Evidence of Bacterial Metabolic Activity in Culture-Negative Otitis Media With Effusion

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Abstract
OTITIS MEDIA is the most common reason for an ill child to visit a physician and is the most common reason for a child to receive antimicrobial agents or surgery.1,2 Chronic otitis media with effusion (OME), the persistence of fluid in the middle ear with minimal constitutional symptoms, can lead to significant hearing loss in pediatric patients with the sequelae of developmental problems in speech, language, and the acquisition of socialization skills.3,4 Otitis media with effusion has variously been attributed to infectious, allergic, and anatomic processes.3Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis are the bacterial pathogens most commonly cultured from effusions obtained from children with OME, but 40% to 60% of effusions are sterile by culture.5,6 Previous work at the Center for Genomic Sciences at the University of Pittsburgh and elsewhere has shown that polymerase chain reaction (PCR)–based detection systems for these organisms can detect bacterial DNA in a significant percentage of culturally sterile effusions.7,8 The significance of these findings was not clear, however, and it was suggested that such bacterial DNA was merely "fossilized remains" and did not represent a viable population.9 Subsequent work with chinchilla models showed, however, that DNA from viable, intact bacteria could be detected by the PCR-based system for up to 22 days after antimicrobial treatment in the absence of culturability. This finding was in contrast to an inability to detect DNA from heat-killed bacteria or raw DNA inoculated simultaneously with the viable organisms.10