Two decades of otitis media in northern Israel: Changing trends in the offending bacteria and antibiotic susceptibility

Miki Paker, Elena Pichkhadze, Dan Miron, Lev Shlizerman, Salim Mazzawi, Avi Shupak

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: Bacteriology and antibiotic resistance trends changed considerably following introduction of the pneumococcal conjugate vaccines (PCV) 7 and 13, with differences between geographic regions. The objective of this study was to evaluate changes in acute otitis media (AOM) bacteriology and antibiotic susceptibility from the pre-vaccination period (2002-2008) to after the introduction of PCV13 (2010-2019) in northern Israel.

METHODS: Data were collected from 3277 middle ear fluid (MEF) cultures and 4822 common AOM-generating pathogens of children aged <5 years with otitis media, taken during 2002-2019. Age of the child, bacteriology, and antibiotic resistance were compared between 2002 and 2008, the pre-vaccination period when no vaccination was available and 2010-2019 when PCV13 was introduced.

RESULTS: The mean age of the children in the pre-vaccination and the vaccination periods was 18.7 ± 13.7 and 15.7 ± 12.5 months, respectively (p < 0.001); the mean age of those with group A streptococcus (GAS) positive cultures was older, p < 0.001.The prevalence of Streptococcus pneumoniae (S. pneumoniae) decreased between those periods, from 47% to 25.8%, p < 0.001, Haemophilus influenzae (H. influenza) increased from 38.4% to 47.1%, p < 0.001, GAS increased from 12.9% to 23.8%, p < 0.001, and Moraxella catarrhalis (M. cat) increased but not statistically significant from 1.7% to 3.1%. The yearly number of positive MEF cultures decreased from 395.1 to 205.6, p < 0.001. The antibiotic sensitivity rate of almost all antibiotics increased between the two study periods.

CONCLUSION: The most common MEF bacteria in northern Israel today is H. influenzae. Comparing the pre-vaccination to the vaccination period, the incidence of S. pneumonia-positive cultures decreased while GAS and H. influenza cultures increased. The age of children with positive cultures increased, and the antibiotic sensitivity rate increased. Key This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Original languageEnglish
Article number110940
JournalInternational Journal of Pediatric Otorhinolaryngology
StatePublished - Jan 2022

Bibliographical note

Publisher Copyright:
© 2021 Elsevier B.V.


  • Acute Disease
  • Anti-Bacterial Agents/therapeutic use
  • Haemophilus influenzae
  • Humans
  • Infant
  • Israel/epidemiology
  • Otitis Media/drug therapy
  • Pneumococcal Infections/drug therapy
  • Pneumococcal Vaccines
  • Streptococcus pyogenes


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