiotic therapy was initiated based on the culture results. Results: Pseudomonas aeruginosa was the most commonly isolated pathogen (n=128; 24%), followed by Staphylococcus aureus (n=98; 18%). Since otorrhea could not be resolved with outpatient treatment, broad-spectrum antibiotics were applied in 54 (4%) of 1290 patients, 54% of whom were infected with P. aeruginosa. Recovery time was similar in intravenous treatment and topical piperacillin/tazobactam treatment in patients with ear discharge and multidrug-resistant P. aeruginosa infection (P = .82). Conclusion: In medical treatment of chronic suppurative otitis media, obtaining a dry ear can be highly difficult in some patients. Antibiotic resistance was relatively greater in gram-negative bacteria. In particular, multidrug-resistant P. aeruginosa can remain unresponsive to treatment. Data from future prospective studies and clinical trials may provide useful information on the results of topical piperacillin/tazobactam treatment in patients with chronic suppurative otitis media caused by multidrug-resistant P. aeruginosa infections to further improve clinical practice and off-label prescribing decisions.