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Background  Otitis media is endemic in remote Indigenous communities of Australia’s Northern Territory.  Alloiococcus otitidis  is an outer ear commensal and putative middle ear pathogen that has not previously been described in acute otitis media (AOM) in this population. The aims of this study were to determine the presence, antibiotic susceptibility and bacterial load of  A. otitidis  in nasopharyngeal and ear discharge swabs collected from Indigenous Australian children with AOM with perforation.    Methods  Paired nasopharyngeal and ear discharge swabs from 27 children with AOM with perforation were tested by  A. otitidis  quantitative PCR (qPCR). Positive swabs were cultured for 21 days. Total and respiratory pathogen bacterial loads in  A. otitidis -positive swabs were determined by qPCR.    Results   A. otitidis  was detected by qPCR in 11 ear discharge swabs from 10 of 27 (37%) children, but was not detected in paired nasopharyngeal swabs.  A. otitidis  was cultured from 5 of 11 qPCR-positive swabs from four children. All  A. otitidis  isolates had minimum inhibitory concentrations consistent with macrolide resistance. All  A. otitidis  qPCR-positive swabs were culture-positive for other bacteria.  A. otitidis  bacterial load ranged from 2.2 × 10 4 -1.1 × 10 8  cells/swab (median 1.8 × 10 5  cells/swab). The relative abundance of  A. otitidis  ranged from 0.01% to 34% of the total bacterial load (median 0.7%). In 6 of 11 qPCR-positive swabs the  A. otitidis  relative abundance was <1% and in 5 of 11 it was between 2% and 34%. The  A. otitidis  bacterial load and relative abundance measures were comparable to that of  Haemophilus influenzae .    Conclusions   A. otitidis  can be a dominant species in the bacterial communities present in the ear discharge of Indigenous children with AOM with perforation. The absence of  A. otitidis  in nasopharyngeal swabs suggests the ear canal as the likely primary reservoir. The significance of  A. otitidis  at low relative abundance is unclear; however, at higher relative abundance it may be contributing to the associated inflammation. Further studies to better understand  A. otitidis  as a secondary otopathogen are warranted, particularly in populations at high-risk of progression to chronic suppurative otitis media and where macrolide therapies are being used.

bmc ear, nose and throat disorders

Quantitative PCR of ear discharge from Indigenous Australian children with acute otitis media with perforation supports a role for Alloiococcus otitidis as a secondary pathogen