Acute Mastoiditis Associated with Pseudomonas Aeruginosa in the Pediatric Population of the Umbria Region, Italy

Abstract

Acute mastoiditis (AM) is the most common complication of acute otitis media (AOM) and is one of the most severe acute bacterial diseases in infants and children. In some geographic areas, the incidence of AM is increasing, and the causative role of some bacterial pathogens could be greater than previously thought. In this paper, the results of a study that evaluated the epidemiology and microbial etiology of paediatric AM in Umbria, which is a region of central Italy, are reported. This is a retrospective study of patients aged 0–14 years with AM admitted to the pediatric wards of the hospitals of Umbria, Italy, between June 1 and September 30 in four consecutive years (2015–2018). A total of 108 children were enrolled. The prevalence of AM in males during the four years of analysis was significantly higher than that in females at 63% (95% confidence intervals [CI]: 0.54–0.72). The most frequently affected age groups were 5–9 years (45.4%) and 10–14 years (31.5%), with statistically significant differences in comparison with children aged <1 year (5.6%, 95% CI: 0.01–0.10) and 1–4 years (17.6%, 95% CI: 0.10–0.25). In most cases (64, 59.3%), AM was associated with spontaneous tympanic membrane perforation (STP). The culture of the middle ear fluid revealed the presence of Pseudomonas aeruginosa in 56 cases (51.6%). The mean incidence rates of pediatric AM in Umbria during the study increased significantly with time, as it was 18.18/100,000 children/year in 2015–2016 and 29.24/100,000 children/year in 2017–2018 (CI difference: +2.5 – +19.9, p < 0.05). The incidence rates of Pseudomonas aeruginosa detection in pediatric AM associated with STP significantly increased with time. The incidence was 6.06/100,000 children/year in 2015–2016 and 18.61/100,000 children/year in 2017–2018 (CI difference: +6.1 – +19.0, p < 0.001). This study demonstrated the high and increasing incidence of AM in the Umbria region during the summer months and the frequent detection of P. aeruginosa as an etiologic agent of the disease in the presence of STP. Confirmation of these results with a larger study population, in different settings, and throughout the whole year is needed to define the first-line approach of AM with STP in pediatrics.

Acute paediatric mastoiditis in the UK before and during the COVID‐19 pandemic: A national observational study

“…The pre‐COVID‐19 figure is comparable to a recent UK series, 17 though older than most large International cohorts (1.3–2.1 years) 11,12,19 . In line with our hypothesis, Camanni et al found children aged 5–9 years were most commonly affected by mastoiditis in the summer, and an association between older age and P. aeruginosa as a causative organism for mastoiditis is described 16,18 …”

“…Both blood inflammatory marker levels (white cell counts and CRP) and the rate of intracranial complications and adverse events were lower in period 2. This difference is likely due to the lack of a winter effect during the pandemic: P. aeruginosa has previously been found to be associated with lower inflammatory markers, 16,18 and in our series was not associated with any intracranial complications. There is also evidence for lower inflammatory markers 15 and fewer complications in comparative older age groups 13,18,23 …”

“…Camanni et al reported cases of paediatric mastoiditis limited to summer months (June‐September), finding P. aeruginosa to be the most commonly isolated organism, accounting for 51.6% of positive samples. 16 Our study did not collect data from the preceding summer to compare with period 2 unfortunately, and it is noted that P. aeruginosa can be prominent in some multi‐year series. 17 , 18 …”

“…16 Our study did not collect data from the preceding summer to compare with period 2 unfortunately, and it is noted that P. aeruginosa can be prominent in some multi-year series. 17 hypothesis, Camanni et al found children aged 5-9 years were most commonly affected by mastoiditis in the summer, and an association between older age and P. aeruginosa as a causative organism for mastoiditis is described 16,18 The weekly rate of cases associated with P. aeruginosa significantly increased in period 2, which may not be expected from simply suppressing URTI-related infection. Children with Pseudomonasassociated mastoiditis are more likely to have had previous otologic problems, 18 but there was no significant change in the presentation rate of cholesteatoma-associated mastoiditis (unchanged at 0.21 cases per week before COVID-19 measures and 0.22 after) or in the rate of preceding primary care management.…”

“…reported cases of paediatric mastoiditis limited to summer months (June-September), finding P. aeruginosa to be the most commonly isolated organism, accounting for 51.6% of positive samples. 16 Our study did not collect data from the preceding summer to compare with period 2 unfortunately, and it is noted that P. aeruginosa can be prominent in some multi-year series. 17 hypothesis, Camanni et al found children aged 5-9 years were most commonly affected by mastoiditis in the summer, and an association between older age and P. aeruginosa as a causative organism for mastoiditis is described 16,18 The weekly rate of cases associated with P. aeruginosa significantly increased in period 2, which may not be expected from simply suppressing URTI-related infection.…”