Work

Global and temporal shifts in the cultured-based bacteriology of otitis media with effusion: a systematic review and meta-analysis

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Objective This study systematically synthesized geographic variation and calendar-period differences in culture-based bacteriology of OME to examine their implications for child hearing health, pathogen surveillance, and antimicrobial stewardship. Methods PubMed, Embase, and Cochrane Library were searched for studies published from Jan 1980 to Dec 2025 that reported the results of bacterial culture from patients with OME. Studies were eligible if they included human subjects with otitis media with effusion (OME) and reported the prevalence of bacteria. Studies were excluded if they were unrelated to the review objective or eligibility criteria, duplicate records, non-original reports, non-human studies, studies lacking basic demographic information, studies with insufficient data, or studies not eligible for quantitative synthesis. Three reviewers screened the articles and extracted data. Finally, 22 studies were included (North America: n = 4, Europe: n = 9, Asia: n = 7, Oceania: n = 1, Middle East: n = 1). Culture positivity was meta-analyzed using culture-positive specimens as the numerator and all cultured specimens as the denominator. Organism-specific proportions were meta-analyzed using culture-positive specimens as the denominator. Raw bacterial isolate counts were summarized separately and were not used as denominators for the meta-analysis. Results The random-effects pooled culture-positivity proportion was 43.4% (95% CI, 35.4–51.8%). Among culture-positive specimens, the pooled organism-specific proportions were 26.4% for H. influenzae , 26.1% for CoNS, 16.0% for MSSA, 14.2% for S. pneumoniae , and 13.1% for MRSA. In North American studies, CoNS and H. influenzae showed comparable pooled proportions, whereas H. influenzae predominated in European studies and CoNS predominated in Asian studies. Studies conducted from 2000 onward showed higher pooled proportions of CoNS and MSSA and lower pooled proportions of H. influenzae and S. pneumoniae than earlier studies. Conclusion The bacteriological profile of OME varied meaningfully by region and period. These findings support strengthened pathogen surveillance and antimicrobial stewardship in the context of childhood hearing health, rather than a single universal empirical management approach. Systematic review registration The protocol was registered in the International Prospective Register of Systematic Reviews, https://www.crd.york.ac.uk/PROSPERO/home , PROSPERO, CRD420261291723.

Source: Frontiers in Public Health

DOI: 10.3389/fpubh.2026.1909909