What is in the pus? Antibiotic resistance in patients with chronic ear discharge awaiting surgery in Nepal

Abstract Setting: Biratnagar eye hospital, Nepal that offers ear surgery for Chronic Suppurative Otitis Media (CSOM). Objective: In CSOM patients awaiting surgery, to determine the 1) socio-demographic characteristics 2) bacterial isolates and their antibiotic resistance patterns, and 3) characteristics of those who were refused for surgery and associated risk factors.Design: A cohort study using hospital data (January 2018-January 2020).<br>Results: Of 117 patients with CSOM and awaiting surgery, 64% were in the 18-35 age group, and 79% were cross-border from India. Of 118 bacterial isolates, 80% were Pseudomonas aeruginosa and 16% were Staphylococcus aureus. All isolates showed Multidrug-resistance to nine of the 12 antibiotics tested. The lowest antibiotic resistance in Pseudomonas aeruginosa was for vancomycin (29%) and moxifloxacin (36%) and for Staphylococcus aureus, vancomycin (9%), and amikacin (17%).Fourteen (12%) patients underwent surgery: seven (50%) myringoplasty, four (29%) cortical mastoidectomy with tympanostomy, and three (21%) modified radical mastoidectomy. Those infected with Pseudomonas aeruginosa and with resistance to over six antibiotics were significantly more, likely to be refused for surgery.<br>Conclusion: Patients awaiting ear surgery were predominantly infected with multidrug-resistant Pseudomonas aeruginosa and consequently refused surgery. This study can help to inform efforts for improving surgical uptake and for introducing cross-border surveillance for antimicrobial resistance.