title: Pneumococcal mastoiditis in children.
abstract: OBJECTIVE
  To determine the impact of antibiotic resistance on the frequency, clinical features, and management/outcome of mastoiditis attributable to Streptococcus pneumoniae.
  
  
  METHODS
  Retrospective review of the medical records of children with mastoiditis caused by S pneumoniae from September 1993 through December 1998.
  
  
  METHODS
  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.
authors.affiliation: Pediatric Infectious Disease Section of ¿Baylor College of Medicine, Houston, Texas 77030-2399, USA. skaplan@bcm.tmc.edu
authors.forename: S L
authors.initials: SL
authors.lastname: Kaplan
authors.forename: E O
authors.initials: EO
authors.lastname: Mason
authors.forename: E R
authors.initials: ER
authors.lastname: Wald
authors.forename: K S
authors.initials: KS
authors.lastname: Kim
authors.forename: L B
authors.initials: LB
authors.lastname: Givner
authors.forename: J S
authors.initials: JS
authors.lastname: Bradley
authors.forename: W J
authors.initials: WJ
authors.lastname: Barson
authors.forename: T Q
authors.initials: TQ
authors.lastname: Tan
authors.forename: G E
authors.initials: GE
authors.lastname: Schutze
authors.forename: R
authors.initials: R
authors.lastname: Yogev
mesh_terms: D018550:Cephalosporin Resistance; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008417:Mastoiditis / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy; D008826:Microbial Sensitivity Tests; D010403:Penicillin Resistance; D011008:Pneumococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D012189:Retrospective Studies; D013296:Streptococcus pneumoniae / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology