Acute mastoiditis in children: A retrospective study of 188 patients

Quesnel, S.; Nguyen, M.H.; Pierrot, S.; Contencin, P; Manac'h, Y; Couloigner, V.

doi:10.1016/j.ijporl.2010.09.013

Cited by 77 publications

(45 citation statements)

References 36 publications

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“…Of the total, 42% children were under 24 months and this group had significantly more complications that older children (p ¼ 0.006), similar to what's described by other data [1,5,12,17,18]. This reflects the anatomic and immunologic particular features of this age group which predisposes them not only to the disease but also to its complications [4,6].…”

Section: Discussionsupporting

confidence: 79%

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Acute mastoiditis in children: Middle ear cultures may help in reducing use of broad spectrum antibiotics

Garcia

Salgueiro

Luís

et al. 2017

International Journal of Pediatric Otorhinolaryngology

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a b s t r a c tBackground: Acute mastoiditis (AM) is a suppurative infection of the mastoid air cells, representing the most frequent complication of acute otitis media. AM remains an important entity in children due to its potential complications and sequelae. We aim to describe the cases of AM admitted at our department, identify risk factors potentially associated with complications and analyse the changes in clinical approach of AM over time. Methods: Case review of clinical files of children admitted with acute mastoiditis from June 1996 to May 2013 at a Lisbon metropolitan area hospital. Data was divided into two groups (prior and after May 2005) in order to evaluate changes in AM approach over the years. Results: 135 AM episodes were included. The median age was 3.8 years and 42% children were less than 24 months of age. Symptoms at presentation included fever (69%), ear pain (56%) and otorrhea (40%). Complications occurred in 22% patients and were more common in children under 24 months (33% vs 15%, p 0.01). Leukocyte count was significantly higher in children with complications (16.7 vs 14.5 Â 10 9 /mL, p 0.05) as was C-Reactive Protein value (13 vs 6.3 mg/dL, p 0.001). There was a significant association between the development of complications and C-Reactive Protein value at admission (OR 1.892; IC95%: 1.018 e2.493, p 0.01). The optimal cut-off value was 7.21 mg/dL. Over time there was a significant increase in middle ear cultures obtained by tympanocentesis during surgery (2% vs 16%, p 0,01) and also a decrease in the use of broad spectrum antibiotherapy as initial treatment (52% vs 25%,p 0,001). Conclusions: Children under 24 months, with high leukocyte count or with high C-Reactive Protein value should be monitored closely since complications tend to be more frequent. A CRP value of 7.21 mg/dL at admission seems to be a good cut-off to monitor children for potential complications. Throughout the period analysed more cultures were performed allowing identification of the pathogens and implementation of appropriate antibiotic therapy.

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Section: Discussionsupporting

confidence: 79%

“…Ear exudate cultures were performed in only 33% of cases, a very modest number when compared to other reports [13,18,19]. Although 33 children underwent surgery, only 39% middle-ear cultures were obtained.…”

Section: Discussionmentioning

confidence: 71%

Acute mastoiditis in children: Middle ear cultures may help in reducing use of broad spectrum antibiotics

Garcia

Salgueiro

Luís

et al. 2017

International Journal of Pediatric Otorhinolaryngology

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“…While some studies reported decreased AM rates after the introduction of PCV7 (7,10), others found no change or even an increase (11). This study's main strengths are in the reporting of MEF cultures, not relying on nasopharyngeal cultures, and knowledge of the exact PCV status for each child at his or her AM presentation.…”

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confidence: 97%

Acute Mastoiditis in the Pneumococcal Conjugate Vaccine Era

Tamir

Roth

Dalal

et al. 2014

Clin. Vaccine Immunol.

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bFollowing the introduction of the 7-and 13-valent pneumococcal conjugate vaccines, we observed an inverse relationship between the increasing rate of immunized children and the proportion of middle ear fluid cultures collected during acute mastoiditis episodes that tested positive for Streptococcus pneumoniae among a subset of children 0 to 6 years old who had initially presented with severe acute otitis media and had bacterial cultures collected during tympanocentesis or from spontaneous otorrhea.A cute mastoiditis (AM) is a suppurative complication of acute otitis media (AOM), which often requires hospitalization and intravenous antibiotics and sometimes requires surgery. The most common otopathogen in AM is Streptococcus pneumoniae (1). In an attempt to control the impact of pneumococcal diseases, pneumococcal conjugate vaccines (PCVs) were gradually implemented in many countries during the past decade. In Israel, PCV7 was formally introduced into the national immunization program in July 2009 and was replaced by PCV13 in November 2010 (2). Both vaccines were or are, respectively, given at 2, 4, and 12 months of age. This change in the vaccination regimen allowed us to study the dynamics of AM incidence and bacteriology in a subset of children with AOM throughout a short time frame, from the pre-PCV7 era to the post-PCV13 era.This study was approved by the Edith Wolfson Medical Center's ethics review board. We retrospectively identified children 0 to 6 years of age who presented to the pediatric emergency room from 1 January 2008 through 31 December 2013 with severe AOM, defined as an AOM episode which either required tympanocentesis, due to a lack of clinical improvement after Ն48 h of antibiotic therapy, or presented with spontaneous otorrhea. In these children, we identified AM episodes (International Classification of Diseases code 383.0X). The AM diagnosis was based on clinical findings (postauricular tenderness, erythema or swelling, protruding auricle, palpable/fluctuating mass) and systemic signs (fever, lethargy, irritability, poor feeding, diarrhea). Children with previous ear surgery, immune deficiencies, and congenital malformations of the ear, nasopharynx, or palate were excluded from the study. In all eligible children, middle ear fluid (MEF) cultures were collected either during tympanocentesis with the use of a sterile flocked swab or from spontaneous otorrhea, from which pus was collected by swabbing the external ear meatus. Samples were processed for conventional cultures at the Edith Wolfson Medical Center's microbiology laboratory. MEF cultures that tested positive for external ear canal saprophytes were excluded.The PCV status for each AM episode was obtained from records at the Mother and Child Health Clinics, where all childhood vaccines are given in Israel. Each child was categorized according to his or her vaccination status at his or her AM presentation as either "unimmunized" if no dose of PCV immunization had been given or "any PCV7/PCV13 immunized" if Ն1 dose of PCV7/ PCV13 had b...

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“…This variability depends largely on the pathogen, with the two streptococcus-species often resulting in severe disease and sometimes in complications [4,5], whereas the gram-negative pathogens result in milder infections and rarely cause complications. The main reason for treating AOM with antibiotics is to prevent complications.…”

Section: Antibiotics or Watchful Waiting?mentioning

confidence: 99%

Acute Otitis Media in Children—Current Treatment and Prevention

Gisselsson-Solén

2015

Curr Infect Dis Rep

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Acute otitis media (AOM) is the most common bacterial infection in children, and has a very varied clinical spectrum, ranging from spontaneous resolutions to serious complications. The effect of antibiotics in AOM depends on the chosen outcome, but has been shown to reduce pain somewhat, and have a greater beneficial effect in severe cases of AOM. Today, not all episodes of AOM are treated with antibiotics, but most countries have issued guidelines that include an option of watchful waiting in many cases. Prevention of AOM reaches from modification of environmental risk factors to vaccinations and surgery. Conjugate pneumococcal vaccines and influenza vaccines have been shown to somewhat reduce the number of AOM episodes in different groups of children. Grommets, with or without adenoidectomy, are effective at least during the first 6 months after surgery.

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Acute mastoiditis in children: A retrospective study of 188 patients

Cited by 77 publications

References 36 publications

Acute mastoiditis in children: Middle ear cultures may help in reducing use of broad spectrum antibiotics

Acute mastoiditis in children: Middle ear cultures may help in reducing use of broad spectrum antibiotics

Acute Mastoiditis in the Pneumococcal Conjugate Vaccine Era

Acute Otitis Media in Children—Current Treatment and Prevention

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