PEDIATRICS Vol. 106 No. 4 October 2000, pp. 695-699
Pneumococcal Mastoiditis in Children
Received Aug 9, 1999; accepted Jan 3, 2000.
,
,, and
From the Pediatric Infectious Disease Sections of * Baylor
College of Medicine, Houston, Texas; University of Pittsburgh School
of Medicine, Pittsburgh, Pennsylvania; § University of Southern
California School of Medicine, Los Angeles, California; Wake Forest
University School of Medicine, Winston-Salem, North Carolina;
¶ Children's Hospital San Diego, San Diego, California; # Ohio State
University College of Medicine and Public Health, Columbus, Ohio;
** Northwestern University Medical School, Chicago, Illinois; and
University of Arkansas for Medical Sciences, Little Rock,
Arkansas.
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 
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.Streptococcus pneumoniae, mastoiditis, serotypes, resistance. .
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