Methicillin-resistant Staphylococcus Aureus (MRSA) in Chronic Supporative Otitis Media

Objective: To review our experience with patients with active chronic ear disease and positive cultures for MRSA.

Method: A retrospective analysis of all chronic supporative otitis media (CSOM) patients with a positive culture for MRSA, that were hospitalized between the years of 2000-2015 and a review of literature.

Results: A total of eight patients (Mean age was 12.8 years, range 4.5- 25 years) with CSOM and MRSA positive ear cultures were identified, accounting for less than 2% of CSOM patients that were hospitalized during that period. These patients did not have additional bacterial growth. The mean hospital stay lasted 7.2 days and ranged between 3-19 days. Of the 8 patiets, three underwent prior VT insertion, one patient had previous mastoidectomy and one had previous tympanoplasy. Patients received parenteral antibiotics (vancomycin, ceftriaxone), topical therapy consisting of quinolone and steroid drops & aural toilet. One patient was identified with cholesteatoma and a complication of lateral semicircular canal fistula. She was operated shortly after.

Conclusions: Based on the literature and our limited experience, active CSOM with MRSA otorrhea is nor associated with a unique clinical course or complication. It should be treated the same as otorrhea with Methicillin-ensitive Staphylococcus Aureus (MSSA) and other pathogens such as Pseudomonas A. , with consideration of the sensitivity to antibiotics. The literature shows an advantage for intra-venous vancomycin, aiding topical therapy and aural toilet to overcome the exacerbation of infection.