Pneumococcal mastoiditis in children

Objective. To determine the impact of antibiotic resistance on the frequency, clinical features, and management/outcome of mastoiditis attributable to Streptococcus pneumoniae. Design. Retrospective review of the medical records of children with mastoiditis 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 recurrent otitis media. A subperiosteal abscess was noted in 13 children (37%). The 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 nonsusceptible to penicillin. Serogroup 19 accounted for 57% of isolates, serogroup 23 for 14.3% of isolates, and serotype 3 for 10.7% of isolates. Except for receipt of less antibiotic therapy in the previous 30 days, children with penicillin-susceptible isolates had similar demographic features and clinical findings and surgical treatment as did children whose isolates were nonsusceptible to penicillin. Conclusions. Pneumococcal mastoiditis occurs primarily in children <2 years of age and usually is not associated with a history of recurrent otitis media. The number of cases of mastoiditis caused by S pneumoniae occurring among 8 children's hospitals has remained stable despite increasing rates of antibiotic-resistant S pneumoniae. Serogroup 19 is the leading serogroup associated with pneumococcal mastoiditis.