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.
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.
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.
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.
D. Alhamad, None
S. Gupta, None
B. Asmar, None