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Wesson T, Sharma D, Rodman C, Tucker BJ, Romano DR, Chen J, Mulinaro L, Carroll AE, Illing EA, Bennett W, Burgin SJ. Evolving microbial patterns of acute mastoiditis in pediatric patients undergoing mastoidectomy. Int J Pediatr Otorhinolaryngol 2023; 172:111690. [PMID: 37544073 DOI: 10.1016/j.ijporl.2023.111690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE To investigate the microbial patterns and clinical outcomes of pediatric patients undergoing mastoidectomy for acute coalescent mastoiditis and to identify factors associated with poor outcomes and/or prolonged treatment. STUDY DESIGN Monocentric retrospective cohort study. SETTING Tertiary referral pediatric hospital in Indiana. METHODS By cross-referencing database data from the Pediatric Health Information System (PHIS) querying for all inpatient stays (patients younger than eighteen) with a diagnostic code of mastoiditis between January 1st, 2010 and August 31, 2019, and the electronic health record (Cerner) for Riley Hospital for Children, 46 patients with mastoidectomy were included. A two-tailed T-test was used to evaluate continuous parametric data. Statistical significance was determined as P < 0.05. For continuous variables, data was analyzed using continuous logistic regression. A criteria of p > 0.1 was used for inclusion in the multivariate regression. RESULTS Inclusion criteria was met by 46 patients. From 2010 to 2019, S. pyogenes and S. pneumoniae were the most common bacteria, each isolated in 11 of 42 bacterial isolates (26.2%). There was no growth in 35.4% (17/48) of intra-operative wound cultures. On univariate analysis, patients with negative cultures had longer length of hospital stay (LOS) (7.7 days [6.5] vs. 4.3 [2.8]; p = 0.018) as well as higher rates of PICC (peripherally inserted central catheter) placement (53.3% vs. 19.4%; p = 0.021). There was a statistically significant difference in terms of gender (p = 0.021), with 15 males and 16 females in the positive culture cohort and 13 males and 2 females in the negative culture cohort. On multivariate analysis, which included gender, PICC placement, both intracranial and extracranial complications, duration of antibiotics, and LOS, female gender was the only significant predictor of positive culture status (p = 0.039). CONCLUSION S. pyogenes and S. pneumoniae were the predominant etiologic agents in acute coalescent mastoiditis between 2010 and 2019, and negative wound cultures were associated with worse clinical outcomes.
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Affiliation(s)
- Troy Wesson
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dhruv Sharma
- Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Department of Otolaryngology-Head and Neck Surgery, Indianapolis, IN, USA
| | - Cole Rodman
- Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Department of Otolaryngology-Head and Neck Surgery, Indianapolis, IN, USA
| | - Brady J Tucker
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Daniel R Romano
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jerry Chen
- Indiana University Department of Otolaryngology-Head and Neck Surgery, Indianapolis, IN, USA
| | - Lindsay Mulinaro
- Indiana University School of Medicine, Indianapolis, IN, USA; Eskenazi Health Ear, Nose, and Throat and Audiology, Indianapolis, IN, USA
| | - Aaron E Carroll
- Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Department of Pediatrics, Indianapolis, IN, USA
| | - Elisa A Illing
- Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Department of Otolaryngology-Head and Neck Surgery, Indianapolis, IN, USA; Eskenazi Health Ear, Nose, and Throat and Audiology, Indianapolis, IN, USA
| | - William Bennett
- Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Department of Pediatrics, Indianapolis, IN, USA
| | - Sarah J Burgin
- Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Department of Otolaryngology-Head and Neck Surgery, Indianapolis, IN, USA; Eskenazi Health Ear, Nose, and Throat and Audiology, Indianapolis, IN, USA. http://sburgin.iupui.edu
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Chengazi HV, Desai A, Bhatt AA. Emergency radiologic approach to mastoid air cell fluid. Emerg Radiol 2021; 28:633-40. [PMID: 33449261 DOI: 10.1007/s10140-020-01890-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
Mastoid air cell fluid is a commonly seen, but often dismissed finding. Given the location of the mastoid portion of the temporal bone and its location adjacent to vital structures, a careful evaluation is important for the emergency radiologist. While occasionally benign, fluid within the mastoid air cells can be an early sign of more severe pathology, and familiarity of regional anatomy allows for early identification of disease spread. This article describes the important anatomy, the common pathologies, and a radiologic approach to assessing the mastoid air cells in order to guide referring clinicians.
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