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Methicillin-Resistant Staphylococcus Aureus (MRSA) Pediatric Tympanostomy Tube Otorrhea

Sunday, October 21, 2012: 12:00 PM
Room 203 (Morial Convention Center)
Jeffrey Cheng, M.D. and Luv Javia, M.D., Division of Pediatric Otolaryngology, The Children's Hospital of Philadelphia, Philadelphia, PA

Purpose: Review our experience with methicillin-resistant Staphylococcus aureus (MRSA) tympanostomy tube otorrhea in the pediatric population.

Methods: Retrospective chart review at a tertiary-care, pediatric hospital of patients (age < 18) diagnosed with culture-positive MRSA tympanostomy tube otorrhea and treated between January 1, 2006 and December 6, 2011.  

Results: A total of 650 patients and 1165 ear culture results were identified. MRSA positive ear cultures in the presence of tympanostomy tubes were identified in 42 patients. The average age was 2.9 years old. Medical treatment was clinician-dependent and extremely varied. In all cases, culture results indicated sensitivity to trimethoprim/sulfamethoxazole and gentamicin; resistance to fluoroquinolones and clindamycin occurred in 88.1% and 59.5% of cases, respectively. In 22 of the 42 (52.4%) patients, resolution of MRSA otorrhea, required tympanostomy tube removal or extrusion. MRSA sensitivity to fluoroquinolones, clindamycin, or both was not associated with successful treatment without tympanostomy tube removal (p = 0.57, 0.06, 0.14, respectively).  

Conclusion: Appropriately treated recurrent or recalcitrant tympanostomy tube-related otorrhea should raise the suspicion for MRSA. Conservative management with ototopical antibiotic drops and/or systemic antibiotics has variable results but when employed, culture-directed therapy should be considered when choosing ototopical drops and/or systemic antibiotics. In some cases, removal of the infected tympanostomy tube is necessary. No standard management guidelines currently exist. We recommend that tube removal be given strong consideration.