Chebib Emilien, Ok Vichita, Cohen Jérémie F, Léger Maelys, Lecuyer Hervé, Bille Emmanuelle, Simon François, Couloigner Vincent, Ferroni Agnes, Luscan Romain
Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France; Université Paris Cité, Faculté de Médecine, Paris, France.
Department of Microbiology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.
J Pediatr. 2025 Oct;285:114672. doi: 10.1016/j.jpeds.2025.114672. Epub 2025 May 28.
To analyze the changes over the last 2 decades in clinical presentation, initial management, bacterial etiology, and rates of complications of acute mastoiditis (AM) in children.
We conducted a retrospective study including all children diagnosed with AM between 2021 and 2024 in a French tertiary care center. Age at diagnosis, first-line surgical and medical treatment modalities, complications and bacteriological findings were collected. These data were compared with those of a previously published cohort of AM between 2001 and 2008 from the same facility.
During the 3-year study period, 223 cases of AM were included (42 cases in 2021-2022; 104 in 2022 -2023; and 77 in 2023-2024). Among the 223 cases, 211 (95%) had a subperiosteal abscess (95%), 65 (29%) an extradural empyema, and 55 (25%) a lateral sinus thrombosis. The main pathogens identified were Streptococcus pyogenes (37%), Streptococcus pneumoniae (23%), and Fusobacterium necrophorum (19%). In cases of AM with intracranial complications, S. pyogenes and F. necrophorum were causative in over 70% compared with 46% in noncomplicated cases (P < .001). Comparing the 2021-2024 cohort with 2001-2008 cohort, we observed an increase in the number of cases (74 cases/year vs 27 cases/year), a rise in rate of intracranial complications (39% vs 4%; P < .001), an increase in performance of mastoidectomy (54% vs 33%; P < .001), and a shift in etiologic agents, with an increase in the proportion of S. pyogenes (P < .001) and F. necrophorum (P = .02) and concomitant decline in S. pneumoniae (P < .001).
This large, single-center study highlights clear changes in the clinical manifestations and bacterial etiology of AM over the past decades. Ongoing surveillance of the bacterial etiology of AM is essential to optimize its initial management.
分析过去20年儿童急性乳突炎（AM）的临床表现、初始治疗、细菌病因及并发症发生率的变化。
我们进行了一项回顾性研究，纳入了2021年至2024年在法国一家三级医疗中心诊断为AM的所有儿童。收集了诊断时的年龄、一线手术和药物治疗方式、并发症及细菌学检查结果。将这些数据与该机构先前发表的2001年至2008年AM队列的数据进行比较。
在3年研究期间，共纳入223例AM病例（2021 - 2022年42例；2022 - 2023年104例；2023 - 2024年77例）。在223例病例中，211例（95%）有骨膜下脓肿，65例（29%）有硬膜外积脓，55例（25%）有乙状窦血栓形成。鉴定出的主要病原体为化脓性链球菌（37%）、肺炎链球菌（23%）和坏死梭杆菌（19%）。在伴有颅内并发症的AM病例中，化脓性链球菌和坏死梭杆菌导致的病例超过70%，而在无并发症病例中为46%（P < 0.001）。将2021 - 2024年队列与2001 - 2008年队列进行比较，我们观察到病例数增加（74例/年对27例/年）、颅内并发症发生率上升（39%对4%；P < 0.001）、乳突切除术的实施增加（54%对33%；P < 0.001）以及病原体的转变，化脓性链球菌（P < 0.001）和坏死梭杆菌（P = ；02）的比例增加，同时肺炎链球菌比例下降（P < 0.001）。
这项大型单中心研究突出了过去几十年AM临床表现和细菌病因的明显变化。持续监测AM的细菌病因对于优化其初始治疗至关重要。
