Children's Ear Infections Caused by MRSA Following Tympanostomy Tube Placement Not Associated With Additional Surgical Procedures or Other Complications

A diagnosis of otorrhea (ear discharge and drainage) due to methicillin-resistant Staphylococcus aureus(MRSA) following ear tube placement in children does not appear to be associated with an increased risk for requiring additional surgery or developing further complications, compared to a diagnosis of non-MRSA otorrhea, according to a study in the December issue of Archives of Otolaryngology - Head & Neck Surgery, one of the JAMA/Archives journals.

"More than half a million procedures are performed annually to place tympanostomy tubes in children, making this the most common surgical procedure performed in childhood," the authors provide as background information. Otorrhea is a common complication of this procedure.

Nathan S. Alexander, M.D., from the Children's Hospital of Alabama, Birmingham, and colleagues reviewed medical records to examine the prevalence of otorrhea after tympanostomy tube placement in children and to determine the risk factors and outcomes for treatment for MRSA compared with non-MRSA infections. The researchers classified patients into groups using the otorrhea culture reports for each of the 1,079 patients whose otorrhea was caused by MRSA (n = 135) and those with non-MRSA otorrhea (n = 141). They then reviewed the medical records to obtain information on medical treatments, surgical procedures performed, hearing analysis and other infection-related illnesses.

"The overall incidence of MRSA in this series was about 16 percent (170 or 1,079 patients)," the authors report. "The groups [MRSA vs. non-MRSA otorrhea patients] did not differ significantly in type of insurance;history of tympanostomy tube placement, cholesteatoma [skin cyst in middle ear], or prematurity;number or type (minor/major) of surgical procedures performed;or risk of subsequent infection-related diagnoses. More patients in the MRSA group received intravenous antibiotic therapy (11 percent vs. 3.6 percent)." And the researchers report that a slightly higher proportion of patients in the MRSA group had a mild hearing loss (14.5 percent vs. 6.2 percent).

"In conclusion, MRSA otorrhea as a complication of tympanostomy tube placement has become more prevalent since the late 1990s," the authors write. "Children with MRSA otorrhea were more likely to receive intravenous and oral antibiotics, but they were not more likely to need additional surgical procedures to control otorrhea or to be hospitalized for infection-related diagnoses or to suffer complications of otitis media (ear infections). These findings should facilitate appropriate care for MRSA otorrhea after tympanostomy tube placement and help to decrease parental anxiety regarding a diagnosis of MRSA otorrhea vs. non-MRSA otorrhea."

(Arch Otolaryngol Head Neck Surg. 2011;(12):1223-1227.)