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.
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.
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.
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: firstname.lastname@example.org.