Parent-Reported Otorrhea in Children with Tympanostomy Tubes: Incidence and Predictors

Purpose

Although common in children with tympanostomy tubes, the current incidence of tympanostomy tube otorrhea (TTO) is uncertain. TTO is generally a sign of otitis media, when middle ear fluid drains through the tube. Predictors for otitis media are therefore suggested to have predictive value for the occurrence of TTO.

Objective

To determine the incidence of TTO and its predictors.

Methods

We performed a cohort study, using a parental web-based questionnaire to retrospectively collect data on TTO episodes and its potential predictors from children younger than 10 years of age with tympanostomy tubes.

Results

Of the 1,184 children included in analyses (total duration of time since tube placement was 768 person years with a mean of 7.8 months per child), 616 children (52%) experienced one or more episodes of TTO. 137 children (12%) had TTO within the calendar month of tube placement. 597 (50%) children had one or more acute TTO episodes (duration <4 weeks) and 46 children (4%) one or more chronic TTO episodes (duration ≥4 weeks). 146 children (12%) experienced recurrent TTO episodes. Accounting for time since tube placement, 67% of children developed one or more TTO episodes in the year following tube placement. Young age, recurrent acute otitis media being the indication for tube placement, a recent history of recurrent upper respiratory tract infections and the presence of older siblings were independently associated with the future occurrence of TTO, and can therefore be seen as predictors for TTO.

Conclusions

Our survey confirms that otorrhea is a common sequela in children with tympanostomy tubes, which occurrence can be predicted by age, medical history and presence of older siblings.     

DGGE法分析慢性化脓性中耳炎耳道菌群变化及药敏试验研究

目的解析正常成人及慢性化脓性中耳炎（CSOM）患者耳道内菌群结构的差别,寻找有效抑制致病菌同时对皮肤主导菌群影响不大的抗生素,指导临床合理用药。方法取20例正常成人及20例CSOM患者耳道分泌物行血琼脂平板划线法分离鉴定细菌,选择典型病例进行DGGE法分析耳道菌群多样性,对培养的常见细菌进行药物敏感试验,分析药敏结果。结果（1）20例正常成人耳道分泌物中18例培养分离出表皮葡萄球菌（90％）,2例培养阴性（10％）;20例CSOM患者耳道分泌物中离出金黄色葡萄球菌8例（40％）,铜绿假单胞菌5例（25％）,溶血性葡萄球菌、表皮葡萄球菌各2例（各10％）,阴沟肠杆菌、洋葱伯克霍尔德菌各1例（各5％）,无菌生长1例（5％）。（2）DGGE分析显示,正常成人耳道菌群种类比CSOM明显增多。（3）金黄色葡萄球菌、表皮葡萄球菌、铜绿假单胞菌对环丙沙星均敏感。表皮葡萄球菌对阿莫西林、头孢唑林、左旋氧氟沙星耐药而金黄色葡萄球菌对其敏感。结论（1）正常人耳道正常菌群多样性高于CSOM。（2）目前培养出的正常成人主要耳道菌群为表皮葡萄球菌,CSOM主要菌群为金黄色葡萄球菌、铜绿假单胞菌。（3）环丙沙星同时抑制正常菌群和致病菌的生长。阿莫西林、头孢唑林、左旋氧氟沙星在抑制金黄色葡萄球菌等致病菌的同时,可以在一定程度上保护正常菌群成员表皮葡萄球菌。     

慢性化脓性中耳炎患者耳道分泌物的病原菌检测及药物敏感性分析

目的 分析慢性化脓性中耳炎（CSOM）患者耳道分泌物的病原菌分布及其药敏情况,为临床合理应用抗菌药物提供参考。方法 收集浙江省立同德医院100例（116耳）CSOM患者耳道分泌物标本进行常规病原菌分离、鉴定及药敏试验。结果 116耳中有97耳培养出病原菌,检出率为83.6%。共检出病原菌103株,其中革兰阳性菌占53.4%（55/103）,革兰阴性菌占41.7%（43/103）,真菌占4.9%（5/103）。金黄色葡萄球菌和表皮葡萄球菌对青霉素和磺胺甲恶唑/甲氧苄啶耐药性较高,对利福平和莫西沙星敏感性较高,对呋喃妥因和万古霉素完全敏感。铜绿假单胞菌和肺炎克雷伯菌对头孢唑啉、氨苄西林、头孢吡肟、头孢曲松、哌拉西林/舒巴坦耐药性均较高,对妥布霉素、氨曲南、哌拉西林/他唑巴坦敏感性较高,对阿米卡星、美罗培南及亚胺培南完全敏感。真菌对氟胞嘧啶、两性霉素B及制霉菌素均敏感,而对酮康唑和氟康唑有一定的耐药性。结论 CSOM患者耳道分泌物中病原菌以金黄色葡萄球菌、表皮葡萄球菌、铜绿假单胞菌及肺炎克雷伯菌为主,这4种病原菌对多数常用抗菌药物有较强的耐药性,治疗时需根据细菌培养及药敏分析结果合理选用抗菌药物。     

椒样薄荷、薄荷和苏格兰留兰香精油与抗生素的协同抑菌功能

以开花期的椒样薄荷（Mentha×piperita）、薄荷（M.haplocalyx）和苏格兰留兰香（M.×gentilis）叶片部位提取的精油为研究对象,通过GC-MS分析,并采用纸片扩散法研究了3种精油单独使用及与抗生素联合使用时对金黄色葡萄球菌、蜡状芽孢杆菌、大肠杆菌、绿脓杆菌和肺炎克雷伯氏菌的抑制情况。结果表明,（1）椒样薄荷与薄荷精油中含量最高的成分为薄荷醇、薄荷酮和异薄荷酮,苏格兰留兰香精油的主要成分为香芹酮和柠檬烯。薄荷和苏格兰留兰香精油符合欧洲药典与ISO标准,椒样薄荷需要继续改良以提高其精油品质与抑菌功能。（2）精油单独使用时,Pseudomonas aeruginosa ATCC15442对椒样薄荷精油和薄荷精油敏感;P.aeruginosa ATCC27853对薄荷精油和苏格兰留兰香精油敏感。精油与抗生素联合使用时抑菌范围和强度均有所改变：绿脓杆菌的2个菌株对精油与抗生素的组合最为敏感,其中,椒样薄荷精油与头孢他啶的组合对P.aeruginosa ATCC15442显示出最强的增效作用,薄荷精油与头孢他啶混合之后对P.aeruginosa ATCC27853出现拮抗作用。Staphylococcus aureus ATCC25923对所有精油以及精油与抗生素混合物均有抗性。（3）椒样薄荷、薄荷和苏格兰留兰香精油的不同成分及其含量差异不仅对精油品质有影响,而且影响精油对测试菌种的抑制作用,可考虑将其作为薄荷属植物品质育种的参考指标。     

Mode of action of acidocin 8912, a bacteriocin produced by Lactobacillus acidophilus TK8912

K.A. HOEKSTRA AND R.J.L. PAULTON. 1996. Disc agar diffusion testing was performed on 547 isolates (two common pathogens) to determine if the site of isolation influenced the antimicrobial susceptibility results for a given bacterium. The most statistically significant results ( P < 0.05) included cephalothin (ear) against Staphylococcus aureus and cephalothin (ear), lincomycin (ear), trimethoprim sulpha (ear), and amoxycilin and clavulanic acid (nose) against Staph. intermedius. Although the impact of these results (empirical treatment) is unknown, it is hypothesized that the site of isolation of Staph. aureus and Staph. intermedius may influence the choice of antimicrobial therapy in the dog and cat.     

椒样薄荷、薄荷和苏格兰留兰香精油与抗生素的协同抑菌功能

以开花期的椒样薄荷(Mentha × piperita)、薄荷(M. haplocalyx)和苏格兰留兰香(M. × gentilis)叶片部位提取的精油为研究对象, 通过GC-MS分析, 并采用纸片扩散法研究了3种精油单独使用及与抗生素联合使用时对金黄色葡萄球菌、蜡状芽孢杆菌、大肠杆菌、绿脓杆菌和肺炎克雷伯氏菌的抑制情况。结果表明, (1) 椒样薄荷与薄荷精油中含量最高的成分为薄荷醇、薄荷酮和异薄荷酮, 苏格兰留兰香精油的主要成分为香芹酮和柠檬烯。薄荷和苏格兰留兰香精油符合欧洲药典与ISO标准, 椒样薄荷需要继续改良以提高其精油品质与抑菌功能。(2) 精油单独使用时, Pseudomonas aeruginosa ATCC 15442对椒样薄荷精油和薄荷精油敏感; P. aeruginosa ATCC 27853对薄荷精油和苏格兰留兰香精油敏感。精油与抗生素联合使用时抑菌范围和强度均有所改变: 绿脓杆菌的2个菌株对精油与抗生素的组合最为敏感, 其中, 椒样薄荷精油与头孢他啶的组合对P. aeruginosa ATCC 15442显示出最强的增效作用, 薄荷精油与头孢他啶混合之后对P. aeruginosa ATCC 27853出现拮抗作用。Staphylococcus aureus ATCC 25923对所有精油以及精油与抗生素混合物均有抗性。(3) 椒样薄荷、薄荷和苏格兰留兰香精油的不同成分及其含量差异不仅对精油品质有影响, 而且影响精油对测试菌种的抑制作用, 可考虑将其作为薄荷属植物品质育种的参考指标。     

The antibacterial and antifungal properties of trappin-2 (pre-elafin) do not depend on its protease inhibitory function

Trappin-2 (also known as pre-elafin) is an endogenous inhibitor of neutrophil serine proteases and is involved in the control of excess proteolysis, especially in inflammatory events, along with the structurally related secretory leucocyte proteinase inhibitor. Secretory leucocyte proteinase inhibitor has been shown to have antibacterial and antifungal properties, whereas recent data indicate that trappin-2 has antimicrobial activity against Pseudomonas aeruginosa and Staphylococcus aureus. In the present study, we tested the antibacterial properties of trappin-2 towards other respiratory pathogens. We found that trappin-2, at concentrations of 5-20 microm, has significant activity against Klebsiella pneumoniae, Haemophilus influenzae, Streptococcus pneumoniae, Branhamella catarrhalis and the pathogenic fungi Aspergillus fumigatus and Candida albicans, in addition to P. aeruginosa and S. aureus. A similar antimicrobial activity was observed with trappin-2 A62D/M63L, a trappin-2 variant that has lost its antiprotease properties, indicating that trappin-2 exerts its antibacterial effects through mechanisms independent from its intrinsic antiprotease capacity. Furthermore, the antibacterial and antifungal activities of trappin-2 were sensitive to NaCl and heparin, demonstrating that its mechanism of action is most probably dependent on its cationic nature. This enables trappin-2 to interact with the membranes of target organisms and disrupt them, as shown by our scanning electron microscopy analyses. Thus, trappin-2 not only provides an antiprotease shield, but also may play an important role in the innate defense of the human lungs and mucosae against pathogenic microorganisms.     

Potential pathogens carried by Spanish ibex (Capra pyrenaica hispanica) in southern Spain

The Spanish ibex (Capra pyrenaica hispanica) population of southern Spain was surveyed for potential pathogens associated with the conjunctiva, external ear canal, as well as reproductive and upper respiratory tracts. We sampled 321 ibex (131 adult males, 100 adult females, and 90 yearlings); these included 271 apparently healthy animals and 50 that were naturally infected with Sarcoptes scabiei. A total of 688 bacterial isolates were identified (377 gram-negatives, 225 gram-positives, and 86 Mycoplasma spp.); sex, age, location, infection with S. scabiei, and disposition of the animal (free-ranging versus captive) were evaluated as risk factors for infection. Infections with Mycoplasma agalactiae and Mycoplasma arginini were associated with age, having a higher frequency of isolation in young animals. With Escherichia coli, Mannheimia haemolytica, Pasteurella multocida biotype A, and Staphylococcus aureus, significantly higher isolation rates were associated with adults. The isolation frequency for E. coli was higher in females, whereas Moraxella bovis isolations were mostly associated with males. The presence of mange increased the risk of infection with both Streptococcus equi subsp. zooepidemicus and M. haemolytica. The geographic origin of sampled animals was related to the isolation of Branhamella ovis, M. agalactiae, and all Pasteurella sp. Isolations of M. haemolytica, P. multocida biotype A, E. coli, and B. ovis were more prevalent in samples from free-ranging rather than captive animals. Of the gram-positive bacteria, S. aureus represented the predominant species isolated from nasal, vaginal, and ocular samples. Mycoplasma agalactiae and M. arginini were the predominant Mycoplasma spp., and both were associated most often with the external ear canal. The most frequently isolated gram-negative bacteria included E. coli, M. haemolytica, P. multocida biotype A, and B. ovis. Isolation rates of gram-negative species varied by source. In nasal samples, M. haemolytica and P. multocida biotype A were isolated most frequently, whereas in ocular and vaginal samples, B. ovis and E. coli, respectively, were most frequently isolated.     

A review of antimicrobial resistance in Canada

Antimicrobial resistance is a global concern. Over the past 10 years, considerable efforts and resources have been expended to detect, monitor, and understand at the basic level the many different facets of emerging and increasing resistance. This review summarizes our current understanding of bacterial antimicrobial resistance issues in Canada with particular emphasis given to the Enterobacteriaceae, Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus, Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, and Streptococcus pyogenes. In addition, future concerns and programs for ongoing surveillance are discussed.     

Detection of volatile metabolites produced by bacterial growth in blood culture media by selected ion flow tube mass spectrometry (SIFT-MS)

To achieve faster bacteremia diagnosis, selected ion flow tube mass spectrometry (SIFT-MS) measured metabolic gases in the headspaces of BacT/ALERT blood culture bottles. Pseudomonas aeruginosa, Streptococcus pneumoniae, Escherichia coli, Staphylococcus aureus and Neisseria meningitidis growth and trace gas patterns were detected from 10 colony forming units after 6 h.     

Synthesis and antimicrobial activity of 7-fluoro-3-aminosteroids

A series of 7-fluoro-3-aminosteroids were synthesized and their in vitro antimicrobial activities were evaluated against Gram-positive and Gram-negative bacteria. The nucleophilic fluorination of several 7beta-hydroxysteroids by diethylaminosulfur trifluoride in n-pentane, followed by reductive amination of the resulting 7-fluoro-3-ketosteroids with spermidine in the presence of NaBH(3)CN, afforded 7-fluoro-3-aminosteroids in high yield. Compound 25 showed the highest antimicrobial activity against Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus pyogenes, and Escherichia coli.     

Bactericidal action of carbon dioxide laser radiation in experimental dental root canals

The ability of a carbon dioxide laser to sterilize the root canal of human teeth has been investigated. Three oral bacteria, Streptococcus sanguis, Streptococcus mutans, and Actinomyces viscosus, and three other bacteria, Bacillus cereus, Staphylococcus aureus, and Pseudomonas aeruginosa were used as experimental organisms. Exposure of cells on glass slides to laser radiation showed there was little difference in the exposure required to kill these six organisms. Complete recovery of bacteria from the root canal was initially a problem and was only achieved when bacterial manipulations and removal were carried out in rapid succession, within 5 min of inoculation. However, the geometry of the instrumented canal and the laser alignment were major factors in achieving consistent cell death of oral bacteria in the root canals. Using sets of 10 teeth, four repeated exposures of 10 W for 1 s was found to sterilize 4 or more of the teeth.     

The antimicrobial activity of extracts of the lichen Cetraria aculeata and its protolichesterinic acid constituent

In this study, the antimicrobial activity of the acetone, diethyl ether and ethanol extracts of the lichen Cetraria aculeata has been investigated. The extracts were tested against twelve bacteria and eight fungi and found active against Escherichia coli, Staphylococcus aureus, Aeromonas hydrophila, Proteus vulgaris, Streptococcus faecalis, Bacillus cereus, Bacillus subtilis, Pseudomonas aeruginosa, Listeria monocytogenes. No antimicrobial activity against the fungi was detected. It was determined that only one substance in the extracts has antimicrobial activity and it was characterized as protolichesterinic acid. The MICs of the extracts and protolichesterinic acid were also determined.     

Antimicrobial susceptibility of staphylococci isolated from otitis externa in dogs

Samples were obtained from 65 unmedicated adult dogs, processed for isolation of Staphylococcus species and tested for susceptibility to penicillin G, gentamicin, oxacillin, tetracycline, trimethoprim-sulphamethoxazole, streptomycin, ampicillin and rifampin. Forty-four isolates were obtained, which represents 67.7% of samples. Coagulase-negative species were most commonly found, and the most frequently isolated staphylococcus species were Staph. epidermidis and Staph. aureus. Other species, such as Staph. simulans, Staph. haemolyticus, Staph. saprophyticus and Staph. intermedius were also isolated. Resistance to antibiotics was frequently observed, with 90.9% of the isolates showing resistance to at least one drug. The most active antimicrobial agents against staphylococci isolated from otitis externa of dogs were rifampin and oxacillin. Multidrug resistance was a common finding, and one strain of Staph. haemolyticus species, was resistant to all tested antimicrobial agents. Resistance to three or more different drugs was a common finding, observed in 16 strains (36.4%) of both coagulase-positive and coagulase-negative staphylococci. This study highlights the emergence of cases of otitis externa determined by coagulase-negative staphylococcus strains and once more emphasizes the need for bacterial culture with species identification and susceptibility testing of swab specimens from the ear canal in order to choose appropriate antimicrobial agents.     

In vitro effect of a buffered chelating agent and neomycin or oxytetracycline on bacteria associated with diseases of fish

The antimicrobial agents used to treat bacterial fish diseases are archaic, and their uses may result in the emergence of drug-resistant bacterial strains. This study evaluated the in vitro antimicrobial activity of combinations of Tricide and neomycin or oxytetracycline on common disease-causing bacteria of fish and its possible use as an alternative treatment of these diseases. Tricide solutions containing of 8 mM United States Pharmacopeia (USP) disodium ethylenediaminetetraacetate dehydrate (chelator) and 20 mM USP 2-amino-2-hydroxymethyl-1,3-propanediol (buffer) potentate the antimicrobial action of neomycin and oxytetracycline when reacted in vitro with Aeromonas hydrophila, Streptococcus iniae, Pseudomonas aeruginosa, and Staphylococcus aureus. Serial passage of the test organisms in Tricide or Tricide and neomycin or oxytetracycline did not result in the development of resistant forms. Combinations of Tricide and neomycin or oxytetracycline reduced the amount of antibiotics necessary for fish therapy, render drug-resistant bacteria sensitive to antimicrobial therapy, may be used to decontaminate recently shipped fish, and should reduce the formation of antibiotic-resistant forms.     

Chemical compositions and antimicrobial activities of four different Anatolian propolis samples

Propolis means a gum that is gathered by bees from various plants. It is known for its biological properties, having antibacterial, antifungal and healing properties. The aims of this study were to evaluate the antimicrobial activity of four different Anatolian propolis samples on different groups of microorganisms including some oral pathogens and comparison between their chemical compositions. Ethanol extracts of propolis (EEP) were prepared from four different Anatolian propolis samples and examined whether EEP inhibit the growth of the test microorganisms or not. For the antimicrobial activity assays, minimum inhibitory concentrations (MIC) were determined by using macrodilution method. The MIC values of the most effective propolis (TB) were 2 microg/ml for Streptococcus sobrinus and Enterococcus faecalis, 4 microg/ml for Micrococcus luteus, Candida albicans and C. krusei, 8 microg/ml for Streptococcus mutans, Staphylococcus aureus, Staphylococcus epidermidis and Enterobacter aerogenes, 16 microg/ml for Escherichia coli and C. tropicalis and 32 microg/ml for Salmonella typhimurium and Pseudomonas aeruginosa. The chemical compositions of EEP's were determined by high-temperature high-resolution gas chromatography coupled to mass spectrometry. The main compounds of four Anatolian propolis samples were flavonoids such as pinocembrin, pinostropin, isalpinin, pinobanksin, quercetin, naringenin, galangine and chrysin. Although propolis samples were collected from different regions of Anatolia all showed significant antimicrobial activity against the Gram positive bacteria and yeasts. Propolis can prevent dental caries since it demonstrated significant antimicrobial activity against the microorganisms such as Streptococcus mutans, Streptococcus sobrinus and C. albicans, which involves in oral diseases.     

Synthesis of 1,2,4-triazole derivatives containing benzothiazoles as pharmacologically active molecule

In attempt to make significant pharmacologically active molecule, we report here the synthesis and in vitro antimicrobial and antitubercular activity of various series of 3-(3-pyridyl)-5-(4-nitrophenyl)-4-(N-substituted-1,3-benzothiazol-2-amino)-4H-1,2,4-triazole. The antimicrobial activity of title compounds were examined against two Gram-positive bacteria (Staphylococcus aureus, Streptococcus pyogenes), two Gram-negative bacteria (Escherichia coli, Pseudomonas aeruginosa), and three fungi (Candida albicans, Aspergillus niger, Aspergillus clavatus) using the broth microdilution method and antitubercular activity H(37)Rv using Lowenstein-Jensen agar method.     

An Escherichia coli cell membrane chromatography-offline LC-TOF-MS method for screening and identifying antimicrobial peptides from Jatropha curcas meal protein isolate hydrolysates

A novel, simple, and rapid method, named cell membrane affinity extraction (CMAE)-offline liquid chromatography time-of-flight mass spectrometry (LC-TOF-MS) was developed for screening and identifying antimicrobial peptides from Jatropha curcas meal protein isolate hydrolysates (JCMPIH) obtained by proteolytic enzyme (pepsin, trypsin, protamex, neutrase, flavourzyme, papain, alcalase, and acid protease) hydrolysis. A cationic antimicrobial peptide (CAILTHKR, JCpep8) was successfully isolated and identified by this method. Antimicrobial assay indicated that JCpep8 was active against the tested microorganisms (Escherichia coli ATCC 25922, Shigella dysenteriae ATCC 51302, Pseudomonas aeruginosa ATCC 27553, Staphylococcus aureus ATCC 25923, Bacillus subtilis ATCC 23631, Streptococcus pneumoniae ATCC 49619) with minimal inhibitory concentration values ranging from 29 to 68 μg/mL. JCpep8 induced significant morphological alterations of the tested microbe surfaces, as shown by transmission electron microscopy, indicating strong membrane disruption. The results showed that CMAE-offline LC-TOF-MS could be a promising method for discovering high-throughput screening antimicrobial peptides from JCMPIH.     

Lactoferrampin: a novel antimicrobial peptide in the N1-domain of bovine lactoferrin

The antimicrobial activity of bovine lactoferrin is attributed to lactoferricin, situated in the N1-domain. Based on common features of antimicrobial peptides, a second putative antimicrobial domain was identified in the N1-domain of lactoferrin, designated lactoferrampin. This novel peptide exhibited candidacidal activity, which was substantially higher than the activity of lactoferrin. Furthermore, lactoferrampin was active against Bacillus subtilis, Escherichia coli, and Pseudomonas aeruginosa, but not against the fermenting bacteria Actinomyces naeslundii, Porphyromonas gingivalis, Streptococcus mutans and Streptococcus sanguis. Notably, lactoferrampin is located in the N1-domain in close proximity to lactoferricin, which plays a crucial role in membrane-mediated activities of lactoferrin.