Acute otitis media in infants less than three months of age: Clinical presentation, etiology and concomitant diseases Waheeb Sakran a,b, * , Hassan Makary a , Raul Colodner c , Dror Ashkenazi d , Yoseph Rakover d , Raphael Halevy a , Ariel Koren a,b a Pediatric Department ‘‘B’’, Ha’Emek Medical Center, Afula 18101, Israel b The Bruce Rappaport School of Medicine, Technion, Haifa, Israel c Microbiology Laboratory, Ha’Emek Medical Center, Afula, Israel d Department of Otolaryngology, Ha’Emek Medical Center, Afula, Israel Received 5 June 2005; accepted 4 August 2005 International Journal of Pediatric Otorhinolaryngology (2006) 70, 613—617 www.elsevier.com/locate/ijporl KEYWORDS Acute otitis media; Infants; Sepsis work-up; Tympanocentesis Summary Objective: Acute otitis media (AOM) in the neonatal period can be difficult to diagnose. This infection can be isolated and localized, or it may be associated with serious bacterial infections or other illnesses. The objectives of this study were to determine the clinical presentation, etiology, susceptibility pattern, and frequency of bacteremia, meningitis and other serious bacterial infections associated with the first episode of AOM in young infants. Methods: From July 2002 to August 2004, infants less than 12 weeks of age with confirmed AOM underwent tympanocentesis with culture of the middle ear fluid. Sepsis work-up was performed in all infants, and they were admitted to the pediatric department. Parenteral antibiotic therapy with a combination of ampicillin and gentamicin was initiated. Results: Sixty-eight infants were diagnosed with AOM. The median age was 43  17 days, 17 infants (25%) were less than 4 weeks of age. Fever was present in 45 (66%) of the patients. Meningitis or bacteremia was not diagnosed in any of the cases. Concomitant urinary tract infection was diagnosed in six (8.8%) cases and broncholitis in seven (10.4%). Forty-seven bacterial pathogens were isolated from the middle-ear fluid. Streptococcus pneumoniae was the leading pathogen with 18 isolates (38%), followed by non-typable Haemophilus influenzae with nine (19%). Fourteen of the S. pneumoniae (78%) isolates were susceptible to penicillin and the other four (22%) * Corresponding author. Tel.: +972 4 6495257; fax: +972 4 6495589. E-mail address: sakran_w@clalit.org.il (W. Sakran). 0165-5876/$ — see front matter # 2005 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijporl.2005.08.003