01 Oct Acute Otitis Media: Using Nasopharyngeal PCR to Detect Pathogens in Children
MedicalResearch.com Interview with:
Holly Frost, MD
Assistant Professor Pediatrics
University of Colorado Anschutz School of Medicine
Thersia Sebastian, MD
Pediatrics, Denver Health
MedicalResearch.com: What is the background for this study?
Response: Among children with acute otitis media (AOM) S.pneumoniae, H.influenzae, and M.catarrhalis are the predominant bacterial otopathogens. Historically, the gold standard for diagnosing otopathogens has been through middle ear fluid (MEF) culture.
The challenge with MEF culture is that it is time-consuming and requires expert training often only done by specialists, thereby limiting its diagnostic utility to guide routine clinical care. Recent studies have shown that there is a high correlation between nasopharyngeal (NP) and MEF organisms during AOM. It is easier to collect NP swabs and less training is required. Thus, NP samples could serve as a surrogate for detection of otopathogens, potentially making identification of otopathogens practical and feasible in a typical practice environment compared to a MEF collection.
Identification of otopathogens could be critical in treatment management of AOM, especially in the era of antimicrobial stewardship efforts to overall reduce unnecessary antibiotic use. Our goal was to compare the sensitivity and specificity of NP PCR to NP culture for common bacteria that cause ear infections.
MedicalResearch.com: What are the main findings?
Response: Patients ages 6-35 months with uncomplicated AOM who were prospectively enrolled in an AOM study in Denver, CO from Jan 2019-Dec 2020 were included in the study. All patients had an NP swab at enrollment.
Of the 80 children included in this analysis, 18 (22.5%) had no organism detected on culture, 31 (38.8%) had one and 31 (38.8%) had multiple organisms detected. The sensitivity of PCR was high (>94%) for all organisms whereas the specificity was lower (50.0-77.8%) and varied by the specific organism. The negative predictive values were high (>96%) for all otopathogens. PCR detected 1.6 times more organisms than culture (149 organisms detected by PCR vs. 96 detected by culture). Thus, NP PCR could be a useful technique to exclude the presence of specific bacteria in children with AOM.
MedicalResearch.com: What should readers take away from your report?
Response: Nasopharyngeal PCR may be a practical method to use in clinical settings to determine need for antibiotic treatment and, if a child required an antibiotic, which antibiotic agent would be optimal in cases of uncomplicated AOM in children.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Nasopharyngeal PCR warrants further exploration as a diagnostic tool to evaluate for otopathogens in children. Studies to understand how use of a rapid diagnostic test for AOM would change antibiotic prescribing habits and affect clinical outcomes for children would be beneficial.
MedicalResearch.com: Is there anything else you would like to add?
Response: It is a critical time in medicine for the health care community to practice improved antimicrobial stewardship efforts. Acute otitis media is the most common childhood infection for which antibiotics are prescribed, and therefore a pragmatic approach to limiting antibiotic use in its management could significantly improve antibiotic resistance patterns in children. A diagnostic tool that is practical and feasible may be vital to ensure this behavior change.
Citation: ID Week 2021
Reliability of Nasopharyngeal PCR for the Detection of Otopathogens in Children with Uncomplicated Acute Otitis Media
Holly Frost, Thresia Sebastian, Amy Keith, Melanie Kurtz, Andreas Bress, Richard Egan, Sarah Parker, Samuel Dominguez, Tim Jenkins
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