The Pediatric infectious disease journal · 2026
Beyond Traditional Pathogens: Clinical and Microbiologic Insights Into Atypical Pediatric Otitis Media.
СтатьяНазвание и аннотация: Перевод в очереди
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Ben Hayoun Din Haim, Keidar-Friedman Danielle, Cohen Michael Ori, Ovnat Tamir Sharon, Brosh-Nissimov Tal, Fogel Ofir, Cahan Amos, Tsur Anka, Marom Tal
Аннотация
INTRODUCTION: Advanced microbiologic diagnostics have expanded the spectrum of bacterial species identified in otitis media (OM). The clinical significance of atypical otopathogens remains unclear. This study compares characteristics and outcomes of pediatric OM caused by atypical versus typical pathogens.
METHODS: In this retrospective cross-sectional study of children (0-18 years) with culture-positive monomicrobial OM at a secondary care center (2021-2024), we assigned Streptococcus pneumoniae , Haemophilus influenzae , Streptococcus pyogenes , Staphylococcus aureus , Moraxella catarrhalis and Pseudomonas aeruginosa from chronic suppurative OM (CSOM) cases to the typical group; other isolates were atypical. Clinical outcomes were compared using 1:1 matched cohorts and propensity scores.
RESULTS: Thirty-one children were included in both the atypical and typical groups. Six typical cases involving P. aeruginosa from CSOM were included in a supplementary analysis. Turicella otitidis predominated among atypical isolates (n = 13, 42%). Following 1:1 matching, atypical otopathogens were significantly associated with older age (5.41 ± 5.08 vs. 2.7 ± 3.7 years, P = 0.006) and prior otologic surgery (42% vs. 10%, P = 0.008). Acute OM was more associated with typical otopathogens (87% vs. 61%, P = 0.016). CSOM was associated with atypical otopathogens (48% vs. 30%, P = 0.034). These differences remained significant after applying the inverse propensity score-weighted approach. No statistically significant differences were observed in clinical outcomes, complication rates or inflammatory biomarkers. Atypical otopathogens demonstrated markedly elevated quinolone resistance (53% vs. 7%).
CONCLUSIONS: Atypical otopathogens predominantly affect older children and are associated with distinct disease phenotypes but comparable outcomes to typical pathogens. Current management appears appropriate; however, elevated quinolone resistance warrants consideration in selecting empirical therapy.
METHODS: In this retrospective cross-sectional study of children (0-18 years) with culture-positive monomicrobial OM at a secondary care center (2021-2024), we assigned Streptococcus pneumoniae , Haemophilus influenzae , Streptococcus pyogenes , Staphylococcus aureus , Moraxella catarrhalis and Pseudomonas aeruginosa from chronic suppurative OM (CSOM) cases to the typical group; other isolates were atypical. Clinical outcomes were compared using 1:1 matched cohorts and propensity scores.
RESULTS: Thirty-one children were included in both the atypical and typical groups. Six typical cases involving P. aeruginosa from CSOM were included in a supplementary analysis. Turicella otitidis predominated among atypical isolates (n = 13, 42%). Following 1:1 matching, atypical otopathogens were significantly associated with older age (5.41 ± 5.08 vs. 2.7 ± 3.7 years, P = 0.006) and prior otologic surgery (42% vs. 10%, P = 0.008). Acute OM was more associated with typical otopathogens (87% vs. 61%, P = 0.016). CSOM was associated with atypical otopathogens (48% vs. 30%, P = 0.034). These differences remained significant after applying the inverse propensity score-weighted approach. No statistically significant differences were observed in clinical outcomes, complication rates or inflammatory biomarkers. Atypical otopathogens demonstrated markedly elevated quinolone resistance (53% vs. 7%).
CONCLUSIONS: Atypical otopathogens predominantly affect older children and are associated with distinct disease phenotypes but comparable outcomes to typical pathogens. Current management appears appropriate; however, elevated quinolone resistance warrants consideration in selecting empirical therapy.