Bacterial etiologies, antimicrobial susceptibility profiles and associated factors among patients with otitis media referred to Nekemte Public Health Research and Referral Laboratory Center, Western Ethiopia: A prospective cross-sectional study

Bacterial etiologies, antimicrobial susceptibility profiles and associated factors among patients with otitis media referred to Nekemte Public Health Research and Referral Laboratory Center, Western Ethiopia: A prospective cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Bacterial etiologies, antimicrobial susceptibility profiles and associated factors among patients with otitis media referred to Nekemte Public Health Research and Referral Laboratory Center, Western Ethiopia: A prospective cross-sectional study Endalu Guteta, Fedasan Abdi, Seifu Gizaw, Belay Merkeb, Betrearon Sileshi, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4452931/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 07 Jan, 2025 Read the published version in BMC Microbiology → Version 1 posted 10 You are reading this latest preprint version Abstract Background Otitis media is among the leading causes of illnesses responsible for causing hearing problems and adding significant costs to the public health system. Bacteria are the most common causative agents for otitis media. Currently, there is little information on the prevalence and antimicrobial susceptibility patterns of pathogenic bacterial isolates from patients with otitis media in Ethiopia. Methodology A laboratory – based cross-sectional study was conducted from June to September 2023 among 242 patients with otitis media referred to Nekemte Public Health Research and Referral Laboratory Center. Sociodemographic and clinical data were obtained by trained nurses and/or health officers in face-to-face interviews using structured questionnaires. Middle ear discharge samples were collected by trained clinical microbiology experts following all aseptic techniques. Conventional culture, different biochemical tests and antimicrobial susceptibility testing were performed for all the isolated bacteria. Reference strains were used as a positive and negative controls. The data were checked for completeness and consistency, entered into EpiData version 4.6.06 and analyzed by SPSS version 25. Logistic regression analysis was performed to determine the associated factors of otitis media. Adjusted odds ratio was used to determine strength of association. Statistical significance was obtained at p-value of below 0.05. The data were interpreted using graphs, tables, and results statements. Results A total of 242 middle ear discharge samples were collected and cultured from which 212 (87.6%) were culture positive. A total of 228 pathogenic bacterial isolates were recovered. The predominant bacterial isolates were S. aureus 92 (40.4%) followed by P. aeruginosa 33 (14.5%) and E. coli 24 (10.5%). One hundred fifty-one (66.2%) bacterial pathogens were multidrug resistant. Piperacillin-tazobactam and tobramycin are relatively common drugs to which most of the isolates were susceptible while ampicillin and tetracycline were the most resistant. Purulent discharge (p-value = 0.001), middle ear discharge ≥ 14 days (P-value = 0.000) and a history of active/passive smoking (P-value = 0.043) were significantly associated with otitis media. Conclusion The prevalence of bacterial pathogens, most of which were multidrug-resistant, was high among patients with otitis media. A significant association was observed with purulent ear discharge, chronic otitis media, and passive or active smoking. Choosing the proper antibiotic for the treatment of bacterial infection is crucial. Otitis media bacteria antimicrobial resistance Background Otitis media (OM) is a common inflammatory illness that can affect people of all ages and results in temporary or permanent hearing loss due to fluid effusion or pathological alterations in the tympanic membrane of the middle ear ( 1 ). The spectrum of illnesses associated with OM ranges from acute to chronic and is clinically indicated by the presence of fluid accumulation in the middle ear that can cause temporary hearing loss ( 2 ). Otitis media (OM) is a significant contributor to hearing loss in people of all ages but is more common among children under-five years of age. Globally, among 709 million patients with AOM, 51% were children under five years old. On the other hand, AOM is responsible for approximately 25% of antibiotic prescriptions among children ( 3 – 5 ). The peak prevalence of OM among children is mainly attributed to immature immune status, the anatomy of the Eustachian tube (shorter and horizontal), frequent exposure to URTIs and malnutrition ( 6 , 7 ). OM is increasingly prevalent in Sub-Saharan Africa and other developing nations including Ethiopia. Due to limited microbiological laboratories, Sub-Saharan African nations rely solely on clinical data for therapy which could be responsible for more complicated OM ( 8 ). Bacteria are the most common agents for OM. The most predominant pathogenic bacteria isolated from AOM included M. catarrhalis, S. pneumoniae and H. influenzae . On the other hand, P. aeruginosa , Klebsiella species , Proteus species , S. aureus and E. coli are the predominant bacteria isolated from patients with CSOM ( 9 ). The extensive application of antibiotics to treat OM has led to the growth of resistant bacteria, including strains that are resistant to many drugs ( 10 ). Several studies have reported considerable resistance rates of bacteria isolated from middle ear. To ensure the best possible care and fight antibiotic resistance, it is essential to continuously and periodically evaluate the microbiological profile and antimicrobial susceptibility ( 11 , 12 ). In Ethiopia, few studies have investigated bacteriological profiles and antimicrobial susceptibility patterns of the middle ear discharge. The number of antibiotic-resistant bacteria is alarming and becoming a major public health problem in the management of patients with middle ear infection ( 13 – 15 ). There are no data on the prevalence and antimicrobial susceptibility patterns of bacterial pathogens from middle ear infections in referred health facilities. This on the other hand might indicate that clinicians base their treatment on empirical evidence. Knowing the local antibiogram is important for cost-effective and appropriate treatment of otitis media and helps prevent complications that may arise due to the lack of treatment or improper treatment. Thus, the aim of this study was to acquire data on bacterial pathogens responsible for otitis media and their antibacterial susceptibility patterns among patients with otitis media referred to the Nekemte Public Health Research and Referral Laboratory Center for culture tests. Methods Study area, period and design This study was conducted at Nekemte Public Health Research and Referral Laboratory Center among referred patients with otitis media from nearby health facilities from June to September 2023. A laboratory-based cross-sectional study was conducted in 242 patients with otitis media. Study design Study participants and sampling technique Patients with middle ear discharge accompanied by laboratory-appropriate request form and those who were not receiving antibiotic were included in the study. Participants were selected through convenience sampling. We used the presence of middle ear discharge as an entry point because routine otoscopic examination might not be carried out in the referring health facilities even if this approach undermines the magnitude of middle ear discharge as we might have missed some patients who didn’t have an obvious middle ear discharge Data collection, sample processing and laboratory analysis Sociodemographic and clinical data were collected in face-to-face interviews from study participants by nurses/health officers using structured questionnaires. Middle ear discharge data were collected by trained clinical microbiology experts. The collected discharge samples were inoculated on blood agar, chocolate agar and MacConkey agar following standard bacteriological techniques. Bacterial pathogens from positive culture results were identified by their characteristic appearance on the respective media, gram-staining reaction and pattern of biochemical profiles using standard procedures. The antibiotic susceptibility all the isolated bacterial pathogens was tested via Kirby-Bauer disc diffusion method. Inocula were prepared by transferring 3–5 colonies from pure culture into 5 ml of normal saline and mixing thoroughly to make a homogenous suspension equivalent to the 0.5 McFarland standard. Using a sterile cotton swab, the bacterial suspension was distributed evenly over the entire surface of MHA (HIMEDIA, India) and left at room temperature for 15 minutes. The plates were then incubated at 37°C for 16–18 hours and observed for the zones of inhibition. The growth inhibition zone was measured by a ruler, and results were interpreted as whether the organism was sensitive, intermediate or resistant to the antimicrobial agents by comparison with standard guidelines based on the Clinical and Laboratory Standards Institute (CLSI) 2023 ( 16 ). Data quality assurance Different methods were used for assuring data quality. A standard and structured questionnaire prepared in English was used. The questionnaire was then translated to the local language (Afan Oromo) for data collection and then re-translated back into English for analysis. One day of training was given to the data collectors and supervisors on the data collection tool and procedures. To ensure validity, 5% of the questionnaire was pretested. The findings from the pretesting were utilized for modifying and adjusting of the instrument and interviewing technique. The data collectors were supervised closely by the supervisors and the principal investigator. The completeness of each questionnaire was checked daily by the principal investigator and the supervisors. To ensure consistency, coding, double entry and cleaning were performed. The entire data collection process was guided by the principal investigator. The specimen containers were properly labeled with patient identifier, codes, collector initial and collection date and time. Then, the collected specimens were immediately transported to the clinical microbiology laboratory for processing according to existing SOPs. All patient information was checked for clarity and completeness. Media and all relevant reagents were carefully inspected and checked for expiration dates prior to use. The sterility of the prepared culture media was checked by incubating 5% of the batch at 35–37°C overnight and evaluating it for possible contamination. Trained laboratory experts performed the tests. All testing procedures were performed depending on the existing SOPs of the clinical microbiology laboratory. S. aureus was used for checking the functionality of blood agar and chocolate agar, and E. coli (ATCC 25922) and P. aeruginosa (ATCC 27853) were used for MacConkey and biochemical tests. Antimicrobial susceptibility testing Antimicrobial susceptibility tests were performed using the Kirby–Bauer disk diffusion method on Muller Hinton agar (MHA) (HIMEDIA, India). Antibiotic discs were selected based on the prescription pattern in the study area and recommendations from the Clinical Laboratory Standards Institute (CLSI). The grades of the susceptibility profile were read as sensitive (S), intermediate (I), or resistant (R) by comparison of the zone of inhibition with clinical and laboratory standards institute guidelines 33rd edition ( 16 ). The following antibiotic disks were used for susceptibility testing: Ceftriaxone (30 µg), Cefoxitin (30 µg), Ceftazidime (30 µg), Penicillin G (10 µg), Ampicillin (10 µg), Amoxicillin-clavulanate (20/10µg), Piperacillin-tazobactam (100/10 µg), Meropenem (10 µg), Gentamicin (10 µg), Tobramycin (10 µg), Ciprofloxacin (5 µg), Azithromycin (15 µg), Clindamycin (30 µg), Vancomycin (30 µg), Tetracycline (30 µg), Chloramphenicol (30 µg) and Trimethoprim sulfamethoxazole (1.25/23.75). Statistical analysis The collected data were coded, entered into Epi-data version 4.6.0.6 software and then cleaned. From this software, they were exported to SPSS version 25 for analysis. Descriptive statistics were calculated to describe relevant variables. The data were presented in words, figures, and tables. Binary logistic regression analysis was used to select candidate variables for multivariable logistic regression analysis. Variables with P-values < 0.25 were candidates for multivariate analysis. The adjusted odds ratio (AOR) was used to determine the strength of the association. A P-value < 0.05 was considered to indicate statistical significance. Results Characteristics of the study participants A total of 242 middle ear discharge samples were collected from the study participants and analyzed. Males and females accounted for 129 (53.3%) and 113 (46.7%) of the participants, respectively. The age of the participants ranged from 1 to 65 years, with mean and median ages of 17.1 and 14.0 years, respectively. Ninety-one (37.6%) of them were aged less than five years, while 73 (30.2%) were aged 25 years and older. One hundred sixty-five (68.2%) and 77 (31.8%) of the participants were from urban and rural areas, respectively (Table 1 ). Table 1 Age, sex and residence distribution of patients with otitis media referred to Nekemte Public Health Research and Referral Laboratory Center, Nekemte, June-September 2023. Variable Frequency Percentage Age < 5 91 37.6 5–14 34 14.0 15–24 44 18.2 ≥ 25 73 30.2 Sex Male 129 53.3 Female 113 46.7 Residence Urban 165 68.2 Rural 77 31.8 Prevalence of bacterial pathogens Two hundred twelve middle ear discharge samples were positive for culture resulting in an overall 87.6% prevalence of bacterial isolates. A total of 228 bacterial pathogens were recovered from positive cultures constituting (107, 46.9%) Gram-positive and (121, 53.1%) Gram-negative bacteria. From the total bacterial isolates, S. aureus (92, 40.4%) and P. aeruginosa (33, 14.5%) were the predominant bacterial species followed by E. coli (24, 10.5%) and K. pneumoniae (16, 7.0%) (Table 2 ). Table 2 Bacterial etiologic agents among patients with otitis media referred to Nekemte Public Health Research and Referral Laboratory Center, Nekemte, Ethiopia, June-September 2023. Bacterial isolates Frequency Percentage Gram – positive S. aureus 92 40.4 CONS 10 4.4 S. pneumoniae 4 1.8 Enterococcus spp. 1 0.4 Gram – negative E. coli 24 10.5 P. aeruginosa 33 14.5 K. pneumonia 16 7.0 Providencia spp. 13 5.7 P. mirabilis 11 4.8 P. vulgaris 11 4.8 Acinetobacter spp. 6 2.6 Citrobacter spp. 4 1.8 K. oxytoca 3 1.3 Total 228 100 Antimicrobial susceptibility testing Antimicrobial susceptibility testing was performed for both gram-positive (n = 107) and gram-negative (n = 121) bacterial pathogens isolated from the study participants. The predominant gram-positive isolate, S. aureus showed the highest level of resistance to penicillin (86, 93.5%) followed by cefoxitin (81, 88.0%) but gentamicin (72, 78.3%) and clindamycin (74, 80.4%), the two antibiotics to which S. aureus is susceptible (Table 3 ). Table 3 Antimicrobial resistance patterns of gram-positive bacterial isolates from patients with otitis media referred to Nekemte Public Health Research and Referral Laboratory Center, Nekemte, Ethiopia, June- September 2023. Antibiotics tested Number of resistant bacteria [n (%)] S. aureus CONS S. pneumoniae Enterococcus spp . Total 92 10 4 1 107 Ampicillin NT NT NT 0 (0.0) 0 (0.0) Azithromycin 41 (44.6) 7 (70.0) 0 (0.0) NT 48 (44.9) Cefoxitin 81 (88.0) 8 (80.0) NT NT 89 (83.2) Chloramphenicol 29 (31.5) 5 (50.0) NT 0 (0.0) 34 (31.8) Ciprofloxacin 41 (44.6) 3 (30.0) NT NT 44 (41.1) Clindamycin 17 (18.5) 3 (30.0) 0 (0.0) NT 20 (18.7) Cotrimoxazole 47 (51.1) 8 (80.0) 0 (0.0) NT 55 (51.4) Gentamicin 17 (18.5) 0 (0.0) NT NT 17 (15.9) Penicillin 86 (93.5) 8 (80.0) NT 0 (0.0) 94 (87.9) Tetracycline 71 (77.2) 9 (90.0) 2 (50.0) NT 82 (76.7) CONS – Coagulase negative staphylococci, NT – Not tested Twenty-three (95.8%), 32 (97%), 16 (100%), and 12 (92.3%) E. coli, P. aeruginosa , K. pneumoniae , and Providencia species , respectively, demonstrated susceptibility to piperacillin-tazobactam. Twenty (60.6%) P. aeruginosa strains exhibited resistance to meropenem. The majority of 22 (91.7%) of E. coli isolates were resistant to ampicillin (Table 4 ). Table 4 Antimicrobial resistance patterns of gram-negative bacterial isolates from patients with otitis media referred to Nekemte Public Health Research and Referral Laboratory Center, Nekemte, Ethiopia, June-September 2023. Bacterial isolates (n = 121) Antibiotics tested AMC AP CAZ CHL CIP COT CRO GEN MEM PTZ TOB TTC P. aeruginosa n = 33 NT NT 12 (36.4) NT 13 (39.4) NT NT NT 20 (60.6) 1 (3.0) 13 (9.1) NT E. coli n = 24 3 (12.5) 22 (91.7) 7 (29.2) 8 (33.3) 12 (50.0) 13 (54.2) 17 (70.8) 3 (12.5) 12 (50.0) 1 (4.2) 4 (16.7) 21 (87.5) K. pneumoniae n = 16 2 (12.5) NT 8 (50.0) 4 (25.0) 6 (37.5) 7 (43.8) 8 (50.0) 1 (6.3) 7 (43.8) 0 (0.0) 1 (6.3) 11 (68.8) Providencia spp. n = 13 NT NT 2 (15.4) 4 (30.8) 4 (30.8) 9 (69.2) 7 (53.8) 2 (15.4) 9 (69.2) 1 (7.7) 2 (15.4) NT P. mirabilis n = 11 1 (9.1) 11 (100) 4 (36.4) 5 (45.5) 3 (27.3) 4 (36.4) 6 (54.5) 3 (27.3) 6 (54.5) 0 (0.0) 3 (27.3 NT P. vulgaris n = 11 1 (9.1) NT 3 (27.3) 1 (9.1) 5 (45.5) 6 (54.5 8 (72.7) 0 (0.0) 7 (63.6) 0 (0.0) 0 (0.0) NT Acinetobacter spp. n = 6 NT NT 1 (16.7) NT 1 (16.7) 5 (83.3) 1 (16.7) 0 (0.0) 2 (33.3) 2 (33.3) 0 (0.0) NT Citrobacter spp. n = 4 NT NT 1 (25.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (50.0) 0 (0.0) 2 (50.0) 0 (0.0) 0 (0.0) 3 (75.0) K. oxytoca n = 3 0 (0.0) NT 0 (0.0) 1 (33.3) 2 (66.7) 0 (0.0) 1 (33.3) 1 (33.3) 1 (33.3) 0 (0.0) 1 (33.3) 1 (33.3) AMC = Amoxicillin – clavulanate AP = Ampicillin CAZ = Ceftazidime CHL = Chloramphenicol CIP = Ciprofloxacin COT = Cotrimoxazole CRO = Ceftriaxone GEN = Gentamicin MEM = Meropenem PTZ = Piperacillin-tazobactam TOB = Tobramycin TTC = Tetracycline NT = Not tested Multidrug Resistance The overall prevalence of MDR bacteria in this study was 151 (66.2%). Among the gram-positive and gram-negative isolates, 91 (39.9%) and 60 (26.3%) were multidrug resistant, respectively. The predominant bacterial pathogens isolates were S. aureus (82, 54.3%), E. coli (20, 13.2%) and K. pneumoniae (11, 7.3%) (Table 5 ). Table 5: Multidrug resistance patterns of gram-positive and gram-negative bacterial isolates from patients with otitis media referred to Nekemte Public Health Research and Referral Laboratory Center, Nekemte, Ethiopia, June-September 2023. Bacteria isolates Antimicrobial susceptibility test results, N o (%) Total MDR R0 R1 R2 ≥R3 Gram-positive isolates S. aureus (n = 92) 0 (0.0) 5 (5.4) 5 (5.4) 82 (89.1) 82 (76.6) CONS (n = 10) 0 (0.0) 1 (10.0) 0 (0.0) 9 (90.0) 9 (8.4) S. pneumoniae ( n = 4) 3 (75) 1 (25.0) 0 (0.0) 0 (0.0) 0 (0.0) Enterococcus spp . (n = 1) 1 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Total (n = 107) 4 (3.7) 7 (6.5) 5 (4.7) 91 (85.1) 91 (85.1) Gram-negative isolates P. aeruginosa (n = 33) 6 (18.2) 11 (33.3) 11 (33.3) 5 (15.2) 5 (4.1) E. coli (n = 24) 0 (0.0) 2 (8.3) 2 (8.3) 20 (83.3) 20 (16.5) K. pneumoniae (n = 16) 1 (6.3) 0 (0.0) 4 (25.0) 11 (68.8) 11 (9.1) Providencia spp . (n = 13) 2 (15.4) 2 (15.4) 2 (15.4) 7 (53.8) 7 (5.8) P. mirabilis (n =11) 0 (0.0) 0 (0.0) 3 (27.3) 8 (72.7) 8 (6.6) P. vulgaris (n = 11) 1 (9.1) 1 (9.1) 3 (27.3) 6 (54.5) 6 (5.0) Acinetobacter spp . (n = 6) 1 (16.7) 1 (16.7) 2 (33.3) 2 (33.3) 2 (1.7) Citrobacter spp . (n = 4) 4 (100) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) K. oxytoca (n = 3) 1 (33.3) 1 (33.3) 0 (0.0) 1 (33.3) 1 (0.8) Total (n = 121) 16 (13.2) 18 (14.9) 27 (22.3) 60 (49.6) 60 (49.6) R0 - ≥R3 refers to the number of pathogenic bacterial isolates resistant to 0 - ≥3 different antibiotics Possible risk factors for otitis media Both bivariate and multivariate logistic regression analyses were performed to assess the possible risk factors for middle ear infection. Statistical significance was obtained for purulent middle ear discharge, duration of middle ear discharge ≥ 14 days and history of active/passive smoking. Study participants with purulent middle ear discharge were approximately six times more likely to have positive cultures for bacterial pathogens responsible for causing otitis media [AOR = 6.534 (95% CI: 2.112–20.208; P-value = 0.001)]. On the other hand, participants who experienced otorrhea of ≥ 14 days are approximately seven times more likely to have positive cultures than were those who experienced otorrhea of < 14 days [7.628 (95% CI = 3.135–18.558; P-value = 0.000)]. Those who had an active or passive smoking history were approximately eight times more likely to develop otitis media than to those without a history of active or passive smoking [8.817 (95% CI = 1.072–72.534; P-value = 0.043)] (Table 6 ). Table 6 Multivariate analyses to identify associated factors among study participants with otitis media referred to Nekemte Public Health Research and Referral Laboratory Center, Nekemte, June – September 2023. Variables Culture Result, N o (%) COR (95% CI) AOR (95% CI) P-value Positive Negative Age group < 5 75 (31.0) 16 (6.6) 0.272 (0.087–0.853) 0.436 (0.116–1.641) 0.220 5–14 28 (11.6) 6 (2.5) 0.271 (0.071–1.032) 0.524 (0.112–2.455) 0.412 15–24 40 (16.5) 4 (1.7) 0.580 (0.137–2.446) 0.672 (0.132–3.408) 0.631 ≥ 25 69 (28.5) 4 (1.7) Reference Reference Residence Rural 71 (29.3) 6 (2.5) 2.014 (0.788–5.151) 0.923 (0.305–2.791) 0.880 Urban 141 (58.3) 24 (9.9) Reference Reference Ear involved Right 114 (47.1) 20 (8.3) Reference Reference Left 98 (40.5) 10 (4.1) 1.719 (0.768–3.848) 1.219 (0.470–3.162) 0.683 Appearance of middle ear discharge Bloody 17 (7.0) 9 (3.7) Reference Reference Purulent 157 (64.9) 10 (4.1) 8.312 (2.967–23.288) 6.534 (2.112–20.208) 0.001* Mucoid 38 (15.7) 11 (4.5) 1.829 (0.640–5.228) 1.398 (0.427–4.580) 0.580 Duration of middle ear discharge < 14 days 34 (14.0) 18 (7.4) Reference Reference ≥ 14 days 178 (73.6) 12 (5.0) 7.853 (3.468–17.783) 7.628 (3.135–18.558) 0.000* History of smoking No 164 (67.8) 29 (12.0) Reference Reference Yes 48 (19.8) 1 (0.4) 8.488 (1.127–63.936) 8.817 (1.072–72.534) 0.043* Treatment history for otitis media No 122 (50.4) 21 (8.7) Reference Reference Yes 90 (37.2) 9 (3.7) 1.721 (0.753–3.936) 0.895 (0.354–2.736) 0.976 *Associated factors for otitis media CI = Confidence interval, COR = Crude odds ratio, AOR = Adjusted odds ratio Discussion Otitis media is a major reason people seek medical attention globally, and its complications play a significant role in the development of preventable hearing loss, particularly in developing nations ( 17 ). According to the present study OM was found to be a common health problem at all ages. According to the present study, OM was found a common health problem in all ages. However, a peak prevalence of 31.0% was observed among children under five years of age, which was similar to that reported in other studies in Ethiopia (28.1%) ( 18 ), higher than that reported in India (14.9%) ( 19 ) but lower than that study performed in Yemen (66.7%) ( 20 ). This prevalence of OM in children is mainly attributed to immature immune status, the anatomy of the Eustachian tube (shorter and horizontal), frequent exposure to URTIs and malnutrition. Gender-wise analysis of this study showed that males were more affected than females were. This finding, with male predominance, is in agreement with a study performed in Wollo, Ethiopia (50.4%) ( 13 ) and Pakistan (43.9%) ( 21 ) but lower than a study performed in India (56.7%) ( 22 ). In contrast, other studies in Iran (57.8%) and Iraq (60.0%) ( 23 , 24 ) showed that females were more affected by otitis media than males were. The differences in male and female predominance may be attributed to the nature of the sampling technique. This study also provides insight into the prevalence of otitis media with respect to the residential location of study participants. The prevalence of otitis media among study participants from urban areas was 58.3%. This finding agrees with a study performed in Mekele, Ethiopia (52.0%) ( 25 ) but is lower than that in a study performed in Gondar, Ethiopia (76.5%) ( 26 ). However, the present study disagrees with a study performed in China ( 27 ) in which 85.9% of rural areas were positive for OM. These disparities may come from the involvement of study participants from urban areas due to increased health seeking-behavior, proximity to health facilities and culture diagnostic services in the study areas. In the present study, the overall middle ear discharge culture positivity rate was 87.6% (95% CI = 82.8–91.5). This finding is similar to that of study performed in Dessie, Ethiopia, which reported 89.4% ( 28 ) but it was higher than that of studies done in Gondar (76.7%) and Bahir Dar (80.4%) ( 14 , 29 ). In contrast, the current culture positivity rate was lower than that studies performed in Ghana (97%) and India (95.7%) ( 30 , 31 ), which may be related to variations in the availability of isolation and identification media. This may be correlated with the fact that availability of relevant media and other supplies maximizes the frequency of culture positivity in middle ear discharge. A total of 228 bacterial isolates were identified. Analysis of the Gram reactions of the isolates revealed that 53.1% [95% CI (46.6–59.5)] and 46.9% [95% CI (40.5–53.4%)] were gram-negative and gram-positive bacterial pathogens, respectively. Another study in Ethiopia reported 56.0% gram-negative bacteria as the predominant species isolated from middle ear discharge, which was consistent with the results of the present study ( 25 ). Reports from Somalia, Nigeria and Malaysia agree with the predominance of gram-negative bacteria, with higher frequencies of 77.3%, 71.6% and 75.3%, respectively ( 32 – 34 ). The reason for the higher prevalence could be the chronic nature of infection, where gram-negative bacteria from external sources gain access to the auditory canal and eventually become predominant. The predominant bacterial isolates in this study were S. aureus (40.5%) and P. aeruginosa (14.5%) which was similar to the findings of studies in Ethiopia ( 35 ), Pakistan ( 36 ) and China ( 37 ) but inconsistent with the findings of other studies in Ethiopia ( 13 ), India ( 38 ) and Turkey ( 39 ). In addition, the isolation rates of Coagulase negative staphylococci , S. pneumoniae and Enterococcus species were 4.4%, 1.8% and 0.4%, respectively. At least one of these bacterial isolates has also been reported in other studies ( 25 , 26 , 29 , 40 – 42 ). This study revealed that gram-negative bacterial isolates included E. coli (19.8%), K. pneumoniae (13.2%), Providencia species (10.7%), P. mirabilis (9.1%), P. vulgaris (9.1%), Acinetobacter species (5.0%), Citrobacter species (3.3%) and K. oxytoca (2.5%). Other studies from Ethiopia and other countries have also reported these bacteria at varying frequencies ( 8 , 13 , 18 , 26 , 33 , 43 ). Variations in climate and geography are possible reasons for the differences in the distribution of bacterial isolates ( 29 ). In the present study, 93.5% of the S. aureus isolates resistant to penicillin whereas clindamycin and gentamicin were the two drugs to which 80.4% and 78.3% of isolates were susceptible, respectively. This finding is in agreement with other studies ( 29 , 32 ). On the other hand, P. aeruginosa demonstrated susceptibility patterns ranging from 33.3–97% with piperacillin-tazobactam being the most effective antibiotic but 60.6% of the isolates were found to be resistant to meropenem. Studies from other parts of Ethiopia used different antibiotics and reported varying susceptibility patterns ( 25 , 35 ). Studies from other parts of the world tested different antibiotics with varying susceptibility patterns ( 30 , 36 , 44 ) with one of the studies ( 30 ) that tested piperacillin-tazobactam, ciprofloxacin and ceftazidime, which were also tested in this study. The use of different antibiotics in different studies is attributed to the occasional emergence of resistant strains from time to time, the availability of proposed antibiotics and local prescribing practices. The overall MDR rate in this study was 66.2% [95% CI (59.7–72.3%)]. This finding is similar to those of studies performed in Ethiopia, which reported MDR rates of 67.0% ( 15 ) and 61.5% ( 45 ), but lower than those of another study that reported rates of 88.3% ( 26 ), however; these rates are higher than those of a study performed in India ( 46 ). Variations in the reports of MDR rates might be attributed to differences in operational definitions of MDR strains, bacterial isolates and antibiotic discs tested. There were statistically significant differences in culture positivity between those who were with purulent middle ear discharge compared to those who presented with other middle ear discharge appearances [p-value = 0.001, AOR = 6.534 (95% CI: 2.112–20.208). In contrast, a study done in Jimma reported that there was no significant association between purulent discharge and culture positivity ( 15 ), but one study from Iraq revealed a statistically significant association between middle ear discharge culture positivity and purulent discharge ( 44 ). A significant difference was also observed between a middle ear discharge duration of ≥ 14 days and culture positivity [p-value = 0.000, AOR = 7.628 (95% CI: 3.135– 18.558)], which was also supported by other studies ( 25 , 26 ). Chronic otitis is characterized by middle ear discharge that lasts for at least 14 days and a perforated tympanic membrane. Another risk factor for otitis media was a history of smoking in either an active or passive state. A significant association was observed between patients with history of smoking and the development of otitis media [p-value = 0.043, AOR = 8.817 (95% CI: 1.072–72.534)]. This association was also supported by other studies ( 15 , 47 , 48 ). Smoking decreases the mucociliary activity of the respiratory epithelium, depresses local immune function, and enhances the adhesion of bacteria to the respiratory epithelium ( 48 ). Strengths and limitations of the study The strength of the study was that all the laboratory procedures were conducted following standard operating procedures. In addition, further studies can be built upon these findings, as there are no published data regarding the problem in the study area. The temporal relation between the exposure and outcome variables could not be established because the study design was cross-section in nature. The small sample size and convenience sampling nature of this study prevented it from being representative of patients with otitis media in Ethiopia. On the other hand, anaerobic culture methods for fastidious bacteria and molecular techniques were not employed. Conclusion The present study indicated that bacterial middle ear infection has become an increasing health problem coupled with levels of multidrug resistance. S. aureus and P. aeruginosa were the leading causes for middle ear infection. There is an increase in the number of antibiotic-resistant bacteria recovered from patients with otitis media in the study area, and these bacteria are becoming a major public health problem in the management of patients with middle ear infection. Abbreviations AOM Acute Otitis Media AOR Adjusted Odds Ratio ATCC American Type Culture Collection CI Confidence Interval CLSI Clinical Laboratory Standards Institute CSOM Chronic Suppurative Otitis Media MDR Multidrug Resistance MHA Muller Hinton Agar OM Otitis Media SOP Standard Operating Procedure SPSS Statistical Software for Social Sciences URTI Upper Respiratory Tract Infection Declarations Acknowledgements The authors are grateful to Salale University and the Oromia Health Bureau for providing opportunity to conduct this research. We also acknowledge Nekemte Public Health Research and Referral Laboratory Center for providing the laboratory setup, chemicals and reagents. Our deepest gratitude also goes to the study participants, staff members of the Clinical Microbiology Department of Nekemte Public Health Research and Referral Laboratory Center, referring health facilities and data collectors and supervisors. We would also sincerely thank the study participants for their participation in the study. Funding Partially funded by Oromia Health Bureau but does not have grant number. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript Data Availability Statement All relevant data are within this paper Author’s contributions Endalu Tesfaye had a substantial contribution from conception to the acquisition of data. All the authors had a great contribution to study design, analysis, and interpretation of the findings. Endalu Tesfaye and Hunduma Feyisa involved in laboratory analysis. Endalu Tesfaye and Fedasan Alemu drafted the manuscript. All authors revised the paper carefully for important intellectual contents. All authors read and approved the final manuscript. Ethics approval and consent to participate The research proposal was ethically cleared by the Salale University Institutional Review Board (Reference Number: S/U-IRB/25/23). An official permission letter was obtained from Nekemte Public Health Research and Referral Laboratory Center. Participants were informed of the purpose of the study, risks associated with the study, confidentiality of personal data, and their right to take part in the study. After that, we obtained a written informed consent from adult study participants, whereas an assent was obtained from study participants less than 18 years of age. In addition, a consent was also obtained from their parents or legal guardians to participate in this study. Finally, specimens were collected from all study participants and analyzed accordingly. Laboratory results of study participants were communicated with their respective physicians for better management Competing interests The authors declare that they have no competing interests. Author details 1 Clinical Microbiology Department, Nekemte Public Health Research and Referral Laboratory Center, P.O.Box 061, Nekemte, Ethiopia 2 Department of Medical Laboratory Sciences, College of Health Sciences, Salale University, P.O.Box 245, Fitche, Ethiopia 3 Department of Pharmacy, College of Health Sciences, Salale University, P.O.Box 245, Fitche, Ethiopia References Santoshi Kumari M, Madhavi J, Bala Krishna N, Raja Meghanadh K, Jyothy AJ. Prevalence and associated risk factors of otitis media and its subtypes in South Indian population. Egypt J Ear Nose Throat Allied Sci. 2021;17(2):57–62. Coleman A, Wood A, Bialasiewicz S, Ware RS, Marsh RL, Cervin A. 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Identification and Role of Antimicrobial Susceptibility Patterns of Aerobic Bacteria in the Management of Refractory Chronic Suppurative Otitis Media-A Tertiary Hospital-based Retrospective Study. J Adv Lab Res Biol. 2021;12(4):30–7. Aidah M, Mohanna B, Bahannan AA. Bacterial profile and antibiogram of otitis media among children in Yemen. 28, J Ayub Mededical Coll ege Abbottabad. 2016. Ahmed K, Mir A, Jan M, Imran R, Shah G, Latif A. Prevalence of Bacteria in Chronic Suppurative Otitis Media Patients and Their Sensitivity Patterns Against Various Antibiotics in Human Population of Gilgit. 45, Pakistan J Zool. 2013. Poorey VK, Thakur P. Clinicomicrobiological evaluation and antibiotic susceptibility in cases of chronic suppurative otitis media. Indian J Otology. 2015;21(2):107–10. Mofatteh MR, Shahabian Moghaddam F, Yousefi M, Namaei MH. A study of bacterial pathogens and antibiotic susceptibility patterns in chronic suppurative otitis media. J Laryngol Otol. 2018;132(1):41–5. Hussein EF. Detection of the Antibiotic Susceptibility Against Proteus Species and Escherichia coli Isolated from Patients with Ear Infections. Int J Drug Delivery Technol. 2022;12(1):221–4. Wasihun AG, Zemene Y. Bacterial profile and antimicrobial susceptibility patterns of otitis media in Ayder Teaching and Referral Hospital, Mekelle University, Northern Ethiopia. Springerplus. 2015;4(1):1–9. Worku SAG, Muluye D, Derbie A, Fantahun B. Bacterial etiologies, antibiotic susceptibility patterns and risk factors among patients with ear discharge at the University of Gondar Hospital, Northwest Ethiopia. Asian Pac J Trop Dis. 2017;7(1):36–42. Wang J, Chen B, Xu M, Wu J, Wang T, Zhao J, et al. Etiological factors associated with chronic suppurative otitis media in a population of Han adults in China. Acta Otolaryngologica. 2016;136(10):1024–8. Seid A, Deribe F, Ali K, Kibru G. Bacterial otitis media in all age group of patients seen at Dessie referral hospital, North East Ethiopia. Egypt J Ear Nose Throat Allied Sci. 2013;14(2):73–8. Hailu D, Mekonnen D, Derbie A, Mulu W, Abera B. Pathogenic bacteria profile and antimicrobial susceptibility patterns of ear infection at Bahir Dar Regional Health Research Laboratory Center. Springerplus. 2016;5(466):1–6. Dayie NT, Bannah V, Dwomoh FP, Kotey FC, Donkor ES. Distribution and Antimicrobial Resistance Profiles of Bacterial Aetiologies of Childhood Otitis Media in Accra, Ghana. Microbiol Insights. 2022;15(1):1–7. Yadav G, Yadav M, Singla P, Sharma N, Naik SM, Professor A, et al. Clinico-bacteriological and antibiotic drug resistance profile of Chronic Otitis Media: Mucosal disease, at a tertiary care hospital in rural Haryana: A retrospective observational study. Eur J Mol Clin Med. 2022;9(6):648–55. Mohamed Ali I, Duman C, Bozdağ İ, Abdi AA, Abdi MN, Karakurt SE, et al. Microbiology and Drug Susceptibility Pattern of Bacterial Isolates from Patients with Chronic Suppurative Otitis Media at a Tertiary Care Hospital in Somalia. Infect Drug Resist. 2022;15(15):7733–9. Wan Draman WNA, Md Daud MK, Mohamad H, Hassan SA, Abd Rahman N. Evaluation of the current bacteriological profile and antibiotic sensitivity pattern in chronic suppurative otitis media. Invest Otolaryngol. 2021;6(6):1300–6. Afolabi OA, Salaudeen AG, Ologe FE, Nwabuisi C, Nwawolo CC. Pattern of bacterial isolates in the middle ear discharge of patients with chronic suppurative otitis media in a tertiary hospital in north central Nigeria. Afr Health Sci. 2012;12(3):362–8. Worku M, Bekele M. Bacterial isolate and antibacterial resistance pattern of ear infection among patients attending at Hawassa university referral Hospital, Hawassa, Ethiopia. Indian J Otology. 2014;20(4):155–9. Naqvi SA, Yaseen R, Naqvi ZA, OTITIS MEDIA. Prevalence of Gram negative Bacteria in Otitis Media Patients in ENT Ward/OPD of Nishtar Hospital Multan. Prof Med J. 2019;26(02):364–7. Xu J, Du Q, Shu Y, Ji J, Dai C. Bacteriological Profile of Chronic Suppurative Otitis Media and Antibiotic Susceptibility in a Tertiary Care Hospital in Shanghai, China. Ear Nose Throat J. 2021;100(9):391–6. Kombade S, Kaur N, Patro S, Nag V. Clinico-bacteriological and antibiotic drug resistance profile of chronic suppurative otitis media at a tertiary care hospital in Western Rajasthan. J Family Med Prim Care. 2021;10(7):2572–9. Çetin YS, Mollamehmetoğlu SO, Düzenli U, Turan M, Bozan N. Treatment of Multi-Drug Resistant Microorganisms in Chronic Suppurative Otitis Media. B-ENT. 2022;18(1):44–51. Khatun MR, Alam KMF, Naznin M, Salam MA. Microbiology of chronic suppurative Otitis media: An update from a tertiary care hospital in Bangladesh. Pakistan J Med Sci. 2021;37(3):821–6. Gavrilovici C, Spoială EL, Miron IC, Stârcea IM, Haliţchi COI, Zetu IN, et al. Acute Otitis Media in Children—Challenges of Antibiotic Resistance in the Post-Vaccination Era. Microorganisms. 2022;10(8):1–10. Aduda DSO, Macharia IM, Mugwe P, Oburra H, Farragher B, Brabin B, et al. Bacteriology of chronic suppurative otitis media (CSOM) in children in Garissa district, Kenya: A point prevalence study. Int J Pediatr Otorhinolaryngol. 2013;77(7):1107–11. Malkappa SK, Kondapaneni S, Surpam RB, Chakraverti TK. Study of aerobic bacterial isolates and their antibiotic susceptibility pattern in chronic suppurative otitis media. Indian J Otology. 2012;18(3):136–9. Ahmed M, Salih. Al. Bacteriological Findings in Active Otitis Media with Perforated Tympanic Membrane. Volume 15. Indian Journal of Forensic Medicine & Toxicology; 2021. Araya BD, Aklilu A, Alahmadi RM. Factors Associated with Otitis Media Among Pediatrics in Two Government Hospitals in Arba Factors Associated with Otitis Media Among Pediatrics in Two Government Hospitals in Arba. Infect Drug Resist. 2023;16(1):6405–26. Navneeta Gangwar G, Kishan Siddapur SS. Clinical Implications of Culture and Sensitivity Data in Chronic Otitis Media. Indian J Otology. 2021;27(3):101–5. Athbi HA, Abed-Ali HN. Risk factors of acute otitis media among infants children in Kerbala Pediatric teaching hospital: A case-control study. Medico-Legal Updates. 2020;20(1):766–71. Paneru M, Shah SP, Chettri ST. Association of Passive Smoking with Otitis Media among School Children of Eastern Nepal. Annals Otology Neurotology. 2021;4(02):062–8. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 07 Jan, 2025 Read the published version in BMC Microbiology → Version 1 posted Editorial decision: Revision requested 01 Aug, 2024 Reviews received at journal 31 Jul, 2024 Reviewers agreed at journal 11 Jul, 2024 Reviews received at journal 08 Jul, 2024 Reviewers agreed at journal 04 Jul, 2024 Reviewers invited by journal 04 Jul, 2024 Editor invited by journal 21 Jun, 2024 Editor assigned by journal 21 Jun, 2024 Submission checks completed at journal 21 Jun, 2024 First submitted to journal 21 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4452931","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":325563897,"identity":"f20d9ae3-2960-41e3-8c28-318511578931","order_by":0,"name":"Endalu 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Sileshi","email":"","orcid":"","institution":"Department of Medical Laboratory Science, College of Health Sciences, Salale University, P.O.Box 245, Fitche, Ethiopia","correspondingAuthor":false,"prefix":"","firstName":"Betrearon","middleName":"","lastName":"Sileshi","suffix":""},{"id":325563902,"identity":"0a0a5805-3d35-4822-806c-2b06003c77da","order_by":5,"name":"Hunduma Feyisa","email":"","orcid":"","institution":"Department of Medical Laboratory Science, College of Health Sciences, Salale University, P.O.Box 245, Fitche, Ethiopia","correspondingAuthor":false,"prefix":"","firstName":"Hunduma","middleName":"","lastName":"Feyisa","suffix":""},{"id":325563903,"identity":"54a181b7-5939-445d-9d90-643c057b86b6","order_by":6,"name":"Tadese Bekele","email":"","orcid":"","institution":"Department of Pharmacy, College of Health Sciences, Salale University, P.O.Box 245, Fitche","correspondingAuthor":false,"prefix":"","firstName":"Tadese","middleName":"","lastName":"Bekele","suffix":""}],"badges":[],"createdAt":"2024-05-21 07:32:55","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4452931/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4452931/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12866-024-03664-z","type":"published","date":"2025-01-07T15:57:26+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":73694227,"identity":"69fc7e9d-3f8f-4fd8-93cb-e663cfab9cd5","added_by":"auto","created_at":"2025-01-13 16:12:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1646647,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4452931/v1/fde3cfeb-6bf9-4677-b7a8-665e1ba4b5e9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Bacterial etiologies, antimicrobial susceptibility profiles and associated factors among patients with otitis media referred to Nekemte Public Health Research and Referral Laboratory Center, Western Ethiopia: A prospective cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eOtitis media (OM) is a common inflammatory illness that can affect people of all ages and results in temporary or permanent hearing loss due to fluid effusion or pathological alterations in the tympanic membrane of the middle ear (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The spectrum of illnesses associated with OM ranges from acute to chronic and is clinically indicated by the presence of fluid accumulation in the middle ear that can cause temporary hearing loss (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOtitis media (OM) is a significant contributor to hearing loss in people of all ages but is more common among children under-five years of age. Globally, among 709\u0026nbsp;million patients with AOM, 51% were children under five years old. On the other hand, AOM is responsible for approximately 25% of antibiotic prescriptions among children (\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The peak prevalence of OM among children is mainly attributed to immature immune status, the anatomy of the Eustachian tube (shorter and horizontal), frequent exposure to URTIs and malnutrition (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOM is increasingly prevalent in Sub-Saharan Africa and other developing nations including Ethiopia. Due to limited microbiological laboratories, Sub-Saharan African nations rely solely on clinical data for therapy which could be responsible for more complicated OM (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Bacteria are the most common agents for OM. The most predominant pathogenic bacteria isolated from AOM included \u003cem\u003eM. catarrhalis, S. pneumoniae\u003c/em\u003e and \u003cem\u003eH. influenzae\u003c/em\u003e. On the other hand, \u003cem\u003eP. aeruginosa\u003c/em\u003e, \u003cem\u003eKlebsiella species\u003c/em\u003e, \u003cem\u003eProteus species\u003c/em\u003e, \u003cem\u003eS. aureus\u003c/em\u003e and \u003cem\u003eE. coli\u003c/em\u003e are the predominant bacteria isolated from patients with CSOM (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe extensive application of antibiotics to treat OM has led to the growth of resistant bacteria, including strains that are resistant to many drugs (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Several studies have reported considerable resistance rates of bacteria isolated from middle ear. To ensure the best possible care and fight antibiotic resistance, it is essential to continuously and periodically evaluate the microbiological profile and antimicrobial susceptibility (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Ethiopia, few studies have investigated bacteriological profiles and antimicrobial susceptibility patterns of the middle ear discharge. The number of antibiotic-resistant bacteria is alarming and becoming a major public health problem in the management of patients with middle ear infection (\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). There are no data on the prevalence and antimicrobial susceptibility patterns of bacterial pathogens from middle ear infections in referred health facilities. This on the other hand might indicate that clinicians base their treatment on empirical evidence. Knowing the local antibiogram is important for cost-effective and appropriate treatment of otitis media and helps prevent complications that may arise due to the lack of treatment or improper treatment. Thus, the aim of this study was to acquire data on bacterial pathogens responsible for otitis media and their antibacterial susceptibility patterns among patients with otitis media referred to the Nekemte Public Health Research and Referral Laboratory Center for culture tests.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy area, period and design\u003c/h2\u003e \u003cp\u003eThis study was conducted at Nekemte Public Health Research and Referral Laboratory Center among referred patients with otitis media from nearby health facilities from June to September 2023. A laboratory-based cross-sectional study was conducted in 242 patients with otitis media.\u003c/p\u003e \u003cp\u003eStudy design\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy participants and sampling technique\u003c/h2\u003e \u003cp\u003ePatients with middle ear discharge accompanied by laboratory-appropriate request form and those who were not receiving antibiotic were included in the study. Participants were selected through convenience sampling. We used the presence of middle ear discharge as an entry point because routine otoscopic examination might not be carried out in the referring health facilities even if this approach undermines the magnitude of middle ear discharge as we might have missed some patients who didn\u0026rsquo;t have an obvious middle ear discharge\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData collection, sample processing and laboratory analysis\u003c/h2\u003e \u003cp\u003e Sociodemographic and clinical data were collected in face-to-face interviews from study participants by nurses/health officers using structured questionnaires. Middle ear discharge data were collected by trained clinical microbiology experts. The collected discharge samples were inoculated on blood agar, chocolate agar and MacConkey agar following standard bacteriological techniques. Bacterial pathogens from positive culture results were identified by their characteristic appearance on the respective media, gram-staining reaction and pattern of biochemical profiles using standard procedures.\u003c/p\u003e \u003cp\u003eThe antibiotic susceptibility all the isolated bacterial pathogens was tested via Kirby-Bauer disc diffusion method. Inocula were prepared by transferring 3\u0026ndash;5 colonies from pure culture into 5 ml of normal saline and mixing thoroughly to make a homogenous suspension equivalent to the 0.5 McFarland standard. Using a sterile cotton swab, the bacterial suspension was distributed evenly over the entire surface of MHA (HIMEDIA, India) and left at room temperature for 15 minutes. The plates were then incubated at 37\u0026deg;C for 16\u0026ndash;18 hours and observed for the zones of inhibition. The growth inhibition zone was measured by a ruler, and results were interpreted as whether the organism was sensitive, intermediate or resistant to the antimicrobial agents by comparison with standard guidelines based on the Clinical and Laboratory Standards Institute (CLSI) 2023 (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData quality assurance\u003c/h2\u003e \u003cp\u003eDifferent methods were used for assuring data quality. A standard and structured questionnaire prepared in English was used. The questionnaire was then translated to the local language (Afan Oromo) for data collection and then re-translated back into English for analysis. One day of training was given to the data collectors and supervisors on the data collection tool and procedures. To ensure validity, 5% of the questionnaire was pretested. The findings from the pretesting were utilized for modifying and adjusting of the instrument and interviewing technique. The data collectors were supervised closely by the supervisors and the principal investigator. The completeness of each questionnaire was checked daily by the principal investigator and the supervisors. To ensure consistency, coding, double entry and cleaning were performed. The entire data collection process was guided by the principal investigator.\u003c/p\u003e \u003cp\u003eThe specimen containers were properly labeled with patient identifier, codes, collector initial and collection date and time. Then, the collected specimens were immediately transported to the clinical microbiology laboratory for processing according to existing SOPs. All patient information was checked for clarity and completeness. Media and all relevant reagents were carefully inspected and checked for expiration dates prior to use. The sterility of the prepared culture media was checked by incubating 5% of the batch at 35\u0026ndash;37\u0026deg;C overnight and evaluating it for possible contamination.\u003c/p\u003e \u003cp\u003eTrained laboratory experts performed the tests. All testing procedures were performed depending on the existing SOPs of the clinical microbiology laboratory. \u003cem\u003eS. aureus\u003c/em\u003e was used for checking the functionality of blood agar and chocolate agar, and \u003cem\u003eE. coli\u003c/em\u003e (ATCC 25922) and \u003cem\u003eP. aeruginosa\u003c/em\u003e (ATCC 27853) were used for MacConkey and biochemical tests.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eAntimicrobial susceptibility testing\u003c/h2\u003e \u003cp\u003eAntimicrobial susceptibility tests were performed using the Kirby\u0026ndash;Bauer disk diffusion method on Muller Hinton agar (MHA) (HIMEDIA, India). Antibiotic discs were selected based on the prescription pattern in the study area and recommendations from the Clinical Laboratory Standards Institute (CLSI). The grades of the susceptibility profile were read as sensitive (S), intermediate (I), or resistant (R) by comparison of the zone of inhibition with clinical and laboratory standards institute guidelines 33rd edition (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The following antibiotic disks were used for susceptibility testing: Ceftriaxone (30 \u0026micro;g), Cefoxitin (30 \u0026micro;g), Ceftazidime (30 \u0026micro;g), Penicillin G (10 \u0026micro;g), Ampicillin (10 \u0026micro;g), Amoxicillin-clavulanate (20/10\u0026micro;g), Piperacillin-tazobactam (100/10 \u0026micro;g), Meropenem (10 \u0026micro;g), Gentamicin (10 \u0026micro;g), Tobramycin (10 \u0026micro;g), Ciprofloxacin (5 \u0026micro;g), Azithromycin (15 \u0026micro;g), Clindamycin (30 \u0026micro;g), Vancomycin (30 \u0026micro;g), Tetracycline (30 \u0026micro;g), Chloramphenicol (30 \u0026micro;g) and Trimethoprim sulfamethoxazole (1.25/23.75).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe collected data were coded, entered into Epi-data version 4.6.0.6 software and then cleaned. From this software, they were exported to SPSS version 25 for analysis. Descriptive statistics were calculated to describe relevant variables. The data were presented in words, figures, and tables. Binary logistic regression analysis was used to select candidate variables for multivariable logistic regression analysis. Variables with P-values\u0026thinsp;\u0026lt;\u0026thinsp;0.25 were candidates for multivariate analysis. The adjusted odds ratio (AOR) was used to determine the strength of the association. A P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered to indicate statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of the study participants\u003c/h2\u003e \u003cp\u003e A total of 242 middle ear discharge samples were collected from the study participants and analyzed. Males and females accounted for 129 (53.3%) and 113 (46.7%) of the participants, respectively. The age of the participants ranged from 1 to 65 years, with mean and median ages of 17.1 and 14.0 years, respectively. Ninety-one (37.6%) of them were aged less than five years, while 73 (30.2%) were aged 25 years and older. One hundred sixty-five (68.2%) and 77 (31.8%) of the participants were from urban and rural areas, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAge, sex and residence distribution of patients with otitis media referred to Nekemte Public Health Research and Referral Laboratory Center, Nekemte, June-September 2023.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e68.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence of bacterial pathogens\u003c/h2\u003e \u003cp\u003eTwo hundred twelve middle ear discharge samples were positive for culture resulting in an overall 87.6% prevalence of bacterial isolates. A total of 228 bacterial pathogens were recovered from positive cultures constituting (107, 46.9%) Gram-positive and (121, 53.1%) Gram-negative bacteria. From the total bacterial isolates, \u003cem\u003eS. aureus\u003c/em\u003e (92, 40.4%) and \u003cem\u003eP. aeruginosa\u003c/em\u003e (33, 14.5%) were the predominant bacterial species followed by \u003cem\u003eE. coli\u003c/em\u003e (24, 10.5%) and \u003cem\u003eK. pneumoniae\u003c/em\u003e (16, 7.0%) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBacterial etiologic agents among patients with otitis media referred to Nekemte Public Health Research and Referral Laboratory Center, Nekemte, Ethiopia, June-September 2023.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBacterial isolates\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eGram \u0026ndash; positive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eS. aureus\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCONS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eS. pneumoniae\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eEnterococcus\u003c/em\u003e spp.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003eGram \u0026ndash; negative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eP. aeruginosa\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eK. pneumonia\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eProvidencia\u003c/em\u003e spp.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eP. mirabilis\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eP. vulgaris\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eAcinetobacter\u003c/em\u003e spp.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eCitrobacter\u003c/em\u003e spp.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eK. oxytoca\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e228\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eAntimicrobial susceptibility testing\u003c/h2\u003e \u003cp\u003eAntimicrobial susceptibility testing was performed for both gram-positive (n\u0026thinsp;=\u0026thinsp;107) and gram-negative (n\u0026thinsp;=\u0026thinsp;121) bacterial pathogens isolated from the study participants. The predominant gram-positive isolate, \u003cem\u003eS. aureus\u003c/em\u003e showed the highest level of resistance to penicillin (86, 93.5%) followed by cefoxitin (81, 88.0%) but gentamicin (72, 78.3%) and clindamycin (74, 80.4%), the two antibiotics to which \u003cem\u003eS. aureus\u003c/em\u003e is susceptible (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAntimicrobial resistance patterns of gram-positive bacterial isolates from patients with otitis media referred to Nekemte Public Health Research and Referral Laboratory Center, Nekemte, Ethiopia, June- September 2023.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAntibiotics tested\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eNumber of resistant bacteria [n (%)]\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eS. aureus\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eCONS\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eS. pneumoniae\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eEnterococcus\u003c/b\u003e \u003cb\u003espp\u003c/b\u003e.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e92\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e10\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e107\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmpicillin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAzithromycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (44.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (70.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e48 (44.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCefoxitin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (88.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e89 (83.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChloramphenicol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (31.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34 (31.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCiprofloxacin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (44.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e44 (41.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClindamycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (18.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20 (18.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCotrimoxazole\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (51.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e55 (51.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGentamicin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (18.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17 (15.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePenicillin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86 (93.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e94 (87.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTetracycline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71 (77.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (90.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e82 (76.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eCONS \u0026ndash; Coagulase negative staphylococci, NT \u0026ndash; Not tested\u003c/h2\u003e \u003cp\u003eTwenty-three (95.8%), 32 (97%), 16 (100%), and 12 (92.3%) \u003cem\u003eE. coli, P. aeruginosa\u003c/em\u003e, \u003cem\u003eK. pneumoniae\u003c/em\u003e, and \u003cem\u003eProvidencia species\u003c/em\u003e, respectively, demonstrated susceptibility to piperacillin-tazobactam. Twenty (60.6%) \u003cem\u003eP. aeruginosa\u003c/em\u003e strains exhibited resistance to meropenem. The majority of 22 (91.7%) of \u003cem\u003eE. coli\u003c/em\u003e isolates were resistant to ampicillin (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAntimicrobial resistance patterns of gram-negative bacterial isolates from patients with otitis media referred to Nekemte Public Health Research and Referral Laboratory Center, Nekemte, Ethiopia, June-September 2023.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBacterial isolates\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;121)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"12\" nameend=\"c13\" namest=\"c2\"\u003e \u003cp\u003eAntibiotics tested\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAMC\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eAP\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eCAZ\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eCHL\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eCIP\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eCOT\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eCRO\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003eGEN\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003eMEM\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003ePTZ\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003eTOB\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003eTTC\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP. aeruginosa\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u0026thinsp;=\u0026thinsp;33\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13 (39.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e20 (60.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1 (3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e13 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u0026thinsp;=\u0026thinsp;24\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (91.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13 (54.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e17 (70.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e12 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e21 (87.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eK. pneumoniae\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u0026thinsp;=\u0026thinsp;16\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7 (43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e7 (43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e11 (68.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eProvidencia\u003c/em\u003e spp.\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u0026thinsp;=\u0026thinsp;13\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9 (69.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7 (53.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e9 (69.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e2 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP. mirabilis\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u0026thinsp;=\u0026thinsp;11\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (45.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4 (36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6 (54.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e6 (54.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3 (27.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP. vulgaris\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u0026thinsp;=\u0026thinsp;11\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (45.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6 (54.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8 (72.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e7 (63.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAcinetobacter\u003c/em\u003e spp.\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u0026thinsp;=\u0026thinsp;6\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCitrobacter\u003c/em\u003e spp.\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u0026thinsp;=\u0026thinsp;4\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e3 (75.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eK. oxytoca\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u0026thinsp;=\u0026thinsp;3\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1 (33.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eAMC\u0026thinsp;=\u0026thinsp;Amoxicillin \u0026ndash; clavulanate AP\u0026thinsp;=\u0026thinsp;Ampicillin CAZ\u0026thinsp;=\u0026thinsp;Ceftazidime CHL\u0026thinsp;=\u0026thinsp;Chloramphenicol CIP\u0026thinsp;=\u0026thinsp;Ciprofloxacin COT\u0026thinsp;=\u0026thinsp;Cotrimoxazole CRO\u0026thinsp;=\u0026thinsp;Ceftriaxone GEN\u0026thinsp;=\u0026thinsp;Gentamicin MEM\u0026thinsp;=\u0026thinsp;Meropenem PTZ\u0026thinsp;=\u0026thinsp;Piperacillin-tazobactam TOB\u0026thinsp;=\u0026thinsp;Tobramycin TTC\u0026thinsp;=\u0026thinsp;Tetracycline NT\u0026thinsp;=\u0026thinsp;Not tested\u003c/b\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eMultidrug Resistance\u003c/h2\u003e \u003cp\u003eThe overall prevalence of MDR bacteria in this study was 151 (66.2%). Among the gram-positive and gram-negative isolates, 91 (39.9%) and 60 (26.3%) were multidrug resistant, respectively. The predominant bacterial pathogens isolates were \u003cem\u003eS. aureus\u003c/em\u003e (82, 54.3%), \u003cem\u003eE. coli\u003c/em\u003e (20, 13.2%) and \u003cem\u003eK. pneumoniae\u003c/em\u003e (11, 7.3%) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e\u003cstrong\u003eTable 5: Multidrug resistance patterns of gram-positive and gram-negative bacterial isolates from patients with otitis media referred to Nekemte Public Health Research and Referral Laboratory Center, Nekemte, Ethiopia, June-September 2023.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"630\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.206349206349206%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBacteria isolates\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"56.507936507936506%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAntimicrobial susceptibility test results, N\u003cu\u003eo\u003c/u\u003e (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal MDR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.89887640449438%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eR0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.59550561797753%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eR1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.910112359550563%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eR2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.59550561797753%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge;R3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGram-positive isolates\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.206349206349206%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eS. aureus\u0026nbsp;\u003c/em\u003e(n = 92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.46031746031746%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e5 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.380952380952381%\" valign=\"top\"\u003e\n \u003cp\u003e5 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e82 (89.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e82 (76.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.206349206349206%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eCONS\u0026nbsp;\u003c/em\u003e(n = 10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.46031746031746%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e1 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.380952380952381%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e9 (90.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e9 (8.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.206349206349206%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eS. pneumoniae (\u003c/em\u003en = 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.46031746031746%\" valign=\"top\"\u003e\n \u003cp\u003e3 (75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e1 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.380952380952381%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.206349206349206%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eEnterococcus\u0026nbsp;\u003c/em\u003espp\u003cem\u003e.\u0026nbsp;\u003c/em\u003e(n = 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.46031746031746%\" valign=\"top\"\u003e\n \u003cp\u003e1 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.380952380952381%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.206349206349206%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (n = 107)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.46031746031746%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4 (3.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e7 (6.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.380952380952381%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e5 (4.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e91 (85.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e91 (85.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"85.71428571428571%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGram-negative isolates\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.206349206349206%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP. aeruginosa (n = 33)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.46031746031746%\" valign=\"top\"\u003e\n \u003cp\u003e6 (18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e11 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.380952380952381%\" valign=\"top\"\u003e\n \u003cp\u003e11 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e5 (15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e5 (4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.206349206349206%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eE. coli (n = 24)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.46031746031746%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e2 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.380952380952381%\" valign=\"top\"\u003e\n \u003cp\u003e2 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e20 (83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e20 (16.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.206349206349206%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eK. pneumoniae (n = 16)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.46031746031746%\" valign=\"top\"\u003e\n \u003cp\u003e1 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.380952380952381%\" valign=\"top\"\u003e\n \u003cp\u003e4 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e11 (68.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e11 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.206349206349206%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eProvidencia\u0026nbsp;\u003c/em\u003espp\u003cem\u003e. (n = 13)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.46031746031746%\" valign=\"top\"\u003e\n \u003cp\u003e2 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e2 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.380952380952381%\" valign=\"top\"\u003e\n \u003cp\u003e2 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e7 (53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e7 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.206349206349206%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP. mirabilis (n =11)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.46031746031746%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.380952380952381%\" valign=\"top\"\u003e\n \u003cp\u003e3 (27.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e8 (72.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e8 (6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.206349206349206%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP. vulgaris (n = 11)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.46031746031746%\" valign=\"top\"\u003e\n \u003cp\u003e1 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e1 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.380952380952381%\" valign=\"top\"\u003e\n \u003cp\u003e3 (27.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e6 (54.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e6 (5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.206349206349206%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eAcinetobacter\u0026nbsp;\u003c/em\u003espp\u003cem\u003e. (n = 6)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.46031746031746%\" valign=\"top\"\u003e\n \u003cp\u003e1 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e1 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.380952380952381%\" valign=\"top\"\u003e\n \u003cp\u003e2 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e2 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e2 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.206349206349206%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eCitrobacter\u0026nbsp;\u003c/em\u003espp\u003cem\u003e. (n = 4)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.46031746031746%\" valign=\"top\"\u003e\n \u003cp\u003e4 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.380952380952381%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.206349206349206%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eK. oxytoca (n = 3)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.46031746031746%\" valign=\"top\"\u003e\n \u003cp\u003e1 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e1 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.380952380952381%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e1 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e1 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.206349206349206%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (n = 121)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.46031746031746%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e16 (13.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e18 (14.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.380952380952381%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e27 (22.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e60 (49.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e60 (49.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eR0 - \u0026ge;R3 refers to the number of pathogenic bacterial isolates resistant to 0 - \u0026ge;3 different antibiotics\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003ePossible risk factors for otitis media\u003c/h2\u003e \u003cp\u003eBoth bivariate and multivariate logistic regression analyses were performed to assess the possible risk factors for middle ear infection. Statistical significance was obtained for purulent middle ear discharge, duration of middle ear discharge\u0026thinsp;\u0026ge;\u0026thinsp;14 days and history of active/passive smoking. Study participants with purulent middle ear discharge were approximately six times more likely to have positive cultures for bacterial pathogens responsible for causing otitis media [AOR\u0026thinsp;=\u0026thinsp;6.534 (95% CI: 2.112\u0026ndash;20.208; P-value\u0026thinsp;=\u0026thinsp;0.001)]. On the other hand, participants who experienced otorrhea of \u0026ge;\u0026thinsp;14 days are approximately seven times more likely to have positive cultures than were those who experienced otorrhea of \u0026lt;\u0026thinsp;14 days [7.628 (95% CI\u0026thinsp;=\u0026thinsp;3.135\u0026ndash;18.558; P-value\u0026thinsp;=\u0026thinsp;0.000)]. Those who had an active or passive smoking history were approximately eight times more likely to develop otitis media than to those without a history of active or passive smoking [8.817 (95% CI\u0026thinsp;=\u0026thinsp;1.072\u0026ndash;72.534; P-value\u0026thinsp;=\u0026thinsp;0.043)] (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate analyses to identify associated factors among study participants with otitis media referred to Nekemte Public Health Research and Referral Laboratory Center, Nekemte, June \u0026ndash; September 2023.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eCulture Result, N\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eo\u003c/span\u003e (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eAge group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75 (31.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.272 (0.087\u0026ndash;0.853)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.436 (0.116\u0026ndash;1.641)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.220\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (11.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.271 (0.071\u0026ndash;1.032)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.524 (0.112\u0026ndash;2.455)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.412\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (16.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.580 (0.137\u0026ndash;2.446)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.672 (0.132\u0026ndash;3.408)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.631\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (28.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eReference\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eReference\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (29.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.014 (0.788\u0026ndash;5.151)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.923 (0.305\u0026ndash;2.791)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.880\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e141 (58.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eReference\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eReference\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEar involved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e114 (47.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eReference\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cb\u003eReference\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98 (40.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.719 (0.768\u0026ndash;3.848)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.219 (0.470\u0026ndash;3.162)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.683\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAppearance of middle ear discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBloody\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eReference\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eReference\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePurulent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e157 (64.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.312 (2.967\u0026ndash;23.288)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e6.534 (2.112\u0026ndash;20.208)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMucoid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.829 (0.640\u0026ndash;5.228)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.398 (0.427\u0026ndash;4.580)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.580\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDuration of middle ear discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;14 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (14.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (7.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eReference\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eReference\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;14 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e178 (73.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.853 (3.468\u0026ndash;17.783)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e7.628 (3.135\u0026ndash;18.558)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of smoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e164 (67.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (12.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eReference\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eReference\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (19.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.488 (1.127\u0026ndash;63.936)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e8.817 (1.072\u0026ndash;72.534)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.043*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTreatment history for otitis media\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e122 (50.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (8.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eReference\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eReference\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90 (37.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.721 (0.753\u0026ndash;3.936)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.895 (0.354\u0026ndash;2.736)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.976\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e*Associated factors for otitis media\u003c/p\u003e \u003cp\u003eCI\u0026thinsp;=\u0026thinsp;Confidence interval, COR\u0026thinsp;=\u0026thinsp;Crude odds ratio, AOR\u0026thinsp;=\u0026thinsp;Adjusted odds ratio\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOtitis media is a major reason people seek medical attention globally, and its complications play a significant role in the development of preventable hearing loss, particularly in developing nations (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). According to the present study OM was found to be a common health problem at all ages. According to the present study, OM was found a common health problem in all ages. However, a peak prevalence of 31.0% was observed among children under five years of age, which was similar to that reported in other studies in Ethiopia (28.1%) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), higher than that reported in India (14.9%) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) but lower than that study performed in Yemen (66.7%) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). This prevalence of OM in children is mainly attributed to immature immune status, the anatomy of the Eustachian tube (shorter and horizontal), frequent exposure to URTIs and malnutrition.\u003c/p\u003e \u003cp\u003eGender-wise analysis of this study showed that males were more affected than females were. This finding, with male predominance, is in agreement with a study performed in Wollo, Ethiopia (50.4%) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) and Pakistan (43.9%) (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) but lower than a study performed in India (56.7%) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). In contrast, other studies in Iran (57.8%) and Iraq (60.0%) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) showed that females were more affected by otitis media than males were. The differences in male and female predominance may be attributed to the nature of the sampling technique.\u003c/p\u003e \u003cp\u003eThis study also provides insight into the prevalence of otitis media with respect to the residential location of study participants. The prevalence of otitis media among study participants from urban areas was 58.3%. This finding agrees with a study performed in Mekele, Ethiopia (52.0%) (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) but is lower than that in a study performed in Gondar, Ethiopia (76.5%) (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). However, the present study disagrees with a study performed in China (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) in which 85.9% of rural areas were positive for OM. These disparities may come from the involvement of study participants from urban areas due to increased health seeking-behavior, proximity to health facilities and culture diagnostic services in the study areas.\u003c/p\u003e \u003cp\u003eIn the present study, the overall middle ear discharge culture positivity rate was 87.6% (95% CI\u0026thinsp;=\u0026thinsp;82.8\u0026ndash;91.5). This finding is similar to that of study performed in Dessie, Ethiopia, which reported 89.4% (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) but it was higher than that of studies done in Gondar (76.7%) and Bahir Dar (80.4%) (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). In contrast, the current culture positivity rate was lower than that studies performed in Ghana (97%) and India (95.7%) (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), which may be related to variations in the availability of isolation and identification media. This may be correlated with the fact that availability of relevant media and other supplies maximizes the frequency of culture positivity in middle ear discharge.\u003c/p\u003e \u003cp\u003eA total of 228 bacterial isolates were identified. Analysis of the Gram reactions of the isolates revealed that 53.1% [95% CI (46.6\u0026ndash;59.5)] and 46.9% [95% CI (40.5\u0026ndash;53.4%)] were gram-negative and gram-positive bacterial pathogens, respectively. Another study in Ethiopia reported 56.0% gram-negative bacteria as the predominant species isolated from middle ear discharge, which was consistent with the results of the present study (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Reports from Somalia, Nigeria and Malaysia agree with the predominance of gram-negative bacteria, with higher frequencies of 77.3%, 71.6% and 75.3%, respectively (\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). The reason for the higher prevalence could be the chronic nature of infection, where gram-negative bacteria from external sources gain access to the auditory canal and eventually become predominant.\u003c/p\u003e \u003cp\u003eThe predominant bacterial isolates in this study were \u003cem\u003eS. aureus\u003c/em\u003e (40.5%) and \u003cem\u003eP. aeruginosa\u003c/em\u003e (14.5%) which was similar to the findings of studies in Ethiopia (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), Pakistan (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) and China (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) but inconsistent with the findings of other studies in Ethiopia (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), India (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) and Turkey (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). In addition, the isolation rates of \u003cem\u003eCoagulase negative staphylococci\u003c/em\u003e, \u003cem\u003eS. pneumoniae\u003c/em\u003e and \u003cem\u003eEnterococcus species\u003c/em\u003e were 4.4%, 1.8% and 0.4%, respectively. At least one of these bacterial isolates has also been reported in other studies (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan additionalcitationids=\"CR41\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). This study revealed that gram-negative bacterial isolates included \u003cem\u003eE. coli\u003c/em\u003e (19.8%), \u003cem\u003eK. pneumoniae\u003c/em\u003e (13.2%), \u003cem\u003eProvidencia species\u003c/em\u003e (10.7%), \u003cem\u003eP. mirabilis\u003c/em\u003e (9.1%), \u003cem\u003eP. vulgaris\u003c/em\u003e (9.1%), \u003cem\u003eAcinetobacter species\u003c/em\u003e (5.0%), \u003cem\u003eCitrobacter species\u003c/em\u003e (3.3%) and \u003cem\u003eK. oxytoca\u003c/em\u003e (2.5%). Other studies from Ethiopia and other countries have also reported these bacteria at varying frequencies (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). Variations in climate and geography are possible reasons for the differences in the distribution of bacterial isolates (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the present study, 93.5% of the \u003cem\u003eS. aureus\u003c/em\u003e isolates resistant to penicillin whereas clindamycin and gentamicin were the two drugs to which 80.4% and 78.3% of isolates were susceptible, respectively. This finding is in agreement with other studies (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). On the other hand, \u003cem\u003eP. aeruginosa\u003c/em\u003e demonstrated susceptibility patterns ranging from 33.3\u0026ndash;97% with piperacillin-tazobactam being the most effective antibiotic but 60.6% of the isolates were found to be resistant to meropenem. Studies from other parts of Ethiopia used different antibiotics and reported varying susceptibility patterns (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Studies from other parts of the world tested different antibiotics with varying susceptibility patterns (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e) with one of the studies (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) that tested piperacillin-tazobactam, ciprofloxacin and ceftazidime, which were also tested in this study. The use of different antibiotics in different studies is attributed to the occasional emergence of resistant strains from time to time, the availability of proposed antibiotics and local prescribing practices.\u003c/p\u003e \u003cp\u003eThe overall MDR rate in this study was 66.2% [95% CI (59.7\u0026ndash;72.3%)]. This finding is similar to those of studies performed in Ethiopia, which reported MDR rates of 67.0% (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) and 61.5% (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e), but lower than those of another study that reported rates of 88.3% (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), however; these rates are higher than those of a study performed in India (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). Variations in the reports of MDR rates might be attributed to differences in operational definitions of MDR strains, bacterial isolates and antibiotic discs tested.\u003c/p\u003e \u003cp\u003eThere were statistically significant differences in culture positivity between those who were with purulent middle ear discharge compared to those who presented with other middle ear discharge appearances [p-value\u0026thinsp;=\u0026thinsp;0.001, AOR\u0026thinsp;=\u0026thinsp;6.534 (95% CI: 2.112\u0026ndash;20.208). In contrast, a study done in Jimma reported that there was no significant association between purulent discharge and culture positivity (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), but one study from Iraq revealed a statistically significant association between middle ear discharge culture positivity and purulent discharge (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA significant difference was also observed between a middle ear discharge duration of \u0026ge;\u0026thinsp;14 days and culture positivity [p-value\u0026thinsp;=\u0026thinsp;0.000, AOR\u0026thinsp;=\u0026thinsp;7.628 (95% CI: 3.135\u0026ndash; 18.558)], which was also supported by other studies (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Chronic otitis is characterized by middle ear discharge that lasts for at least 14 days and a perforated tympanic membrane. Another risk factor for otitis media was a history of smoking in either an active or passive state. A significant association was observed between patients with history of smoking and the development of otitis media [p-value\u0026thinsp;=\u0026thinsp;0.043, AOR\u0026thinsp;=\u0026thinsp;8.817 (95% CI: 1.072\u0026ndash;72.534)]. This association was also supported by other studies (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). Smoking decreases the mucociliary activity of the respiratory epithelium, depresses local immune function, and enhances the adhesion of bacteria to the respiratory epithelium (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations of the study\u003c/h2\u003e \u003cp\u003eThe strength of the study was that all the laboratory procedures were conducted following standard operating procedures. In addition, further studies can be built upon these findings, as there are no published data regarding the problem in the study area. The temporal relation between the exposure and outcome variables could not be established because the study design was cross-section in nature. The small sample size and convenience sampling nature of this study prevented it from being representative of patients with otitis media in Ethiopia. On the other hand, anaerobic culture methods for fastidious bacteria and molecular techniques were not employed.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe present study indicated that bacterial middle ear infection has become an increasing health problem coupled with levels of multidrug resistance. \u003cem\u003eS. aureus\u003c/em\u003e and \u003cem\u003eP. aeruginosa\u003c/em\u003e were the leading causes for middle ear infection. There is an increase in the number of antibiotic-resistant bacteria recovered from patients with otitis media in the study area, and these bacteria are becoming a major public health problem in the management of patients with middle ear infection.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAOM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAcute Otitis Media\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdjusted Odds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eATCC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAmerican Type Culture Collection\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCLSI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eClinical Laboratory Standards Institute\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCSOM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChronic Suppurative Otitis Media\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMDR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMultidrug Resistance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMHA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMuller Hinton Agar\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOtitis Media\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSOP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard Operating Procedure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Software for Social Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eURTI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUpper Respiratory Tract Infection\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are grateful to Salale University and the Oromia Health Bureau for providing opportunity to conduct this research. We also acknowledge Nekemte Public Health Research and Referral Laboratory Center for providing the laboratory setup, chemicals and reagents. Our deepest gratitude also goes to the study participants, staff members of the Clinical Microbiology Department of Nekemte Public Health Research and Referral Laboratory Center, referring health facilities and data collectors and supervisors.\u0026nbsp;We would also sincerely thank the study participants for their participation in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePartially funded by Oromia Health Bureau but does not have grant number. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll relevant data are within this paper\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEndalu Tesfaye had a substantial contribution from conception to the acquisition of data. All the authors had a great contribution to study design, analysis, and interpretation of the findings. Endalu Tesfaye and Hunduma Feyisa involved in laboratory analysis. Endalu Tesfaye and Fedasan Alemu drafted the manuscript. All authors revised the paper carefully for important intellectual contents. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research proposal was ethically cleared by the Salale University Institutional Review Board (Reference Number: S/U-IRB/25/23). An official permission letter was obtained from Nekemte Public Health Research and Referral Laboratory Center. Participants were informed of the purpose of the study, risks associated with the study, confidentiality of personal data, and their right to take part in the study. After that, we obtained a written informed consent from adult study participants, whereas an assent was obtained from study participants less than 18 years of age. In addition, a consent was also obtained from their parents or legal guardians to participate in this study. Finally, specimens were collected from all study participants and analyzed accordingly. Laboratory results of study participants were communicated with their respective physicians for better management\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eClinical Microbiology Department, Nekemte Public Health Research and Referral Laboratory Center, P.O.Box 061, Nekemte, Ethiopia\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eDepartment of Medical Laboratory Sciences, College of Health Sciences, Salale University, P.O.Box 245, Fitche, Ethiopia\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e3\u003c/sup\u003eDepartment of Pharmacy, College of Health Sciences, Salale University, P.O.Box 245, Fitche, Ethiopia\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSantoshi Kumari M, Madhavi J, Bala Krishna N, Raja Meghanadh K, Jyothy AJ. 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Infect Drug Resist. 2022;15(15):7733\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWan Draman WNA, Md Daud MK, Mohamad H, Hassan SA, Abd Rahman N. Evaluation of the current bacteriological profile and antibiotic sensitivity pattern in chronic suppurative otitis media. Invest Otolaryngol. 2021;6(6):1300\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAfolabi OA, Salaudeen AG, Ologe FE, Nwabuisi C, Nwawolo CC. Pattern of bacterial isolates in the middle ear discharge of patients with chronic suppurative otitis media in a tertiary hospital in north central Nigeria. Afr Health Sci. 2012;12(3):362\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorku M, Bekele M. Bacterial isolate and antibacterial resistance pattern of ear infection among patients attending at Hawassa university referral Hospital, Hawassa, Ethiopia. Indian J Otology. 2014;20(4):155\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaqvi SA, Yaseen R, Naqvi ZA, OTITIS MEDIA. Prevalence of Gram negative Bacteria in Otitis Media Patients in ENT Ward/OPD of Nishtar Hospital Multan. Prof Med J. 2019;26(02):364\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu J, Du Q, Shu Y, Ji J, Dai C. Bacteriological Profile of Chronic Suppurative Otitis Media and Antibiotic Susceptibility in a Tertiary Care Hospital in Shanghai, China. Ear Nose Throat J. 2021;100(9):391\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKombade S, Kaur N, Patro S, Nag V. Clinico-bacteriological and antibiotic drug resistance profile of chronic suppurative otitis media at a tertiary care hospital in Western Rajasthan. J Family Med Prim Care. 2021;10(7):2572\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u0026Ccedil;etin YS, Mollamehmetoğlu SO, D\u0026uuml;zenli U, Turan M, Bozan N. Treatment of Multi-Drug Resistant Microorganisms in Chronic Suppurative Otitis Media. B-ENT. 2022;18(1):44\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhatun MR, Alam KMF, Naznin M, Salam MA. Microbiology of chronic suppurative Otitis media: An update from a tertiary care hospital in Bangladesh. Pakistan J Med Sci. 2021;37(3):821\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGavrilovici C, Spoială EL, Miron IC, St\u0026acirc;rcea IM, Haliţchi COI, Zetu IN, et al. Acute Otitis Media in Children\u0026mdash;Challenges of Antibiotic Resistance in the Post-Vaccination Era. Microorganisms. 2022;10(8):1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAduda DSO, Macharia IM, Mugwe P, Oburra H, Farragher B, Brabin B, et al. Bacteriology of chronic suppurative otitis media (CSOM) in children in Garissa district, Kenya: A point prevalence study. Int J Pediatr Otorhinolaryngol. 2013;77(7):1107\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMalkappa SK, Kondapaneni S, Surpam RB, Chakraverti TK. Study of aerobic bacterial isolates and their antibiotic susceptibility pattern in chronic suppurative otitis media. Indian J Otology. 2012;18(3):136\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmed M, Salih. Al. Bacteriological Findings in Active Otitis Media with Perforated Tympanic Membrane. Volume 15. Indian Journal of Forensic Medicine \u0026amp; Toxicology; 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAraya BD, Aklilu A, Alahmadi RM. Factors Associated with Otitis Media Among Pediatrics in Two Government Hospitals in Arba Factors Associated with Otitis Media Among Pediatrics in Two Government Hospitals in Arba. Infect Drug Resist. 2023;16(1):6405\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNavneeta Gangwar G, Kishan Siddapur SS. Clinical Implications of Culture and Sensitivity Data in Chronic Otitis Media. Indian J Otology. 2021;27(3):101\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAthbi HA, Abed-Ali HN. Risk factors of acute otitis media among infants children in Kerbala Pediatric teaching hospital: A case-control study. Medico-Legal Updates. 2020;20(1):766\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaneru M, Shah SP, Chettri ST. Association of Passive Smoking with Otitis Media among School Children of Eastern Nepal. Annals Otology Neurotology. 2021;4(02):062\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-microbiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"mcro","sideBox":"Learn more about [BMC Microbiology](http://bmcmicrobiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/mcro","title":"BMC Microbiology","twitterHandle":"#bmcmicrobiology","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Otitis media, bacteria, antimicrobial resistance","lastPublishedDoi":"10.21203/rs.3.rs-4452931/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4452931/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOtitis media is among the leading causes of illnesses responsible for causing hearing problems and adding significant costs to the public health system. Bacteria are the most common causative agents for otitis media. Currently, there is little information on the prevalence and antimicrobial susceptibility patterns of pathogenic bacterial isolates from patients with otitis media in Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA laboratory – based cross-sectional study was conducted from June to September 2023 among 242 patients with otitis media referred to Nekemte Public Health Research and Referral Laboratory Center. Sociodemographic and clinical data were obtained by trained nurses and/or health officers in face-to-face interviews using structured questionnaires. Middle ear discharge samples were collected by trained clinical microbiology experts following all aseptic techniques. Conventional culture, different biochemical tests and antimicrobial susceptibility testing were performed for all the isolated bacteria. Reference strains were used as a positive and negative controls. The data were checked for completeness and consistency, entered into EpiData version 4.6.06 and analyzed by SPSS version 25. Logistic regression analysis was performed to determine the associated factors of otitis media. Adjusted odds ratio was used to determine strength of association. Statistical significance was obtained at p-value of below 0.05. The data were interpreted using graphs, tables, and results statements.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 242 middle ear discharge samples were collected and cultured from which 212 (87.6%) were culture positive. A total of 228 pathogenic bacterial isolates were recovered. The predominant bacterial isolates were \u003cem\u003eS. aureus\u003c/em\u003e 92 (40.4%) followed by \u003cem\u003eP. aeruginosa\u003c/em\u003e 33 (14.5%) and \u003cem\u003eE. coli\u003c/em\u003e 24 (10.5%). One hundred fifty-one (66.2%) bacterial pathogens were multidrug resistant. Piperacillin-tazobactam and tobramycin are relatively common drugs to which most of the isolates were susceptible while ampicillin and tetracycline were the most resistant. Purulent discharge (p-value = 0.001), middle ear discharge ≥ 14 days (P-value = 0.000) and a history of active/passive smoking (P-value = 0.043) were significantly associated with otitis media.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of bacterial pathogens, most of which were multidrug-resistant, was high among patients with otitis media. A significant association was observed with purulent ear discharge, chronic otitis media, and passive or active smoking. Choosing the proper antibiotic for the treatment of bacterial infection is crucial.\u003c/p\u003e","manuscriptTitle":"Bacterial etiologies, antimicrobial susceptibility profiles and associated factors among patients with otitis media referred to Nekemte Public Health Research and Referral Laboratory Center, Western Ethiopia: A prospective cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-12 08:07:59","doi":"10.21203/rs.3.rs-4452931/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-08-01T22:18:40+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-31T22:44:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"326401556591022148028562350344549576427","date":"2024-07-11T08:31:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-08T08:57:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"6736400590301073277812124493130225070","date":"2024-07-05T00:28:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-04T16:43:11+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-06-21T12:01:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-21T11:59:46+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-21T11:59:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Microbiology","date":"2024-05-21T07:31:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-microbiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"mcro","sideBox":"Learn more about [BMC Microbiology](http://bmcmicrobiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/mcro","title":"BMC Microbiology","twitterHandle":"#bmcmicrobiology","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"10203b71-3a8c-4df7-bfa9-c7dc18dd1ca6","owner":[],"postedDate":"July 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-13T16:06:12+00:00","versionOfRecord":{"articleIdentity":"rs-4452931","link":"https://doi.org/10.1186/s12866-024-03664-z","journal":{"identity":"bmc-microbiology","isVorOnly":false,"title":"BMC Microbiology"},"publishedOn":"2025-01-07 15:57:26","publishedOnDateReadable":"January 7th, 2025"},"versionCreatedAt":"2024-07-12 08:07:59","video":"","vorDoi":"10.1186/s12866-024-03664-z","vorDoiUrl":"https://doi.org/10.1186/s12866-024-03664-z","workflowStages":[]},"version":"v1","identity":"rs-4452931","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4452931","identity":"rs-4452931","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}