title: Acute mastoiditis in children: Middle ear cultures may help in reducing use of broad spectrum antibiotics.
abstract: BACKGROUND
  Acute mastoiditis (AM) is a suppurative infection of the mastoid air cells, representing the most frequent complication of acute otitis media. AM remains an important entity in children due to its potential complications and sequelae. We aim to describe the cases of AM admitted at our department, identify risk factors potentially associated with complications and analyse the changes in clinical approach of AM over time.
  
  
  METHODS
  Case review of clinical files of children admitted with acute mastoiditis from June 1996 to May 2013 at a Lisbon metropolitan area hospital. Data was divided into two groups (prior and after May 2005) in order to evaluate changes in AM approach over the years.
  
  
  RESULTS
  135 AM episodes were included. The median age was 3.8 years and 42% children were less than 24 months of age. Symptoms at presentation included fever (69%), ear pain (56%) and otorrhea (40%). Complications occurred in 22% patients and were more common in children under 24 months (33% vs 15%, p ≤ 0.01). Leukocyte count was significantly higher in children with complications (16.7 vs 14.5 × 109/μL, p ≤ 0.05) as was C-Reactive Protein value (13 vs 6.3 mg/dL, p ≤ 0.001). There was a significant association between the development of complications and C-Reactive Protein value at admission (OR 1.892; IC95%: 1.018-2.493, p ≤ 0.01). The optimal cut-off value was 7.21 mg/dL. Over time there was a significant increase in middle ear cultures obtained by tympanocentesis during surgery (2% vs 16%, p ≤ 0,01) and also a decrease in the use of broad spectrum antibiotherapy as initial treatment (52% vs 25%,p ≤ 0,001).
  
  
  CONCLUSIONS
  Children under 24 months, with high leukocyte count or with high C-Reactive Protein value should be monitored closely since complications tend to be more frequent. A CRP value of 7.21 mg/dL at admission seems to be a good cut-off to monitor children for potential complications. Throughout the period analysed more cultures were performed allowing identification of the pathogens and implementation of appropriate antibiotic therapy.
authors.affiliation: Department of Pediatrics, Hospital Prof. Doutor Fernando Fonseca, EPE, Estrada IC-19, 2720-276, Amadora, Portugal. Electronic address: catarinasmgarcia@gmail.com.
authors.forename: Catarina
authors.initials: C
authors.lastname: Garcia
authors.affiliation: Department of Pediatrics, Hospital Prof. Doutor Fernando Fonseca, EPE, Estrada IC-19, 2720-276, Amadora, Portugal. Electronic address: bbsalgueiro@gmail.com.
authors.forename: Ana Bárbara
authors.initials: AB
authors.lastname: Salgueiro
authors.affiliation: Department of Pediatrics, Hospital Prof. Doutor Fernando Fonseca, EPE, Estrada IC-19, 2720-276, Amadora, Portugal. Electronic address: csmrluis@gmail.com.
authors.forename: Catarina
authors.initials: C
authors.lastname: Luís
authors.affiliation: Department of Pediatrics, Hospital Prof. Doutor Fernando Fonseca, EPE, Estrada IC-19, 2720-276, Amadora, Portugal. Electronic address: tirado.paula@gmail.com.
authors.forename: Paula
authors.initials: P
authors.lastname: Correia
authors.affiliation: Department of Pediatrics, Hospital Prof. Doutor Fernando Fonseca, EPE, Estrada IC-19, 2720-276, Amadora, Portugal. Electronic address: joao.rochabrito@netcabo.pt.
authors.forename: Maria João
authors.initials: MJ
authors.lastname: Brito
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D004432:Ear, Middle / Q000382:microbiology*; D004433:Earache / Q000209:etiology; D005260:Female; D005334:Fever / Q000209:etiology; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D008297:Male; D008417:Mastoiditis / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology*; D012189:Retrospective Studies; D000069356:Tympanocentesis
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein
keywords: Acute mastoiditis; Acute otitis media; Children; Complications