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The Role of Bacteriologic Studies in Predicting Recurrent Mastoiditis in 456 Patients
Haim Gavriel1, Rani Abu Eta, Ephraim Eviatar
1Department of Otolaryngology Head and Neck Surgery, Assaf Harofeh Medical Center, Zerifin, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
Objectives:
To evaluate the effect of microbiologic growth on the recurrence rate of mastoiditis.
Materials And Methods:
A historical prospective study on all cases of children with acute mastoiditis (AM) admitted between 2000 and 2015, was performed. The following data were collected in the recurrent AM (rAM) group: age, sex, and medical history, antibiotic therapy before hospitalization, clinical presentation at admission including symptoms and signs, blood test results, computed tomography (CT) imaging, microbiological findings, treatment, complications, outcome, and follow-up duration.
Results:
Four hundred fifty six consecutive hospitalizations because of mastoiditis were identified; 22 patients were found to have rAM. The median age at first episode in the rAM group was 1 year (range, 1-11 years), and the median period from one episode to the next was 2 months. There were 15 men and 7 women. The right ear was involved in 11 cases in the first and in the second episode. The rate of Pseudomonas aeruginosa growth in the rAM group was significantly higher compared with the AM group (40.9 and 8.9%, respectively) (p = 0.001) as was found in anerobic growth (15 vs. no growth) (p < 0.001) and in polymicrobial growth (59% vs. 3.6%) (p < 0.001).
Conclusion:
Patients with P. aeruginosa growth, anaerobic bacteria, and polymicrobia infection cultured in an AM infection, are prone to have rAM, and therefore antibiotic adjustments according to their bacteriologic studies should be considered even if clinical improvement is encountered, or surgical intervention during the first AM episode, and closer follow up with proper antibiotic treatment when signs of recurrent ear infection are encountered.
Insights
Microbial growth, particularly Pseudomonas aeruginosa, anaerobic bacteria, and polymicrobial infections, significantly increases the risk of recurrent acute mastoiditis (rAM) in children. Prompt antibiotic adjustments and potential surgical intervention are crucial for managing rAM.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Microbiology
Background:
- Acute mastoiditis (AM) is a serious bacterial infection of the mastoid bone.
- Recurrence of AM (rAM) can lead to prolonged illness and complications.
- Understanding factors contributing to rAM is crucial for effective management.
Purpose of the Study:
- To investigate the association between specific microbial growth patterns and the recurrence rate of acute mastoiditis in children.
- To identify microbiological risk factors for recurrent acute mastoiditis.
Main Methods:
- A historical prospective study was conducted on children diagnosed with AM between 2000 and 2015.
- Data collected included demographics, medical history, antibiotic use, clinical presentation, CT imaging, microbiological findings, treatment, and outcomes.
- Comparison of microbiological data between single episode AM and recurrent AM (rAM) groups.
Main Results:
- Of 456 hospitalizations for mastoiditis, 22 cases were identified as rAM.
- The rate of Pseudomonas aeruginosa growth was significantly higher in the rAM group (40.9%) compared to the AM group (8.9%).
- Anaerobic bacterial growth (15% vs. 0%) and polymicrobial growth (59% vs. 3.6%) were also significantly more prevalent in rAM cases.
Conclusions:
- Children with P. aeruginosa, anaerobic bacteria, or polymicrobial infections in AM are prone to recurrence.
- Antibiotic therapy should be adjusted based on bacteriologic studies, even with apparent clinical improvement.
- Consider surgical intervention during the initial AM episode and ensure close follow-up with appropriate antibiotics for recurrent infections.
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