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Pneumococcal Mastoiditis in Children Before and After the Introduction of Conjugate Pneumococcal Vaccines

Koutouzis, Emmanouil I. MD; Michos, Athanasios MD; Koutouzi, Foteini I. MD; Chatzichristou, Panagiota MSc; Parpounas, Konstantinos MD; Georgaki, Angeliki MD; Theodoridou, Maria MD; Tsakris, Athanasios MD; Syriopoulou, Vassiliki P. MD

The Pediatric Infectious Disease Journal: March 2016 - Volume 35 - Issue 3 - p 292–296
doi: 10.1097/INF.0000000000000995
Original Studies

Objectives: To determine whether serotype distribution and antibiotic resistance of Streptococcuspneumoniae acute mastoiditis (AM) in children have changed in the post pneumococcal conjugate vaccines (PCVs) era.

Methods: Medical records of pneumococcal AM cases, in a tertiary pediatric hospital were reviewed from January 1999 to December 2014. S. pneumoniae isolates were serotyped using the quellung reaction and tested for antibiotic susceptibility by E-test and for macrolide resistance genes by polymerase chain reaction.

Results: Among 334 children with AM, S. pneumoniae was isolated from 89 (26.6%) with median age 22 months (interquartile range: 12–30 months). S. pneumoniae was recovered from ear fluid (58%), mastoid specimens (35.2%) and blood (6.8%). Resistance to penicillin, erythromycin and clindamycin was 12.4%, 49.4% and 18%, respectively. Distribution of pneumococcal serotypes before (1999–2005), after the introduction of PCV7 (2006–2010) and after PCV13 (2011–2014) was found: for the PCV7 serotypes 81%, 25% and 0% (P < 0.0001), for PCV13 additional serotypes 16.3%, 70.8% and 63.6% (P < 0.0001) and for non-PCV serotypes 2.3%, 4.1% and 36.3% (P = 0.0002), respectively. Significant increase was detected for the serotype 19A after PCV7, and this trend was not changed after PCV13 (2.3%, 50% and 50%, respectively; P < 0.0001). A significant proportion of resistant isolates to penicillin (54.5%) and erythromycin (34.8%) was identified as 19A.

Conclusions: After the introduction of PCV7, a significant increase of serotype 19A and replacement of PCVs serotypes was identified. After PCV13, the overall proportion of pneumococcal mastoiditis and the incidence of serotype 19A were not significantly declined. A significant proportion of resistant isolates to penicillin and erythromycin is attributed to serotype 19A.

From the *First Department of Pediatrics, Department of Otolaryngology Head and Neck Surgery, Department of Clinical Microbiology, Aghia Sophia Children’s Hospital, University of Athens, Athens, Greece; and §Department of Microbiology, Medical School, University of Athens, Athens, Greece.

Accepted for publication September 9, 2015.

This work was financed by the grant 70/3/6994 from the Hellenic Center for Disease Control and Prevention. V.P.S. as principal investigator and employee in Athens University had received a grant from the Hellenic Center for Disease Control and Prevention, for this study. All the other authors have no conflicts of interest or funding to disclose.

Address for correspondence: Vassiliki P. Syriopoulou, MD, First Department of Pediatrics, Aghia Sophia Children’s Hospital, University of Athens, Thivon and Levadias street, Athens 11527, Greece. E-mail:

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