Validating Quantitative Polymerase Chain Reaction Assay for the Molecular Diagnosis of Chronic Suppurative Otitis Media

Dina Alia; Ferry Dwi Kurniawan; Azwar Ridwan; Wilda Mahdani; Koichi Hagiwara

doi:10.3889/oamjms.2020.3886

Authors

Dina Alia Department of Internal Medicine, Comprehensive Medicine I, Saitama Medical Centre, Jichi Medical University, Saitama, Japan; Department of Ear, Nose and Throat, Faculty of Medicine, dr. Zainoel Abidin Hospital, Universitas Syiah Kuala, Banda Aceh, Indonesia
Ferry Dwi Kurniawan Department of Respiratory Medicine, Faculty of Medicine, Dr. Zainoel Abidin Hospital, Universitas Syiah Kuala, Banda Aceh, Indonesia
Azwar Ridwan Department of Ear, Nose and Throat, Faculty of Medicine, dr. Zainoel Abidin Hospital, Universitas Syiah Kuala, Banda Aceh, Indonesia
Wilda Mahdani Department of Microbiology, dr. Zainoel Abidin Hospital, Universitas Syiah Kuala, Banda Aceh, Indonesia
Koichi Hagiwara Department of Internal Medicine, Comprehensive Medicine I, Saitama Medical Centre, Jichi Medical University, Saitama, Japan; Department of Internal Medicine, Division of Pulmonary Medicine, Jichi Medical University, Tochigi, Japan

DOI:

https://doi.org/10.3889/oamjms.2020.3886

Keywords:

suppurative otitis media, pathogen, real-time polymerase chain reaction, molecular diagnostics

Abstract

BACKGROUND: Pathogen identification is critical for antibiotic selection in suppurative otitis media. However, bacterial culture challenges from suppurative specimens often cause antibiotic misuse and ineffective treatment. A quantitative polymerase chain reaction (PCR) controlled by the human cells contained in the specimen (HIRA-TAN) has been established in differentiate between pathogens and colonization in the previous pneumonia study.

AIM: The aim of this study was to investigate the utility of HIRA-TAN and determine the causative pathogen in chronic suppurative otitis media.

METHODS: Thirty-nine patients were recruited to the study. The otorrhea was swab-collected and processed for both bacterial culture and a multiplex PCR-based test. The cutoff of cycle threshold to determinate the pathogens was defined by receiver operating characteristic curves.

RESULTS: Thirty-nine patients ranging from 1.7 to 62 years old were enrolled. The hearing impairment was found different between adult and children (p < 0.005) with adults (24/29 patients) had a significantly higher rate. A total of 35.9% of samples were positive for bacterial culture; Pseudomonas aeruginosa, Klebsiella pneumoniae, Proteus mirabilis, and Morganella morganii, while Bacteroides fragilis, Acinetobacter baumannii, Moraxella catarrhalis, and Escherichia coli were not identified by culture, although high cycle-threshold values were obtained suggesting the inability of the culture system in detecting some pathogens.

CONCLUSION: Our results indicate that HIRA-TAN is a potential diagnostic tool in suppurative otitis media and warrant a larger cohort study.

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