Acute otitis media in infants younger than two months of age: Epidemiologic and microbiologic characteristics in the era of pneumococcal conjugate vaccines

Abstract Objectives To evaluate the epidemiology, microbiology, Streptococcus pneumoniae serotypes distribution and serious bacterial infections (SBIs) occurrence in infants Methods The medical records of all hospitalized infants with AOM who underwent tympanocentesis during 2005–2014 were reviewed. Results Of the 303 infants with AOM who were diagnosed by an ENT specialist, 182 underwent tympanocentesis, 92 during 2005–2009 (prevaccine period) and 90 during 2010–2014 (postvaccine period). Streptococcus pneumoniae and nontypeable Hemophilus influenzae were isolated in 46/92 (50%) and 37/92 (40.2%) patients during 2005–2009 and decreased to 27/90 (30%) and 21/90 (23.3%). Respectively, during 2010–2014 (P = 0.006 and P = 0.001). The proportion of culture-negative patients increased from 18/92 (19.6%) during 2005–2009 to 32/90 (35.6%) during 2010–2014 (P = 0.02). There were only 6 (3.3%) patients S. pneumoniae vaccine serotypes isolated during 2005–2009 were 5, 3, 1, 19F and 14 (15.2%, 13.0%, 10.9%, 6.5%, and 4.3%, respectively) and 3, 5, 1, 14 and 19A (22.2%, 11.1%, 7.4%, 7.4%, and 7.4%, respectively) during 2010–2014. The proportion of culture-positive patients decreased during 2013–2014 compared with 2011–2012 (7/18, 38.9% vs. 40/54, 74.1%, P = 0.007). Serotypes 1 and 5 were not isolated during 2013–2014 and serotype 19A was not isolated during 2011–2014. . SBIs were recorded in 23/182 (12.64%) patients and urinary tract infections represented 19/23 (82.61%) of them ( Escherichia coli isolated in 12, 63.2%). Conclusions The overall number of AOM cases needing tympanocentesis seen at the PER and the proportion of S. pneumoniae and nontypeable H. influenzae -AOM decreased while the proportion of culture-negative AOM increased following the introduction of PCVs. SBIs associated with AOM were frequent and were represented mostly by urinary tract infections caused by pathogens unrelated to the etiologic agents of AOM.