Volume 9, Issue 3 (2023)                   IEM 2023, 9(3): 229-238 | Back to browse issues page

XML Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Krisniawati N, Budhi Darmawan A, Puspita Karunia Ning Widhi A, Afifah Nur Hestiyani R, Rujito L. Exploring Antibiotic Susceptibility in Otomycosis: Uncovering Mixed Infections of Fungal and Bacterial Origin in Indonesia. IEM 2023; 9 (3) :229-238
URL: http://iem.modares.ac.ir/article-4-70952-en.html
1- Department of Microbiology, Faculty of Medicine, Jenderal Soedirman University, Porwokerto, Indonesia , Nia.Krisniawati@unsoed.ac.id
2- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Jenderal Soedirman University, Porwokerto, Indonesia
3- Department of Genetic and Molecular Biology, Faculty of Medicine, Jenderal Soedirman University, Porwokerto, Indonesia
4- Department of Microbiology, Faculty of Medicine, Jenderal Soedirman University, Porwokerto, Indonesia
Abstract:   (330 Views)
Background: Otomycosis is a common fungal ear infection affecting people worldwide. Cases may be exacerbated by mixed fungal-bacterial infections, especially those involving antibiotic-resistant bacteria. Understanding the microbiological features and antibiotic susceptibility patterns of the pathogens involved is critical for treatment. This study aimed to investigate the prevalence of mixed fungal-bacterial infections in otomycosis cases in Indonesia, to identify the bacterial species involved, and to determine their antibiotic susceptibility patterns.
Materials & Methods: In this study, 47 ear swab specimens were collected from 41 clinically-diagnosed otomycosis cases from April to August 2022. The collected samples were processed by culture and microscopy to identify fungal and bacterial isolates. Antibiotic susceptibility testing was performed using the Kirby-Bauer disc diffusion method.
Findings: Fungal isolates alone were detected in 80.9% of the specimens, while 19.1% showed mixed fungal-bacterial growth. The most common fungi were Aspergillus (57.1%) and Candida (42.9%) species. Among bacterial isolates, Staphylococcus aureus was the most frequent (observed in 66.7% of mixed cases), followed by Pseudomonas aeruginosa (22.2%). Also, two of the six S. aureus isolates were methicillin-resistant (MRSA). Both P. aeruginosa isolates were extended-spectrum beta-lactamase (ESBL) producers.
Conclusion: Many otomycosis cases in this study demonstrated polymicrobial etiology. The emergence of antibiotic-resistant bacteria poses diagnostic and therapeutic challenges to healthcare systems.
Full-Text [PDF 487 kb]   (119 Downloads)    
Article Type: Original Research | Subject: Mycology
Received: 2023/08/7 | Accepted: 2023/10/18 | Published: 2023/10/18

1. 1. Prasad SC, Kotigadde S, Shekhar M, Thada ND, Prabhu P, D' Souza T, et al. Primary otomycosis in the Indian subcontinent: Predisposing factors, microbiology, and classification. Int J Microbiol. 2014;2014:1-9. [DOI:10.1155/2014/636493] [PMID] []
2. Uyanga FZ, Ekundayo EO, Nwankwo EO, Inimfon AI. Evaluation of CHROMagar ESBL and double disk synergy test (DDST) for screening of extended spectrum beta-lactamase producing uropathogens in South-South Nigeria. J Adv Microbiol. 2019;17(4):1-11. https://doi.org/10.9734/jamb/2019/v18i330171 [DOI:10.9734/jamb/2019/v17i430150]
3. Aremu SK Adewoye KR, Ibrahim TA Prospective analysis of otomycosis in a tertiary care hospital. Int J Trop Dis. 2020;3(1):1-8. [DOI:10.23937/2643-461X/1710029]
4. Krishna H. Assessment of risk factors and identification of fungal and bacterial agents in otomycosis at rural community attending a tertiary care hospital. Int J Integr Med Sci. 2020;7(3):883-7. [DOI:10.16965/ijims.2020.102]
5. Tasić-Otašević S, Golubović M, Đenić S, Ignjatović A, Stalević M, Momčilović S, et al. Species distribution patterns and epidemiological characteristics of otomycosis in southeastern Serbia. J Mycol Med. 2020;30(3):101011. [DOI:10.1016/j.mycmed.2020.101011] [PMID]
6. Saki N, Rafiei A, Nikakhlagh S, Amirrajab N, Saki S. Prevalence of otomycosis in Khouzestan province, southwest Iran. J Laryngol Otol. 2013;127(1):25-7. [DOI:10.1017/S0022215112002277] [PMID]
7. Sangaré I, Amona FM, Ouedraogo RW, Zida A, Ouedraogo MS. Otomycosis in Africa: Epidemiology, diagnosis, and treatment. J Mycol Med. 2021;31(2):101115. [DOI:10.1016/j.mycmed.2021.101115] [PMID]
8. Nemati S, Hassanzadeh R, Khajeh Jahromi S, Delkhosh Nasrollah Abadi A. Otomycosis in the north of Iran: Common pathogens and resistance to antifungal agents. Eur Arch Otorhinolaryngol. 2014;271(5):953-7. [DOI:10.1007/s00405-013-2486-0] [PMID]
9. Debta P, Swain SK, Lenka S, Sahu MC. Otomycosis: A comprehensive review. Indian J Forensic Med Toxicol. 2020;14(4):8429-32.
10. Bojanović M, Stalević M, Arsić-Arsenijević V, Ignjatović A, Ranđelović M, Golubović M, et al. Etiology, predisposing factors, clinical features, and diagnostic procedure of otomycosis: A literature review. J Fungi. 2023;9(6):662-76. [DOI:10.3390/jof9060662] [PMID] []
11. Kiakojuri K, Rajabnia R, Jalili B, Khafri S, Omran SM. Otomycosis in adolescent patients referred to the therapeutic centers in Babol city, Iran. Jundishapur J Microbiol. 2015;8(5):e17138. [DOI:10.5812/jjm.8(5)2015.17138] [PMID]
12. Prakash SB, Leelatejaswini RM, Deekshita V. A clinical and microbial study of otomycosis: An original study. J Evol Med Dent Sci. 2015;4(71):12376-85. [DOI:10.14260/jemds/2015/1786]
13. Clinical and Laboratory Standards Institute. CLSI supplement M100: Performance standards for antimicrobial susceptibility testing. 32nd ed. Wayne, PA: Clinical and Laboratory Standards Institute; 2022.
14. Görür K, İsmi O, Özcan C, Vayısoğlu Y. Treatment of otomycosis in ears with tympanic membrane perforation is easier with paper patch. Turk Arch Otorhinolaryngol. 2019;57(4):182-6. [DOI:10.5152/tao.2019.4384] [PMID] []
15. Singh S, Singh H, Kaur MA. Otomycosis: A clinical and mycological study. Int J Otorhinolaryngol Head Neck Surg. 2018;4(4):1013-6. [DOI:10.18203/issn.2454-5929.ijohns20182704]
16. Krishnan A. Otomycosis: Study of etiopathological factors and mycological spectrum. Ann Otol Neurotol. 2019:2(01):A025. [DOI:10.1055/s-0039-1700218]
17. Khan JA, Paul SK, Chowdhury CS, Mostafa MG, Kamruzzaman M, Paul BK, et al. Bacteriology of chronic supporative otitis media (CSOM) at a tertiary care hospital, Mymensingh. Mymensingh Med J. 2020;29(3):545-52.
18. Kirschner R, Sun PL, Huang SL, Chen CL, Yang CP. A case of bilateral otomycosis associated with Aspergillus flavus and A. terreus in Taiwan. J Mycol Méd. 2017;27(3):412-6. [DOI:10.1016/j.mycmed.2017.04.010] [PMID]
19. Agarwal P, Devi LS. Otomycosis in a rural community attending a tertiary care hospital: Assessment of risk factors and identification of fungal and bacterial agents. J Clin Diagn Res. 2017;11(6):DC14-8. [DOI:10.7860/JCDR/2017/25865.10068] [PMID] []
20. Gu X, Cheng X, Zhang J, She W. Identification of the fungal community in otomycosis by internal transcribed spacer sequencing. Front Microbiol. 2022;13:820423. [DOI:10.3389/fmicb.2022.820423] [PMID] []
21. Mistry M, Pathak A. To study the prevalence & clino-mycological profile of otomycosis in Saurashtra & Kutch region of Gujarat. IP Int J Med Microbiol Trop Dis. 2021;6(4):213-6. [DOI:10.18231/j.ijmmtd.2020.048]
22. Sabz G, Gharaghani M, Mirhendi H, Ahmadi B, Gatee MA, Sisakht MT, et al. Clinical and microbial epidemiology of otomycosis in the city of Yasuj, southwest Iran, revealing Aspergillus tubingensis as the dominant causative agent. J Med Microbiol. 2019;68(4):585-90. [DOI:10.1099/jmm.0.000948] [PMID]
23. Zhang S, Jin M, Hu S, Zhang Y, Zhou G. Administration of 1% topical voriconazole drops was effective and safe in the treatment of refractory otomycosis without tympanic membrane perforation. Ann Otol Rhinol Laryngol. 2021;130(3):273-9. [DOI:10.1177/0003489420946783] [PMID]
24. Ameye S, Adeyemo A, Eziyi J, Amusa Y. Clinical profile of otomycosis in a sub-saharan African tertiary health center. Int J Otorhinolaryngol Clin. 2018;10(2):52-5. [DOI:10.5005/jp-journals-10003-1290]
25. Amona FM, Apoline SK, Ouedraogo RW, Zida A, Sangare I, Cisse M. Epidemiological and clinical study of otomycosis at Sourô Sanou University Hospital in Bobo-Dioulasso, Burkina Faso. Paripex Indian J Res. 2018;7(5):17-22.
26. Jahan T, Mushtaq MB, Bali N, Nargis S, Bashir YU. Clinico-mycological study of otomycosis comparing the cavity slide technique and the conventional agar block slide culture. J Clin Diagn Res. 2019;13(8):8-11. [DOI:10.7860/JCDR/2019/41417.13058]
27. Jimenez-Garcia L, Celis-Aguilar E, Díaz-Pavón G, Muñoz Estrada V, Castro-Urquizo Á, Hernández-Castillo N, et al. Efficacy of topical clotrimazole vs. topical tolnaftate in the treatment of otomycosis. A randomized controlled clinical trial. Braz J Otorhinolaryngol. 2020;86(3):300-7. [DOI:10.1016/j.bjorl.2018.12.007] [PMID] []
28. Ismail MT, Al-Kafri A, Ismail M. Otomycosis in Damascus, Syria: Etiology and clinical features. Curr Med Mycol. 2017;3(3):27-30. [DOI:10.29252/cmm.3.3.27] [PMID] []
29. Itor EA, Noubom M, Nangwat C, Ngueguim DA, Kountchou CL, Thierry NK, et al. Clinical and microbiological epidemiology of otomycosis in the centre region of Cameroon. Eur J Clin Biomed Sci. 2020;6(5):78-83. [DOI:10.11648/j.ejcbs.20200605.12]
30. Wagh Kailash B, Ghule Shubhungi B, Pawar SK, Mohite ST. Bacterial and fungal study in chronic suppurative otitis media from a developing country. Int J Recent Trends Sci Technol. 2015;16(1):104-8.
31. Javidnia J, Ghotbi Z, Ghojoghi A, Solhjoo K, Alshahni MM, Jeddi SA, et al. Otomycosis in the south of Iran with a high prevalence of tympanic membrane perforation: A hospital-based study. Mycopathologia. 2022;187(2):225-33. [DOI:10.1007/s11046-022-00626-9] [PMID]
32. Al-Orphaly M, Hadi HA, Eltayeb FK, Al-Hail H, Samuel BG, Sultan AA, et al. Epidemiology of multidrug-resistant Pseudomonas aeruginosa in the Middle East and north Africa region. mSphere. 2021;6(3):e00202-21. [DOI:10.1128/mSphere.00202-21] [PMID] []
33. Reigada I, San-Martin-Galindo P, Gilbert-Girard S, Chiaro J, Cerullo V, Savijoki K, et al. Surfaceome and exoproteome dynamics in dual-species Pseudomonas aeruginosa and Staphylococcus aureus biofilms. Front Microbiol. 2021;12:672975. [DOI:10.3389/fmicb.2021.672975] [PMID] []
34. Momenah AM, Bakri RA, Jalal NA, Ashgar SS, Felemban RF, Bantun F, et al. Antimicrobial resistance pattern of Pseudomonas aeruginosa: An 11-year experience in a tertiary care hospital in Makkah, Saudi Arabia. Infect Drug Resist. 2023;16:4113-22. [DOI:10.2147/IDR.S409726] [PMID] []

Add your comments about this article : Your username or Email:

Send email to the article author

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.