Acute mastoiditis: 20 years of experience with a uniform management protocol

Area of Science:

• Pediatric Infectious Diseases
• Neurology
• Microbiology

Background:

• Acute meningitis (AM) can lead to serious intracranial complications.
• Identifying patients at risk for these complications is crucial for timely intervention.
• Understanding the causative organisms in AM, especially with prior antibiotic exposure, is important.

Purpose of the Study:

• To characterize the clinical presentation of pediatric AM patients with imaging-diagnosed intracranial complications (ID-ICCs).
• To identify risk factors for developing ID-ICCs in AM patients.
• To update knowledge on microorganisms causing AM, considering prior antibiotic use.

Main Methods:

• Retrospective analysis of 166 pediatric AM patients admitted between 1997 and 2018.
• All patients underwent brain imaging and bacterial culture upon AM diagnosis.
• Risk factors, including prior antibiotic treatment for acute otitis media (AOM) and C-reactive protein (CRP) levels, were analyzed.

Main Results:

• 13% of AM patients presented with ID-ICCs.
• Prior antibiotic treatment for AOM and CRP levels >93.5 mg/L significantly increased the risk of ID-ICC by 22.5-fold.
• Common pathogens without prior antibiotics included Streptococcus pyogenes; with prior antibiotics, Fusobacterium necrophorum and Pseudomonas aeruginosa were more prevalent.

Conclusions:

• Pediatric AM patients with high CRP and prior antibiotic treatment are at significantly higher risk for ID-ICCs.
• Diagnostic imaging upon admission is recommended for these high-risk patients.
• Prior antibiotic use may alter the spectrum of causative pathogens in AM.