Mastoiditis: Culture Early in the Era of Antibiotic Resistance

Abstract

Otolaryngology| September 01 2002 Mastoiditis: Culture Early in the Era of Antibiotic Resistance AAP Grand Rounds (2002) 8 (3): 32–33. https://doi.org/10.1542/gr.8-3-32 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Mastoiditis: Culture Early in the Era of Antibiotic Resistance. AAP Grand Rounds September 2002; 8 (3): 32–33. https://doi.org/10.1542/gr.8-3-32 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: antibiotic resistance, bacterial, mastoiditis Source: Zapalac JS, Billings KR, Schwade ND, et al. Suppurative complications of acute otitis media in the era of antibiotic resistance. Arch Otolaryngol. 2002;128:660–663. Some reports have noted an increase in suppurative complications of acute otitis media (AOM) and have suggested a possible association with increasing prevalence of antibiotic-resistant pneumococci.1–,3 These authors from Dallas Southwestern Medical Center, Dallas, TX, performed a retrospective chart review of all children with suppurative complications of AOM admitted to a pediatric tertiary care center from January 1993 through June 2000. They searched “databases” for the inpatient diagnostic codes for acute mastoiditis, subperiosteal abscess, facial nerve paralysis, labyrinthitis, petrositis, otitic hydrocephalus, sigmoid sinus thrombosis, or intracranial abscess, and confirmed complications of AOM by chart review. Patients with chronic suppurative otitis or known cholesteatoma were excluded. During the 7½-year study period, 90 patients aged 3 months to 16 years (mean 45 months) were treated for 104 suppurative complications of AOM. Mastoiditis was classified as non-coalescent or coalescent, representing a continuum of the disease process. Coalescent mastoiditis typically portends a worse prognosis and requires surgery.4 The complications observed were non-coalescent mastoiditis (51), coalescent mastoiditis with extension of disease externally forming a subperiosteal abscess over the mastoid bone (20), coalescent mastoiditis without extension (4), facial nerve paralysis (14), epidural abscess (7), sigmoid sinus thromboses (5), apical petrositis (2), and suppurative labyrinthitis (1). Of the 40 cases of non-coalescent mastoiditis where a culture of the middle ear or mastoid was obtained, bacteria were isolated in 77%: coagulase (-) staphylococcus (n=10), Group A streptococcus (n=6), Streptococcus pneumoniae (n=5), Staphylococcus aureus (n=3), and other (n=7). Of the 24 cases of coalescent mastoiditis, bacteria were isolated in 83%: S pneumoniae (n=10), Group A streptococcus (n=4), coagulase (-) staphylococcus (n=2), Haemophilus influenzae (n=1), and other (n=3). In the non-coalescent group, 3 of 5 isolates of S pneumoniae were reported as resistant, as were 6 of 10 isolates in the coalescent group. The authors do not specify whether these were multi-drug resistant organisms. Resistant S pneumoniae were collected primarily from children aged 4–24 months (mean 11.9). Forty-six (90%) of non-coalescent cases were treated with intravenous antibiotics alone or in combination with myringotomy and tubes (5 patients). The remaining 5 patients required surgery because of disease progression. All patients who exhibited radiographic features of coalescence underwent mastoidectomy. A linear trend approaching statistical significance was observed for increases in the rate of suppurative complications during the study period (P=.11), surgical intervention (P=.17), and S pneumoniae resistance (P=.15). The authors recommend early acquisition of middle ear cultures in patients with suppurative complications of AOM. This report augments the evidence that acute mastoiditis in children may be increasing nationally due, in part, to increasing antibiotic resistance and virulence of organisms. Acute mastoiditis due to resistant S pneumoniae may be in- creasing in children under age 2 years due to acquisition of virulent resistant organisms in daycare and preschool.5 Limitations of this study include... You do not currently have access to this content.