1132. Evaluation of Broad-Spectrum Antimicrobial Therapy for Acute Mastoiditis in Pediatric Patients: An Antimicrobial Stewardship Perspective

Abstract Background Acute mastoiditis (AM) continues to remain a serious complication of acute otitis media in children. There is a significant variation in antimicrobial management in children with AM. Recent studies and UptoDate recommends empiric coverage with vancomycin and antipseudomonal medication in patients with AM. The purpose of this study was to evaluate the epidemiology, management and outcome of AM in pediatric patients. Methods A retrospective, observational study was designed evaluating epidemiology and management of AM in hospitalized pediatric patients from July 1, 2011 to June 30, 2017. Patients between 6 months and 19 years of age admitted with a diagnosis of AM as per ICD 9/10 coded were included in the study. Information regarding demographic, clinical, laboratory, microbiological, radiological, antibiotic (Abx) usage, surgical intervention and outcome were collected from medical records. Results A total of 97 patients were evaluated (64% male, mean age 6.6 ± 4.3 years). Cultures (Cx) were obtained in 95 patients as in Figure 1. Of the patients who grew P.aeroginosa, 2 had intracranial extension, both of which were polymicrobial and 5 did not receive empiric antipseudomonal therapy but had no complications on follow-up. Table 1 shows the most common empiric Abx therapy. Fifty-nine patients (61.5%) had a change in Abx, the most common being a ceftriaxone or a combination of clindamycin and ceftriaxone. Except for those with complicated AM, none required definitive vancomycin therapy. Thirty-two patients (33%) had a complicated mastoiditis with epidural abscess, thrombosis, and/or intracranial extension. Eighty-six patients (86.8%) required surgical intervention. Mastoidectomy was performed in 34% while others had myringotomy and tympanostomy tube placement and/or drainage of subperiosteal abscesses without subsequent complications. Conclusion Group A Streptococcus, Streptococcus pneumoniae and Pseudomonas were the predominant pathogens in acute AM in children. Vancomycin and empiric antipseudomonal coverage may not be needed in patients with uncomplicated AM. Broader spectrum Abx with intracranial penetration should be reserved for those with complicated AM. Disclosures All authors: No reported disclosures.

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Association between Resistance to Erythromycin and the Presence of the Fibronectin Binding Protein F1 Gene, prtF1, in Streptococcus pyogenes Isolates from German Pediatric Patients

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.49.7.2990-2993.2005 ◽

2005 ◽

Vol 49 (7) ◽

pp. 2990-2993 ◽

Cited By ~ 4

Author(s):

Maria Haller ◽

Kirsten Fluegge ◽

Sandra Jasminder Arri ◽

Brit Adams ◽

Reinhard Berner

Keyword(s):

Streptococcus Pyogenes ◽

Pediatric Patients ◽

Group A Streptococcus ◽

Binding Protein ◽

Macrolide Resistance ◽

Group A ◽

Fibronectin Binding Protein ◽

Fibronectin Binding ◽

Cell Invasiveness

ABSTRACT A total of 301 German pediatric group A streptococcus isolates were screened for the presence of macrolide resistance and the fibronectin binding protein F1 gene (prtF1) encoding an adhesin and cell invasiveness protein. The prtF1 gene was present significantly more often among macrolide-resistant isolates. The majority of these were not clonally related.

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High-dose steroid and heparin: a novel therapy for cerebral vasculitis associated with presumed group A Streptococcus meningitis

BMJ Case Reports ◽

10.1136/bcr-2020-239618 ◽

2021 ◽

Vol 14 (2) ◽

pp. e239618

Author(s):

Brian Alexander Hummel ◽

Julie Blackburn ◽

Anne Pham-Huy ◽

Katherine Muir

Keyword(s):

Treatment Guidelines ◽

Group A Streptococcus ◽

Oral Prednisone ◽

Acute Otitis Media ◽

Antimicrobial Treatment ◽

Cerebral Vasculitis ◽

High Dose ◽

Novel Therapy ◽

Intravenous Heparin ◽

Group A

Cerebral vasculitis is a serious complication of bacterial meningitis that can cause significant morbidity and mortality due to stroke. Currently, there are no treatment guidelines or safety and efficacy studies on the management of cerebral vasculitis in this context. Herein, we report a case of a previously well 11-year-old girl who presented with acute otitis media that progressed to mastoiditis and fulminant meningitis. Group A Streptococcus was found in blood and ear-fluid cultures (lumbar puncture was unsuccessful). Her decreased level of consciousness persisted despite appropriate antimicrobial treatment, and repeat MRI revealed extensive large vessel cerebral vasculitis. Based on expert opinion and a presumed inflammatory mechanism, her cerebral vasculitis was treated with 7 days of pulse intravenous methylprednisolone followed by oral prednisone taper. She was also treated with intravenous heparin. Following these therapies, she improved clinically and radiographically with no adverse events. She continues to undergo rehabilitation with improvement.

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Distribution of emm type and antibiotic susceptibility of group A streptococci causing invasive and noninvasive disease

Journal of Medical Microbiology ◽

10.1099/jmm.0.2008/002642-0 ◽

2008 ◽

Vol 57 (11) ◽

pp. 1383-1388 ◽

Cited By ~ 43

Author(s):

Takeaki Wajima ◽

Somay Y. Murayama ◽

Katsuhiko Sunaoshi ◽

Eiichi Nakayama ◽

Keisuke Sunakawa ◽

...

Keyword(s):

Streptococcus Pyogenes ◽

Macrolide Antibiotic ◽

Group A Streptococcus ◽

Acute Otitis Media ◽

Toxic Shock ◽

Medical Institutions ◽

Invasive Infections ◽

Group A ◽

Resistant Strains ◽

Emm Type

To determine the prevalence of macrolide antibiotic and levofloxacin resistance in infections with Streptococcus pyogenes (group A streptococcus or GAS), strains were collected from 45 medical institutions in various parts of Japan between October 2003 and September 2006. Four hundred and eighty-two strains from patients with GAS infections were characterized genetically. Strains were classified into four groups according to the type of infection: invasive infections (n=74) including sepsis, cellulitis and toxic-shock-like syndrome; acute otitis media (AOM; n=23); abscess (n=53); and pharyngotonsillitis (n=332). Among all strains, 32 emm types were identified; emm1 was significantly more common in invasive infections (39.2 %) and AOM (43.5 %) than in abscesses (3.8 %) or pharyngotonsillitis (10.2 %). emm12 and emm4 each accounted for 23.5 % of pharyngotonsillitis cases. Susceptibility of GAS strains to eight β-lactam agents was excellent, with MICs of 0.0005–0.063 μg ml−1. Macrolide-resistant strains accounted for 16.2 % of all strains, while the percentages of strains possessing the resistance genes erm(A), erm(B) and mef(A) were 2.5 %, 6.2 % and 7.5 %, respectively. Although no strains with high resistance to levofloxacin were found, strains with an MIC of 2–4 μg ml−1 (17.4 %) had amino acid substitutions at either Ser-79 or Asp-83 in ParC. These levofloxacin-intermediately resistant strains included 16 emm types, but macrolide-resistant strains were more likely than others to represent certain emm types.

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Group A streptococcus acute otitis media progressing to neuroinvasive disease in adults

IDCases ◽

10.1016/j.idcr.2018.05.012 ◽

2018 ◽

Vol 12 ◽

pp. 161-164

Author(s):

Kavin M. Patel ◽

Jennie E. Johnson ◽

Jerrold L. Boxerman ◽

Gerard J. Nau

Keyword(s):

Otitis Media ◽

Group A Streptococcus ◽

Acute Otitis Media ◽

Neuroinvasive Disease ◽

Group A

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Management Patterns in Pediatric Complicated Sinusitis

Otolaryngology ◽

10.1177/0194599820918832 ◽

2020 ◽

Vol 163 (4) ◽

pp. 814-821

Author(s):

Sean M. McDermott ◽

Amanda Onwuka ◽

Charles Elmaraghy ◽

Patrick C. Walz

Keyword(s):

Medical Therapy ◽

Pediatric Patients ◽

Surgical Intervention ◽

Early Stage ◽

Tertiary Care ◽

Case Series ◽

Hospital Charges ◽

Intracranial Extension ◽

Disease Characteristics ◽

Outcome Differences

Objectives Sinusitis is a common pediatric illness that can be complicated by periorbital or intracranial extension. Patients can be managed with antimicrobials alone or in conjunction with surgical intervention. This article examines management patterns and outcomes in pediatric patients presenting with complicated sinusitis. Study Design Case series with chart review. Setting Tertiary care pediatric hospital. Subjects and Methods An evaluation of 168 pediatric patients with complicated sinusitis with periorbital complications presenting at a single institution from 2008 to 2018 was performed. Demographics, disease characteristics, in-hospital management, and outcomes were recorded and analyzed. Results The most common complication was orbital cellulitis, seen in 49% of children. Surgical intervention occurred in 49% of patients, with 36% receiving medical therapy followed by surgery (MTS). Chandler I patients underwent surgical intervention 30% of the time, Chandler II patients 29%, and Chandler III patients 83%. Nineteen percent of initially nonoperative patients started on ampicillin-sulbactam required MTS vs 57% of those started on other antibiotic regimens ( P = .01). Twelve percent of initially nonoperative Chandler I to II patients started on ampicillin-sulbactam needed MTS vs 40% started on other antibiotic regimens. Hospital charges for operative patients were $45,056 vs $14,311 for nonoperative patients ( P < .01). Hospital charges for patients with surgery followed by medical therapy (SMT) were $45,563 vs $44,393 for MTS ( P = .92). Conclusion Nonoperative early stage patients started on ampicillin-sulbactam had a lower risk of MTS. MTS did not cost significantly more than SMT, and there were no significant outcome differences seen.

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An unusual presentation of group A streptococcus infection in a newborn: with acute mastoiditis with no obvious clinical manifestation

Case Reports in Perinatal Medicine ◽

10.1515/crpm-2017-0007 ◽

2017 ◽

Vol 6 (2) ◽

Author(s):

Peymaneh Alizadeh Taheri ◽

Mohsen Jafari ◽

Fouzieh Mehrazmai

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Clinical Manifestation ◽

Group A Streptococcus ◽

Term Neonate ◽

Unusual Presentation ◽

Acute Mastoiditis ◽

Group A ◽

Temporal Bones ◽

Streptococcus A

Abstract Acute mastoiditis (AM) is rarely seen in newborns. It is characterized by retroauricular pain, swelling, tenderness and protrusion of the auricle. This is the first report of the neonatal mastoiditis in a 17-day-old term neonate with no obvious clinical manifestation of mastoiditis and no associated malformation of the ears and mastoids. A computed tomography (CT) scan of the temporal bones revealed right mastoiditis without osteitis, destruction of the mastoid bone or abscess formation. Discharge culture revealed streptococcus A colonies sensitive to ampicillin, ceftriaxone, vancomycin and chloramphenicol. She was successfully treated with intravenous ampicillin and ceftizoxime. No complication or recurrence was reported.

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An Outbreak of Group A Streptococcus Invasive Infections among Pediatric Patients in Columbus, Ohio

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.1825 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S682-S682

Author(s):

Stella Antonara ◽

Huanyu Wang ◽

Aslee Ward ◽

Amy Leber ◽

Joshua Watson ◽

...

Keyword(s):

Pediatric Patients ◽

Group A Streptococcus ◽

Invasive Infections ◽

Group A

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Palatal Petechiae in the Absence of Group A Streptococcus in Pediatric Patients with Acute-Onset Neuropsychiatric Deterioration: A Cohort Study

Journal of Child and Adolescent Psychopharmacology ◽

10.1089/cap.2016.0153 ◽

2017 ◽

Vol 27 (7) ◽

pp. 660-666 ◽

Cited By ~ 2

Author(s):

Talia Mahony ◽

Douglas Sidell ◽

Hayley Gans ◽

Michael Cooperstock ◽

Kayla Brown ◽

...

Keyword(s):

Cohort Study ◽

Pediatric Patients ◽

Group A Streptococcus ◽

Acute Onset ◽

Group A

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Detection of group A Streptococcus in tonsils from pediatric patients reveals high rate of asymptomatic streptococcal carriage

BMC Pediatrics ◽

10.1186/1471-2431-12-3 ◽

2012 ◽

Vol 12 (1) ◽

Cited By ~ 83

Author(s):

Amity L Roberts ◽

Kristie L Connolly ◽

Daniel J Kirse ◽

Adele K Evans ◽

Katherine A Poehling ◽

...

Keyword(s):

Pediatric Patients ◽

Group A Streptococcus ◽

High Rate ◽

Group A

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2568. Variability in Pediatric Antibiotic Prescribing for Upper Respiratory Illnesses by Provider Specialty

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy209.176 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S73-S74

Author(s):

Holly M Frost ◽

Huong McLean ◽

Brian Chow

Keyword(s):

Respiratory Infections ◽

Group A Streptococcus ◽

Acute Otitis Media ◽

Urgent Care ◽

Antibiotic Prescribing ◽

Respiratory Illnesses ◽

Upper Respiratory Infection ◽

Medical Diagnoses ◽

Group A ◽

Upper Respiratory

Abstract Background Antibiotic prescribing varies among providers, contributing to antibiotic resistance and adverse drug reactions. Objective. To evaluate variation in antibiotic prescribing between pediatric and nonpediatric providers for common upper respiratory illnesses. Methods Patient encounters for children aged <18 years from a regional healthcare system were identified. Electronic medical records from 2011 to 2016 were extracted for diagnoses of upper respiratory infection (URI), pharyngitis, acute otitis media (AOM), and sinusitis. Encounters with competing medical diagnoses, recent hospitalization, and antibiotic prescriptions within 30 days were excluded. Adherence to antibiotic guidelines was assessed by provider training (pediatric, nonpediatric physicians, and advance practice providers [APP]). Additional factors assessed included clinic or urgent care setting, calendar year, and patient’s age, gender, insurance status, and number of sick visits in the prior year. Results Across 6 years, 141,361 visits were examined: 43,914 for URI, 43,701 for pharyngitis, 43,925 for AOM, and 9,821 for sinusitis. Pediatricians were more likely than APPs and nonpediatric providers to have guideline-concordant prescribing for pharyngitis (pediatricians 66.7 (54.5, 77.0)%, nonpediatricians 49.1 (36.3, 62.0)%, APPs 52.2(39.4, 64.7)%, P < 0.0001) and sinusitis (pediatricians 70.8(53.8, 83.4)%, nonpediatricians 63.3(46.8, 77.2)%, APPs 62.1(45.1, 76.5)%, P = 0.48) and to withhold antibiotics for URI than APPs and nonpediatric providers (pediatricians 86.6(81.2, 90.6)%, nonpediatricians 80.8(73.0, 86.8)%, APPs 76.8(68.4, 83.5)%, P < 0.0001). Pediatricians were less likely to prescribe antibiotics for pharyngitis without a positive Group A Streptococcus test than APPs and nonpediatric providers (pediatricians 15.1(10.4, 21.6)%, nonpediatricians 29.4(20.8, 39.6)%, APPs 27.2(19.3, 36.9)%, P < 0.0001). First-line antibiotic prescribing for pharyngitis and AOM did not differ between provider specialties. A trend toward more guideline-concordant prescribing was seen for pharyngitis and sinusitis over the study period. Conclusion Pediatricians were more likely to adhere to guidelines for pediatric acute respiratory infections. Pediatric antibiotic stewardship efforts should also target non-pediatricians. Disclosures All authors: No reported disclosures.

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