1757. Acute Mastoiditis in Children during the 7-Valent Pneumococcal Conjugate Vaccine (PCV-7) Era
Session: Poster Abstract Session: Pediatric Bacterial Infections
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • Mastoiditis Poster Final.gif (202.1 kB)
  • Background:

    Acute mastoiditis (AM) is a complication of otitis media.  The most common cause is Streptococcus pneumoniae. The incidence of invasive pneumococcal infections has decreased following introduction of PCV-7 (2000) and 13-valent vaccine (2010). The purpose of this study is to examine the changes in the incidence, bacteriology and complications of mastoiditis following introduction of PCV-7. 

    Methods:

    A retrospective review of medical records during 10-year period (2000-2010).  AM was defined as suppurative infection of the mastoid air cells with symptoms of less than 3 weeks.  

    Results:

    A total of 165 children with AM were identified.  During the last 6 years there were 128 patients representing an annual incidence of 16.4 cases/10,000 admissions compared to 5.9 cases/10,000 admissions in the first 5 years of the study (2.8 fold increase).  The age range was 3 mo to 17 yrs (mean 6.47yrs).  Clinical findings included ear pain (72%), fever (61%), abnormal tympanic membrane (69%) and mastoid swelling/tenderness (64%).  Antibiotics were prescribed to 98/165 (59%) of patients prior to hospitalization.  Surgery was performed on 94/165 ((57%) patients. Cultures were obtained from ear drainage or abscesses in 84 patients. S. pneumoniae was recovered from 23/84 (27%) patients, Streptococcus pyogenes (19%), Staphylococcus aureus (12%), Pseudomonas aeruginosa (12%). One child had mastoiditis/abscess and sepsis due to Fusobacterium necrophorum.  During the last 6 years of the study S. pneumoniae was isolated from 33% of patients compared to 10% in the first 5 years.

    The most common antibiotics used to treat hospitalized patients were IV ceftriaxone (56%), IV clindamycin (38%) and IV ampicillin/sulbactam (25%).  The most common oral antibiotics were amoxicillin clavulanate (54%), clindamycin ((13%) and amoxicillin (12%). 

    Complications included bony destruction (calvarial or temporal bone) in 50 patients, soft tissue abscesses in 15, venous sinus thrombosis in 4, facial nerve palsy in 3 and intracranial extension in 1 patient.

    Conclusion:

    Despite the reported decrease of invasive pneumococcal infection after introduction of PCV-7, there was a steady increase in the number of AM cases in our pediatric population with increased recovery of S. pneumoniae and high number of complications. The role of the PCV-13 on the incidence of AM remains to be determined.

    Nahed Abdel-Haq, MD, FIDSA1, Marianela Quizada, MD2, Dania Alhamad, MD2, Shipra Gupta, MD FAAP1 and Basim Asmar, MD, FIDSA1, (1)Children's Hospital of Michigan, Wayne State University, Detroit, MI, (2)Children's Hospital of Michigan, Detroit, MI

    Disclosures:

    N. Abdel-Haq, None

    M. Quizada, None

    D. Alhamad, None

    S. Gupta, None

    B. Asmar, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.