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Epidemiology and variability in management of acute mastoiditis in children
Stephen Edwards1, Shelley Kumar2, Soyoon Lee3
1Baylor College of Medicine Department of Pediatrics, United States of America; Texas Children's Hospital, United States of America; Section of Hospital Medicine, United States of America.
Insights
This study highlights the variable treatment of acute mastoiditis (AM) in children, with frequent use of broad-spectrum antibiotics like vancomycin. Antimicrobial stewardship is crucial for optimizing antibiotic use in pediatric AM cases.
Area of Science:
- Pediatric infectious diseases
- Otolaryngology
- Clinical microbiology
Background:
- Acute mastoiditis (AM) is a serious complication of middle ear infections in children.
- Understanding its epidemiology and management is key to improving patient outcomes.
- Current treatment strategies for AM exhibit significant variability.
Purpose of the Study:
- To analyze the epidemiology, management practices, and outcomes of acute mastoiditis in pediatric patients.
- To identify factors associated with disease severity, such as intracranial extension.
- To inform strategies for enhancing antimicrobial stewardship in AM treatment.
Main Methods:
- Retrospective observational study of children (age >6 months to ≤18 years) admitted with AM.
- Data collected from electronic medical records over an 8-year period (2011-2019).
- Analysis of patient demographics, clinical presentation, causative pathogens, antibiotic regimens, and outcomes.
Main Results:
- 129 pediatric patients with AM were identified.
- Intracranial extension was associated with headaches/neck pain (OR 3.96) and reduced by ear protrusion (OR 0.307).
- Common pathogens included Streptococcus pyogenes, Pseudomonas aeruginosa, and Streptococcus pneumoniae; vancomycin was frequently used empirically despite low MRSA rates.
Conclusions:
- Treatment of pediatric acute mastoiditis shows considerable variability.
- Empirical use of broad-spectrum antibiotics, including vancomycin, is common.
- Implementing robust antibiotic stewardship programs is essential for judicious antibiotic selection and duration.
Background:
To evaluate the epidemiology, management and outcome of acute mastoiditis (AM) in children and to improve strategies for antimicrobial stewardship.
Methods:
We conducted a retrospective observational study of children aged >6 months to ≤18 years of age admitted to a tertiary care hospital with AM over an 8-year period (2011-2019). Electronic medical records were reviewed to collect data.
Results:
A total of 129 patients met inclusion criteria for AM during this time period. Eighty-one (63 %) were males with 110 (81 %) White and 67 (52 %) non-Hispanic. The median age at presentation was 6.4 years (3-10.1 years). Ear protrusion was associated with reduced odds of having AM with intracranial extension (ICE) (OR 0.307, 95 % CI = 0.107-0.883) whereas presence of headaches and/or neck pain increased the odds of having AM with ICE (OR = 3.96, 95%CI 1.29-12.1). The most common etiologies were Streptococcus pyogenes (n = 23, 19.2 %), Pseudomonas aeruginosa (n = 20, 17 %), and Streptococcus pneumoniae (n = 15, 12.5 %). Empiric antibiotic selection and duration of therapy was highly variable. The most common empiric antibiotic used was intravenous vancomycin with a third generation cephalosporin (n = 45, 34.8 %). Majority completed course (n = 92; 73 %) with an oral antibiotic. Shorter (≤10 and ≤14 days) versus longer courses (>10 and >14 days) did not affect readmission rates for AM without ICE.
Conclusion:
There is high variability of treatment of AM in children. Broad spectrum antibiotics, especially vancomycin were used most frequently despite low rates of Methicillin Resistant Staphylococcus aureus. The use of antibiotic stewardship is essential for judicious antibiotic use.
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