Atypical otitis media prevalent in older children, tied to distinct disease phenotypes

Atypical otopathogens of otitis media (OM) are more commonly detected in older children and correlate with distinct disease phenotypes but similar outcomes to typical pathogens, according to a study.

This retrospective cross-sectional study involved children with culture-positive monomicrobial OM at a secondary care centre (2021‒2024). The investigators assigned Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus pyogenes, Staphylococcus aureus, Moraxella catarrhalis, and Pseudomonas aeruginosa from chronic suppurative OM (CSOM) cases to the typical group and the rest to the atypical group. They compared clinical outcomes using 1:1 matched cohorts and propensity scores.

The atypical and typical groups each comprised 31 children. Six typical cases involving P. aeruginosa from CSOM were included in a supplementary analysis

The most common atypical isolate was Turicella otitidis (n=13 ,42 percent). After matching, atypical otopathogens showed a significant association with older age (5.41 vs 2.7 years; p=0.006) and prior otologic surgery (42 percent vs 10 percent; p=0.008).

Typical otopathogens correlated more with acute OM (87 percent vs 61 percent; p=0.016), while CSOM was associated with atypical otopathogens (48 percent vs 30 percent; p=0.034). These differences persisted after applying the inverse propensity score‒weighted approach. Statistically significant differences were not seen in clinical outcomes, complication rates, or inflammatory biomarkers.

Notably, atypical otopathogens were found to be highly resistant to quinolones (53 percent vs 7 percent).

“Current management appears appropriate, [but] elevated quinolone resistance warrants consideration in selecting empirical therapy,” the investigators said.