Bacterial profile, their antimicrobial susceptibility pattern and associated factors of otitis media among children at selected private hospitals in Hargeisa City, Somaliland.

introductionOtitis media (OM), an inflammation of the middle ear, is a major health concern among children, often resulting from bacterial infections. Although widely studied in other regions, there is a critical lack of local epidemiological data on OM in Somaliland. Compounding the issue is the growing threat of antimicrobial resistance (AMR), which undermines the effectiveness of commonly used antibiotics. This study aimed to identify the bacterial profile, examine antimicrobial susceptibility patterns, and explore factors associated with OM in children attending selected private hospitals in Hargeisa City. METHODOLOGY: Hospital based cross sectional study was conducted from March to September, 2020 among children below 15 years who enrolled consecutively from the ENT department of three selected private health facilities in Hargeisa city. Socio demographic and clinical data were collected using questionnaire. Ear swab samples were collected and inoculated on Blood, Chocolate and MacConkey agar. Standard biochemical tests were used to identify bacterial isolates at species level. Antibiotic susceptibility tests were done using the Kirby-Bauer disk diffusion method. Data were analyzed using statistical software (SPSS). Descriptive statistics were used to summarize the data. Bivariable logistic regression was first performed to identify potential factors associated with otitis media. Variables with a p-value ≤ 0.30 in the bivariable analysis were then included in a multivariable logistic regression model to control for confounding and identify independent predictors. A p-value ≤ 0.05 was considered statistically significant.

resultA total of 160 children with OM participated in the study, with the majority (86; 54%) under the age of five. Bacteria were isolated from 144 (90%) patients. The most predominant isolates were Staphylococcus aureus followed by Proteus species and Pseudomonas aeruginosa. Notably, children with parental cigarette smoking exposure (AOR: 12.5; 95% CI: 1.3-27.1) and those with allergic rhinitis (AOR: 4.61; 95% CI: 1.24-16.79) had significantly higher odds of developing bacterial otitis media. Majority of isolates demonstrated high level of susceptibility to amoxicillin clavulanic acid, ciprofloxacin and ceftriaxone whereas High resistance rates were observed to penicillin and amoxicillin.

conclusionIn Hargeisa, our data suggest the high prevalence of bacterial OM among children, and it calls for urgent public health action. Parental cigarette smoking and allergic rhinitis were associated with higher odds of infection. The study demonstrated the need to revise empirical treatment guidelines for OM in children, taking into account local resistance patterns and promoting the use of more effective antibiotics. Strengthening antimicrobial stewardship and routine susceptibility testing is essential to improve treatment outcomes and curb the spread of resistance. It highlights the importance of integrating both environmental and allergic risk factors into the effective management of OM in children.