Impact of resistant pneumococcus on rates of acute mastoiditis

OBJECTIVE: To determine whether the rate of acute mastoiditis is rising, sp ecifically as a result of antibiotic-resistant strains of Streptococcus pne umoniae. METHODS: A retrospective chart review of all patients with a discharge diag nosis of acute mastoiditis between July 1, 1987, and June 30, 1997, was per formed at our academic, tertiary-care medical center. There were no interve ntions, and the main outcome measures included the number of cases of acute or coalescent mastoiditis, stratified by pathogen, per year. RESULTS: The rate of acute mastoiditis as a proportion of yearly otorhinola ryngology admissions increased linearly over time (P = 0.024). Pneumococcal -related rates of acute mastoiditis, expressed as a proportion of yearly ho spital and otorhinolaryngology admissions, increased linearly over time (P = 0.002, P = 0.002). All but 1 case of pneumococcal mastoiditis during the past 3 years were caused by penicillin-resistant strains. CONCLUSIONS:The emergence of antibiotic-resistant S pneumoniae may be respo nsible for an increasing rate of acute mastoiditis.