Etiology of acute otitis media in human immunodeficiency virus-infected children

Background. Acute otitis media (AOM) is one of the most common infections that are implicated as significant contributors to morbidity in HIV-infected children. To establish the optimal antibiotic therapy tympanocentesis is indicated as the first line diagnostic procedure, because unusual pathogens may play a role in advanced stages of deficient humoral or cellular immunity. Methods. The microbiology of 60 episodes of AOM diagnosed in 21 symptomatic HIV-infected children (ages 9 months to 12 years) was compared with that of 121 episodes of AOM occurring in 113 immunocompetent HIV-negative children (ages 6 months to 12 years) in the last 5 years. Results. The prevalence of the three most common pathogens (Streptococcus pneumoniae, Haemophilus influenzae and group A beta-hemolytic Streptococcus) was similar in HIV- infected and in normal children (56.5% vs. 54.9% of the ears). Staphylococcus aureus was significantly more frequent in AOM diagnosed in severely immunosuppressed stages. A significantly lower proportion of middle ear effusions obtained in HIV-infected children yielded no bacteria compared with normal children. Beta-lactamase production among isolates of H. influenzae was a rare phenomenon, both in HIV-infected and in normal children. No penicillin-resistant S. pneumoniae was found. Conclusions. In HIV-infected children with absent or moderate immunosuppression empiric antibiotic therapy should be based on the recommendations given for immunocompetent children of the same geographic area. In severe immunosuppressed stages, given the possible role of Staph. aureus, extended spectrum antibiotics should be considered.