{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T12:29:34Z","timestamp":1777897774242,"version":"3.51.4"},"reference-count":44,"publisher":"American Society for Microbiology","issue":"3","license":[{"start":{"date-parts":[[1998,3,1]],"date-time":"1998-03-01T00:00:00Z","timestamp":888710400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[1998,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            The management of acute otitis media is complicated by the emergence of resistance to \u03b2-lactam and other antibiotics among common pathogens. We conducted a large, international study of infants and children with acute otitis media to identify pathogens and susceptibility patterns. During the winter of 1994 to 1995, middle ear fluid samples were collected from 917 patients with acute otitis media in Bulgaria, the Czech Republic, Hungary, Romania, Slovakia, Israel, and the United States. A single reference laboratory performed in vitro susceptibility testing. Pathogens were isolated from 62% of the patients. For\n            <jats:italic>Streptococcus pneumoniae<\/jats:italic>\n            (30% of the patients), untypeable\n            <jats:italic>Haemophilus influenzae<\/jats:italic>\n            (17%), and\n            <jats:italic>Moraxella catarrhalis<\/jats:italic>\n            (4%), there was significant variation among geographic regions (\n            <jats:italic>P<\/jats:italic>\n            &lt; 0.001). The composite susceptibilities of these three organisms to amoxicillin ranged from 62% in the United States to 89% in Eastern and Central Europe; the corresponding susceptibilities to amoxicillin-clavulanate ranged from 90% in Israel to 95% in Eastern and Central Europe. \u03b2-Lactamase was produced by 31 and 100% of the isolates of\n            <jats:italic>H. influenzae<\/jats:italic>\n            and\n            <jats:italic>M. catarrhalis<\/jats:italic>\n            , respectively. More isolates of\n            <jats:italic>S. pneumoniae<\/jats:italic>\n            were susceptible to amoxicillin (90%) or amoxicillin-clavulanate (90%) than to penicillin (70%;\n            <jats:italic>P<\/jats:italic>\n            = 0.002). The prevalence of resistant\n            <jats:italic>S. pneumoniae<\/jats:italic>\n            was highest in patients less than 12 months of age.\n            <jats:italic>S. pneumoniae<\/jats:italic>\n            ,\n            <jats:italic>H. influenzae<\/jats:italic>\n            , and\n            <jats:italic>M. catarrhalis<\/jats:italic>\n            remain the most important bacterial pathogens in patients with acute otitis media; however, their prevalence is variable and resistance patterns are changing.\n          <\/jats:p>","DOI":"10.1128\/aac.42.3.589","type":"journal-article","created":{"date-parts":[[2018,10,9]],"date-time":"2018-10-09T00:30:35Z","timestamp":1539045035000},"page":"589-595","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":155,"title":["Prevalence of Antimicrobial-Resistant Pathogens in Middle Ear Fluid: Multinational Study of 917 Children with Acute Otitis Media"],"prefix":"10.1128","volume":"42","author":[{"given":"Michael R.","family":"Jacobs","sequence":"first","affiliation":[{"name":"<!--label omitted: 1-->Department of Pathology (Clinical Microbiology), Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Cleveland, Ohio1;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ron","family":"Dagan","sequence":"additional","affiliation":[{"name":"<!--label omitted: 2-->Department of Pediatrics (Pediatric Infectious Disease Unit), Ben-Gurion University of the Negev and Soroka Medical Center, Beer-Sheva, Israel2; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter C.","family":"Appelbaum","sequence":"additional","affiliation":[{"name":"<!--label omitted: 3-->Department of Pathology (Clinical Microbiology), Milton S. Hershey Medical Center, Hershey,3 and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel J.","family":"Burch","sequence":"additional","affiliation":[{"name":"<!--label omitted: 4-->Department of Anti-Infectives, SmithKline Beecham Pharmaceuticals, Collegeville,4 Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","unstructured":"Appelbaum P. C. 1994. Antibiotic-resistant pneumococci\u2014facts and fiction. J. Chemother. 6 (Suppl. 4) : 7\u201315."},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/15.1.77"},{"key":"e_1_3_2_4_2","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1016\/S0140-6736(77)92892-6","article-title":"Streptococcus pneumoniae resistant to penicillin and chloramphenicol.","author":"Appelbaum P. C.","year":"1977","unstructured":"Appelbaum P. C. Bhamjee A. Scragg J. N. Hallett A. F. Bowen A. J. Cooper R. C. 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Infect. Dis. J."},{"key":"e_1_3_2_17_2","unstructured":"Debanne\n              S. M.\n              Rowland\n              D. Y.\n          The conservative chi-square test for sparse data\n          Proceedings of the Business and Economics Section.\n          1983\n          705\n          708\n          American Statistical Association\n          Washington D.C"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.40.5.1208"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199408113310607"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.39.1.271"},{"key":"e_1_3_2_21_2","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1177\/00034894921010S105","article-title":"Otitis media update: pathogenesis and treatment.","volume":"101","author":"Giebink G. S.","year":"1992","unstructured":"Giebink G. S. Otitis media update: pathogenesis and treatment. Ann. Otol. Rhinol. Laryngol. 101 1992 21 23","journal-title":"Ann. 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J.\n              Poupard\n              J.\n              Appelbaum\n              P. C.\n          Antimicrobial susceptibility of Streptococcus pneumoniae isolated from patients with acute otitis media in Eastern Europe Israel and U.S. poster E29.\n          Abstracts of the 35th Interscience Conference on Antimicrobial Agents and Chemotherapy.\n          1995\n          American Society for Microbiology\n          Washington D.C"},{"key":"e_1_3_2_28_2","unstructured":"Jacobs\n              M. R.\n              Burch\n              D.\n              Poupard\n              J.\n              Moonsammy\n              G.\n              Debanne\n              S.\n              Appelbaum\n              P.\n            The International Otitis Media Study Group\n          Microbiology of acute otitis media\u2014results of an international study of 917 patients abstr. 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