No Amikacin, No Problem: a Successful Treatment Approach for Pediatric Otomastoiditis Due to Amikacin-Resistant Mycobacterium abscessus

Clinical characteristics and an evaluation of predictors for a favorable outcome of Mycobacterium abscessus otomastoiditis: a systematic review and meta-analysis of individual participant data

BACKGROUND

Otomastoiditis caused by Mycobacterium abscessus is rare, but its incidence has increased over the last decades and its optimal treatment remains unknown. This study aims to summarise clinical and therapeutic features and to find characteristics associated with favourable treatment outcomes of patients with M. abscessus otomastoiditis.

METHODS

We searched MEDLINE, EMBASE and Web of Science to identify studies including patients with M. abscessus otomastoiditis. A one-stage individual patient data (IPD) meta-analysis was conducted. A two-level mixed-effects linear regression model was provided for antimycobacterial treatment duration.

RESULTS

Twenty-three studies reported a total of 85 patients. Children presented with an unique clinical profile of a history of ear infections, tympanostomy tube placement and antibiotic treatment. Antimycobacterial treatment was administered for 26 (Inter Quartile Range (IQR): 15-35) weeks. Macrolides were prescribed in 98.8%. Surgery was performed in 80.5%, of which 47.1% required revision surgery. Otalgia was a significant predictor (β = 9.3; p = .049) of antimycobacterial treatment duration.

CONCLUSIONS

Mastoid surgery (regularly requiring revision) and a multidrug regimen for a minimum of six months including a minimum of three active agents are most often needed to attain cure. The presence of otalgia significantly extends the treatment duration of M. abscessus otomastoiditis.