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

Acute mastoiditis: 30 years review in a tertiary hospital

OBJECTIVE

Acute mastoiditis, the most common complication of acute otitis media, is approached in our study, focused on children from the Autonomous Community of Cantabria, Spain. The aim is to analyze its clinical-epidemiological characteristics and propose diagnostic and treatment recommendations.

STUDY DESIGN/SETTING

We conducted a 30-year retrospective study on patients under 18 years of age diagnosed with acute mastoiditis in Cantabria.

METHODS

We analysed epidemiological data, clinical presentation, causes, treatment, and follow-up.

RESULTS

We included 111 patients, 60.4 % of which were under 2 years old. The average incidence was 3.9/100,000 children per year. Streptococcus pneumoniae was the most common microorganism. Third-generation cephalosporins and amoxicillin-clavulanic acid were the most frequently used antibiotics. 19 % of patients underwent temporal bone CT scans. Twenty-nine children required surgical intervention, primarily myringotomy and mastoidectomy. Only 5.4 % developed retroauricular abscesses. During follow-up, 32 % experienced new acute otitis media cases.

CONCLUSIONS

The incidence of acute mastoiditis in Cantabria is similar to that of other developed countries. Imaging studies are reserved for cases with poor progression. Conservative management with antibiotics is suitable for many patients, with surgery reserved for poor responders. Complications are rare in our setting.

Epidemiology and variability in management of acute mastoiditis in children

BACKGROUND

To evaluate the epidemiology, management and outcome of acute mastoiditis (AM) in children and to improve strategies for antimicrobial stewardship.

METHODS

We conducted a retrospective observational study of children aged >6 months to ≤18 years of age admitted to a tertiary care hospital with AM over an 8-year period (2011-2019). Electronic medical records were reviewed to collect data.

RESULTS

A total of 129 patients met inclusion criteria for AM during this time period. Eighty-one (63 %) were males with 110 (81 %) White and 67 (52 %) non-Hispanic. The median age at presentation was 6.4 years (3-10.1 years). Ear protrusion was associated with reduced odds of having AM with intracranial extension (ICE) (OR 0.307, 95 % CI = 0.107-0.883) whereas presence of headaches and/or neck pain increased the odds of having AM with ICE (OR = 3.96, 95%CI 1.29-12.1). The most common etiologies were Streptococcus pyogenes (n = 23, 19.2 %), Pseudomonas aeruginosa (n = 20, 17 %), and Streptococcus pneumoniae (n = 15, 12.5 %). Empiric antibiotic selection and duration of therapy was highly variable. The most common empiric antibiotic used was intravenous vancomycin with a third generation cephalosporin (n = 45, 34.8 %). Majority completed course (n = 92; 73 %) with an oral antibiotic. Shorter (≤10 and ≤14 days) versus longer courses (>10 and >14 days) did not affect readmission rates for AM without ICE.

CONCLUSION

There is high variability of treatment of AM in children. Broad spectrum antibiotics, especially vancomycin were used most frequently despite low rates of Methicillin Resistant Staphylococcus aureus. The use of antibiotic stewardship is essential for judicious antibiotic use.

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

OBJECTIVES

To explore the impact of COVID-19 on the management and outcomes of acute paediatric mastoiditis across the UK.

DESIGN

National retrospective and prospective audit.

SETTING

48 UK secondary care ENT departments.

PARTICIPANTS

Consecutive children aged 18 years or under, referred to ENT with a clinical diagnosis of mastoiditis.

MAIN OUTCOME MEASURES

Cases were divided into Period 1 (01/11/19-15/03/20), before the UK population were instructed to reduce social contact, and Period 2 (16/03/20-30/04/21), following this. Periods 1 and 2 were compared for population variables, management and outcomes. Secondary analyses compared outcomes by primary treatment (medical/needle aspiration/surgical).

RESULTS

286 cases met criteria (median 4 per site, range 0-24). 9.4 cases were recorded per week in period 1 versus 2.0 in period 2, with no winter increase in cases in December 2020-Febraury 2021. Patient age differed between periods 1 and 2 (3.2 vs 4.7 years respectively, p < 0.001). 85% of children in period 2 were tested for COVID-19 with a single positive test. In period, 2 cases associated with P. aeruginosa significantly increased. 48.6% of children were scanned in period 1 vs 41.1% in period 2. Surgical management was used more frequently in period 1 (43.0% vs 24.3%, p = 0.001). Treatment success was high, with failure of initial management in 6.3%, and 30-day re-admission for recurrence in 2.1%. The adverse event rate (15.7% overall) did not vary by treatment modality or between periods 1& 2.

CONCLUSION

The COVID-19 pandemic led to a significant change in the presentation and case mix of acute paediatric mastoiditis in the UK.