Antimicrobial Resistance Patterns in Bacterial Otitis Media: A Systematic Review of Global Trends and Clinical Implications

This systematic review and meta-analysis provide an overview of bacterial causative agents for otitis media and antimicrobial resistance patterns against major otitis media pathogens. Out of a total of 180 records that were identified initially (both from database and manual searches), duplicates removal left 122 individual records. After screening titles and abstracts, 24 articles were reviewed in full text, and ultimately, 18 studies were included in the meta-analysis. Frequent reporting of gram-negative pathogens as major causative organisms were seen in the present study and highlighted multiple reports on particular Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae 5 and Proteus spp. Pathogens were generally highly susceptible to most aminoglycosides (amikacin and gentamicin), fluoroquinolones (ciprofloxacin and levofloxacin) carbapenems and colistin. Regarding Gram-positive bacteria Staphylococcus aureus, notably methicillin-resistant strains (MRSA), was similarly associated with resistance, indicative of its endemic β-lactam and multi-class antibiotic resistance. The pooled meta-analysis resulted in a statistically significant overall antibiotic resistance rate of bacterial isolates related to otitis media (pooled prevalence= 0.61 [95% CI: 0.54–0.68], P < 0.001). Such analysis concluded that around 61% of bacterial pathogens found across the studies investigated showed resistance to typically-used antimicrobial agents. There was substantial between-study heterogeneity (I² = 72.4%) in the analysis of subpopulations, likely due to geographic locations, distribution of bacterial species, antibiotic prescribing practices and laboratory methods among studies included. This meta-analysis shows the considerable burden of antibiotic resistance in bacterial pathogens causing otitis media. Staphylococcus aureus and Pseudomonas aeruginosa were identified as the most common resistant organisms, whereas aminoglycosides and fluoroquinolones retained higher efficacy in general.