Miri Gelbart1, Efraim Bilavsky2,3, Gabriel Chodick3,4, Eyal Raveh3,5, Itzhak Levy3,6, Liat Ashkenazi-Hoffnung3,7. 1. From the Departments of Pediatrics A. 2. Pediatrics B. 3. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 4. Department of Epidemiology & Preventive Medicine, Tel Aviv, Israel. 5. Otolaryngology Unit. 6. Infectious Diseases Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel. 7. Pediatrics C.
Abstract
BACKGROUND: Recent reports have reported an increase in the incidence of acute mastoiditis because of Fusobacterium necrophorum. However, the crude incidence and the specific clinical and laboratory characteristics of F. necrophorum mastoiditis in children have not been described. Our aim was to describe these features to identify high-risk patients. METHODS: The electronic medical records of all children with acute mastoiditis at a tertiary medical center between July 2011 and December 2015 were analyzed. Using a stepwise logistic regression to identify independent risk factors for F. necrophorum, we formulated a predictive model. RESULTS: F. necrophorum was identified in 13% (19/149) of mastoiditis cases with an identifiable agent. Its incidence increased 7-fold from 2.8% in 2012 to 20.4% in 2015 (P = 0.02). F. necrophorum infection had unique clinical, laboratory and prognostic features. The vast majority had complications and underwent surgical intervention. The predictive model used 4 parameters to define high-risk patients for F. necrophorum infection at admission: females, winter/spring season, prior antibiotic treatment and a C-reactive protein value >20 mg/dL (area under receiver operating characteristic curve 0.929). CONCLUSIONS: Clinicians should be aware of the increasing incidence of F. necrophorum mastoiditis and consider anaerobic cultures and specific anaerobic coverage in high-risk patients.
BACKGROUND: Recent reports have reported an increase in the incidence of acute mastoiditis because of Fusobacterium necrophorum. However, the crude incidence and the specific clinical and laboratory characteristics of F. necrophorummastoiditis in children have not been described. Our aim was to describe these features to identify high-risk patients. METHODS: The electronic medical records of all children with acute mastoiditis at a tertiary medical center between July 2011 and December 2015 were analyzed. Using a stepwise logistic regression to identify independent risk factors for F. necrophorum, we formulated a predictive model. RESULTS:F. necrophorum was identified in 13% (19/149) of mastoiditis cases with an identifiable agent. Its incidence increased 7-fold from 2.8% in 2012 to 20.4% in 2015 (P = 0.02). F. necrophoruminfection had unique clinical, laboratory and prognostic features. The vast majority had complications and underwent surgical intervention. The predictive model used 4 parameters to define high-risk patients for F. necrophoruminfection at admission: females, winter/spring season, prior antibiotic treatment and a C-reactive protein value >20 mg/dL (area under receiver operating characteristic curve 0.929). CONCLUSIONS: Clinicians should be aware of the increasing incidence of F. necrophorummastoiditis and consider anaerobic cultures and specific anaerobic coverage in high-risk patients.