CSOM is a long-standing condition characterized by ongoing irritation and infection in the middle ear and mastoid cavities with a duration of no less than two weeks, it has the potential to cause various effects, otorrhea as a result of a ruptured tympanic membrane. [1,2] Younger age groups are most affected by the condition. [3] Additionally, individuals of any age and genders are impacted. [4]

Persistent otorrhea, mastoid infection, labyrinthitis, facial palsy and brain abscesses or thromboses are examples of irreversible adverse effects from CSOM. [5] Neglecting CSOM can result in issues such as meningitis, labyrinthitis, lateral sinus thrombosis, facial nerves paralysis, and the formation of a brain abscess.

CSOM is commonly classified into two groups: tubotympanic and atticoantral.

Pseudomonas aeruginosa is the most prevalent bacteria, according to numerous workers in India and in other nations. Pseudomonas aeruginosa has been found to have inherent resistance to a variety of antibiotics. It can also develop resistance through mutations or through acquisition of bacterial resistance gene, which results in bacteria alterations. [6]

It is crucial to understand the symptoms and signs of CSOM in clinical cases, the microorganisms that are frequently present in CSOM infections, and antibiotic resistance in order to deliver better and more effective clinical results.

This observational investigation was conducted on patients diagnosed with CSOM, at TMU Hospital ENT department and department of microbiology, Moradabad, Uttar Pradesh, India. Following Institutional Ethical committee approval.

To collect ear discharge (a pus sample), a pair of sterile cotton swabs, dampened with normal saline, were placed into the middle ear. Two sterile cotton swabs used; one was examined microscopically, while the other culture conditions samples were streaked onto MacConkey agar and 5% defibrinated sheep blood agar and subsequently incubated for 24 hours at 37˚ C to facilitate bacterial growth and identification.

isolates were identified based on colony morphology and conventional or standard biochemical testing, allowing for precise characterization of species.

Following standard clinical protocols, the isolates antibiotic sensitivity was evaluated on Muller Hilton Agar using kirby Bauer method. The zones of inhibition around the discs were then measured to assess the sensitivity of the isolates to the respective antibiotics.

Result Interpretation and reporting by Use of CLSI recommendations 2024.

Statistical analysis

Microsoft Word was used to organize the data.

Ethics statement

The institutional ethical committee gave its approval to this investigation with reference number TMU/ IEC/ 2024-25/ PG/ 132. Each participant gave their informed consent prior to the collection and processing. The goal and nature of the study were explained in general to the participants. The collection data was kept secret.

During the research timeframe, 84 out of 100 samples tested positive for bacterial growth, while 16 showed no detectable growth.

Of the 100 samples studied, eighty-four (84) demonstrated bacterial growth, with Pseudomonas aeruginosa was found in 45 samples, Staphylococcus aureus in 29, Klebsiella species in 5, Escherichia coli in 3, and Proteus species in 2. The remaining 16 samples exhibited no bacterial growth.

Out of the 29 isolated Staphylococcus aureus strains, 8 (28%) exhibited methicillin resistance (MRSA), while 21 (72%) were methicillin sensitive (MSSA).

Among the studied age groups, prevalence of bacterial growth, the highest bacterial growth rate was observed among individuals in 21to 40 years (47 cases) age group, indicating a potential correlation between age and susceptibility to bacterial colonization. This was followed by 34 cases in the 0 to 20 year range, 14 cases in the 41 to 60 range, 3 cases in the 61 to 80 range, and 2 cases in those over 81 years old.

Demonstrating antibiotic susceptibility in S. aureus: Vancomycin (100%), Teicoplanin (93%), Linezolid (93%), Clindamycin (89%), Doxycycline (82%), Cefoxitin (72%), Gentamycin (69.2%)

Displaying the sensitivity profile of Enterobacteriaceae to various antibiotics: Meropenem (100%), Cefepime (90.3%), Piperacillin Tazobactam (90.3%), Ceftazidime (90.1%), Polymyxin B (80.2%), Ampicillin Sulbactam (80.2%), Colistin (80.2%), Imipenem (80.2%), Amikacin (80.1%), Cefoxitin (80%), Ticarcillin clavulanate (80%), Gentamicin (70.1%)

illustrating the drug susceptibility pattern of P. aeruginosa: Polymyxin B (100%), Colistin (100%), Meropenem (88%), Cefepime (75%), Ticarcillin clavulanate (73%), Piperacillin Tazobactam (88%), Ceftazidime (73%), Amikacin (71%)

In our investigation, 84 (84%) of the 100 CSOM discharge from the ears sample had bacterial growth. Likewise, out of 153 samples, 126 (82%) displayed visible bacterial growth in a study carried out by Kombade SP et al. (2021). [7]

Our findings suggest us to the opinion that women were the most affected, accounting for 63% of cases, compared to 37% in men. In a comparable direction, Mofatteh M R et al. (2017) discovered that 41% of patients were men and 59% of patients were women. [8] However, a study by Rathi S et al. (2018) discovered that men were more impacted than women, making up 60% of the total cases compared to 40% for women. [9]

1. aeruginosa was the most frequently isolated bacterium of the bacteria isolated in this investigation, accounted for 45% of cases, with S. aureus coming in second at 29%. According to a study by Garg A et al. (2022), Pseudomonas species was identified 28% of cases, whereas S. aureus was isolated 12% of the cases. [10] According to a study conducted in a tertiary care hospital in South India by Smitha NR et al. (2018), found that P. species and S. aureus was the most common or most frequently isolates. [11]

According to this study, 47% of individuals who were affected by CSOM were between the ages of 21 and 40. Chander VS et al. (2019) conducted a similar study and reported that the maximum percentage of patients in the age group between 21 and 40 years was roughly fifty percent (50.1%). [1] Based to a study by Kaur P et al. (2018), the majority of patients (37%) were between the age of 11 to 20 years. [12]

In the current investigation, we discovered that Pseudomonas aeruginosa responded significantly or extremely susceptible to polymyxin B, Colistin and Meropenem, whereas S. aureus showed marked sensitivity to vancomycin, linezolid and teicoplanin. In a comparable manner, Smitha NR et al. (2018) discovered that Pseudomonas species was extremely or strong responsive to imipenem and aminoglycosides, while S. aureus strains were completely susceptible to vancomycin and linezolid. [11]

1. p aeruginosa was the most frequently isolated microorganism, accounting for 45% of cases, followed by the bacterium Staphylococcus aureus at 29%, species of Klebsiella made up 5%, while E. coli and Proteus species constituted 3% and 2%, respectively and rest 16 were no growth.

The age group mostly affected from CSOM in this study was between 21 to 40 years, indicating a higher prevalence in young to middle aged adults.

The most common antibiotic sensitive to gram positive bacteria are Vancomycin, Linezolid, Clindamycin, Doxycycline and Teicoplanin and in the case of gram-negative bacteria Polymyxin B, Colistin, Piperacillin Tazobactam, Cefepime, Ceftazidime, Ticarcillin clavulanate and Meropenem are most common antibiotics to sensitive.

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