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  1. M. G. Roddy,
  2. S. Glazier,
  3. D. Agrawal
  1. Children's National Medical Center, Washington, DC


Background Studies have shown that the epidemiology, clinical course, and bacterial pathogens for acute otitis media (AOM) have changed in the seven-valent conjugate pneumococcal vaccine (CPV) era. We hypothesize similar changes with mastoiditis, which may require an adjustment of empiric antibiotic therapy.

Objectives To describe the epidemiology, etiology, and clinical course of mastoiditis in the pre-CPV (1/95-12/00) and post-CPV (1/01-4/05) eras.

Methods We performed a retrospective chart review of patients admitted to a tertiary care pediatric hospital with a discharge diagnosis of mastoiditis from 1/95-4/05. Etiological agents were determined by culture results from mastoid fluid, middle ear fluid, and/or blood.

Results 139 charts were reviewed, with 78 pre-CPV and 61 post-CPV. Patient age ranged from 30 days to 18.2 years (median 4.4 years). Myringotomy tubes were placed in 60 (43%), and mastoidectomy was performed in 59 (42%). Etiological agents were determined in 68 (49%). The most common bacterial isolates from the 34 pre-CPV cases were S. pneumoniae (15), P. aeruginosa (10), S. aureus (6), and S. pyogenes (1) and from the 34 post-CPV cases were S. pneumoniae (12), S. pyogenes (8), P. aeruginosa (5), and S. aureus (5). S. pneumoniae was implicated in 15/34 (44%) of pre-CPV cases versus 12/34 (35%) of post-CPV cases (p = .46). Acute mastoiditis was diagnosed in 106/139 (76%), and chronic mastoidits (defined as $ 3 weeks of symptoms) was diagnosed in 33/139 (24%). S. pneumoniae was more likely to be implicated in acute vs chronic mastoiditis (30% vs 7%, p = .06), and P. aeruginosa was more likely to be implicated in chronic vs acute mastoiditis (40% vs 10%, p = .003). Sixty-seven percent of pre-CPV S. pneumoniae isolates were pan-sensitive compared to 33% in the post-CPV era (p = .09). Seven percent of pre-CPV S. pneumoniae isolates were resistant to ceftriaxone compared to 25% in the post-CPV era (p = .18). In the post-CPV era vs pre-CPV era, treating clinicians were more likely to choose empiric parenteral combination therapy with ceftriaxone (38% vs 6%, p < .0001). Conclusion: In this post-CPV era and in chronic mastoiditis, clinicians must consider choosing broader-spectrum initial antibiotic coverage than ceftriaxone alone.

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