title: Acute mastoiditis in children under 15 years of age in Southern Israel following the introduction of pneumococcal conjugate vaccines: a 4-year retrospective study (2009-2012).
abstract: OBJECTIVE
  To describe the epidemiologic, microbiologic, clinical and therapeutic aspects of acute mastoiditis (AM) in children <15 years of age during the 4-year period (2009-2012) following the introduction of pneumococcal conjugate vaccines in Israel.
  
  
  METHODS
  The medical records of all children with a discharge diagnosis of AM were reviewed.
  
  
  RESULTS
  A total of 66 AM episodes occurred in 61 patients. Forty-four (66.6%) cases occurred among patients <4 years, recent acute otitis media (AOM) history was reported in 27.1% and 28.8% patients received previous antibiotics for AOM. Postauricular swelling, postauricular sensitivity, protrusion of auricle and postauricular edema (93.8%, 90.6%, 85.9% and 95.7%, respectively) were the most common signs of AM. Leukocytosis >15,000 WBC/mm(3) was found in 39 (59.1%) cases. Cultures were performed in 52/66 episodes (positive in 27, 51.92% episodes), with recovery of 32 pathogens. The most frequently isolated pathogens were Streptococcus pneumoniae (15/52, 28.85%), Streptococcus pyogenes (9, 17.3%) and nontypeable Haemophilus influenzae (5, 9.62%). Eight (53.3%) S. pneumoniae isolates were susceptible to penicillin. Mean incidence of overall and pneumococcal AM were 11.1 and 2.58 cases/100000, with no significant changes during the study years. Surgical intervention was required in 19 (28.8%) patients.
  
  
  CONCLUSIONS
  (1) AM occurs frequently in patients without previous AOM history and with no previous antibiotic treatment; (2) S. pneumoniae and S. pyogenes continued to be the main etiologic agents of AM during the postvaccination period; (3) No changes were recorded in overall AM incidence and in pneumococcal AM incidence during the postvaccination period.
authors: Department of Otorhinolaryngology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
authors: Sofia
authors: S
authors: Kordeluk
authors: Pediatric Emergency Medicine Department, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
authors: Ran
authors: R
authors: Orgad
authors: Department of Otorhinolaryngology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
authors: Mordechai
authors: M
authors: Kraus
authors: Department of Otorhinolaryngology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
authors: Moshe
authors: M
authors: Puterman
authors: Department of Otorhinolaryngology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
authors: Daniel M
authors: DM
authors: Kaplan
authors: Epidemiology Department, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
authors: Lena
authors: L
authors: Novak
authors: Pediatric Infectious Disease Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
authors: Ron
authors: R
authors: Dagan
authors: Pediatric Emergency Medicine Department, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel; Pediatric Infectious Disease Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel. Electronic address: eugenel@bgu.ac.il.
authors: Eugene
authors: E
authors: Leibovitz
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007557:Israel / Q000453:epidemiology; D007964:Leukocytosis / Q000453:epidemiology; D008297:Male; D008417:Mastoiditis / Q000453:epidemiology* / Q000382:microbiology; D010033:Otitis Media / Q000453:epidemiology; D022242:Pneumococcal Vaccines; D012189:Retrospective Studies; D014611:Vaccination; D018074:Vaccines, Conjugate
chemical_list: D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate
keywords: Children; Mastoiditis; S. pneumoniae; Vaccines