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Published on: February 23, 2014

Pediatric mastoiditis in the pneumococcal conjugate vaccine era: symptom duration guides empiric antimicrobial

Mark G Roddy1, Scott S Glazier, Dewesh Agrawal

  • 1Division of Emergency Medicine, Children's National Medical Center, Washington, DC 20010, USA.

Pediatric Emergency Care
|November 17, 2007
PubMed

Insights

The heptavalent pneumococcal conjugate vaccine (PCV) did not change the rate of Streptococcus pneumoniae causing pediatric mastoiditis. Empiric ceftriaxone therapy is insufficient post-PCV due to increased resistance.

Area of Science:

  • Pediatric infectious diseases
  • Microbiology
  • Vaccinology

Background:

  • The microbiology of acute otitis media has shifted during the heptavalent pneumococcal conjugate vaccine (PCV) era.
  • This study hypothesizes that pediatric mastoiditis may exhibit similar etiological changes.

Purpose of the Study:

  • To compare the etiology of pediatric mastoiditis before and after the introduction of the PCV.
  • To guide empiric antimicrobial therapy in pediatric emergency departments.

Main Methods:

  • A retrospective chart review was conducted for patients diagnosed with mastoiditis between January 1995 and April 2005.
  • Etiological agents were identified through culture results.

Main Results:

  • Streptococcus pneumoniae remained a common cause of mastoiditis, with no significant change in its proportion post-PCV.
  • A notable increase in ceftriaxone non-susceptibility was observed in post-PCV Streptococcus pneumoniae isolates (30% vs. 7%).
  • Pseudomonas aeruginosa was significantly more prevalent in chronic mastoiditis compared to acute mastoiditis.

Conclusions:

  • The introduction of PCV has not altered the incidence of Streptococcus pneumoniae-related pediatric mastoiditis.
  • Current empiric antimicrobial therapy, relying solely on ceftriaxone, is inadequate for treating mastoiditis in the post-PCV era due to emerging resistance patterns.
Abstract

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