Pneumococcal mastoiditis in children

Objective. To determine the impact of antibiotic resistance on the frequenc y, clinical features, and management/outcome of mastoiditis attributable to Streptococcus pneumoniae. Design. Retrospective review of the medical records of children with mastoi ditis caused by S pneumoniae from September 1993 through December 1998. Patients. Infants and children with pneumococcal mastoiditis cared for at 8 children's hospitals in the United States. Results. Thirty-four children with pneumococcal mastoiditis were identified . The median age of the children was 12 months (range: 2 months-12.5 years) ; 28 (82%) were less than or equal to 2 years old. Six children had recurre nt otitis media. A subperiosteal abscess was noted in 13 children (37%). Th e mastoids were abnormal in all 25 patients on whom computed tomography was performed. There was no trend toward increasing numbers of cases per year despite increasing proportions of pneumococcal isolates, which were nonsusc eptible to penicillin. Serogroup 19 accounted for 57% of isolates, serogrou p 23 for 14.3% of isolates, and serotype 3 for 10.7% of isolates. Except fo r receipt of less antibiotic therapy in the previous 30 days, children with penicillin-susceptible isolates had similar demographic features and clini cal findings and surgical treatment as did children whose isolates were non susceptible to penicillin. Conclusions. Pneumococcal mastoiditis occurs primarily in children <2 years of age and usually is not associated with a history of recurrent otitis me dia. The number of cases of mastoiditis caused by S pneumoniae occurring am ong 8 children's hospitals has remained stable despite increasing rates of antibiotic-resistant S pneumoniae. Serogroup 19 is the leading serogroup as sociated with pneumococcal mastoiditis.