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Among children with ear infections following tympanostomy tube placement, infections associated with methicillin-resistant Staphylococcus aureus (MRSA) did not result in worse outcomes than those caused by other pathogens, a single-center study showed.

Although children with MRSA otorrhea were more likely to require oral or intravenous antibiotics (delivered by a peripherally inserted central catheter), there were no differences based on the infecting organism in the need for further surgery (about 56% in each group), according to Brian Wiatrak, MD, of the Children's Hospital of Alabama in Birmingham, and colleagues.

Also, no children required hospitalization for the treatment of skin or soft-tissue infection, or developed complications of otitis media, including sigmoid sinus thrombosis, facial paralysis, or meningitis, the researchers reported in the December issue of Archives of Otolaryngology -- Head & Neck Surgery.

"These findings should facilitate appropriate care for MRSA otorrhea after tympanostomy tube placement and help to decrease parental anxiety regarding a diagnosis of MRSA otorrhea versus non-MRSA otorrhea," the authors wrote.

Otorrhea is the most common complication associated with tympanostomy tube insertion. Since the 1990s, rates of MRSA-related ear infections have been increasing.

To test whether MRSA infections are more severe than other types, Wiatrak and colleagues retrospectively reviewed the records of children treated at their center for otorrhea following tube insertion from 2003 through 2008.

The study included 1,079 patients (mean age 4); 15.8% had a MRSA infection. For the comparison of outcomes, the researchers selected a control group of 170 children with non-MRSA otorrhea matched by age to the children with a MRSA infection.

In the control group, the most common pathogens were Pseudomonas aeruginosa (24.8%), methicillin-sensitive S. aureus (16%), Streptococcus pneumoniae (9.9%), and Haemophilus influenzae (8.5%).

More conservative treatment -- vinegar/water irrigation plus topical antibiotic -- worked more frequently for patients with non-MRSA infections (66% versus 36.3%, P<0.001).

Thus, a greater percentage of patients with MRSA infection required the addition of oral antibiotics (40.7% versus 24.8%) and IV antibiotics (11.1% versus 3.6%). Both differences were significant at P<0.001.

There was no difference in the proportion of children who needed minor or major surgery (P=0.35), which "confirms the safety of the trend to match treatment aggressiveness to infection severity rather than treating more aggressively based on the specific pathogen (MRSA)," according to Wiatrak and colleagues.

"We believe that our selection of specific antibiotic agent based on the culture results and scrupulous attention to infection control practices helps to decrease the risk of new drug resistances developing," they wrote.

They noted that treatment of MRSA otorrhea has undergone substantial changes over the last 10 years.

"Many of the first patients with culture-proven MRSA otorrhea were hospitalized for a two-week course of parenteral antibiotics and were more likely to undergo mastoidectomy if they developed chronic infection of middle ear mucosa or granulation tissue," the researchers wrote.

The treatment for mild-to-moderate infections has become less aggressive but not less effective, they added.

The authors acknowledged some limitations of the study, including the retrospective design, some differences in the medical and surgical management of otorrhea among the four pediatric otolaryngologists who treated all of the patients, and possible selection bias in the control group.

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