{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T02:17:20Z","timestamp":1774923440753,"version":"3.50.1"},"reference-count":16,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2019,10,9]],"date-time":"2019-10-09T00:00:00Z","timestamp":1570579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Section of Paediatrics, Universit\u00e0 degli Studi di Perugia, Perugia, Italy,","award":["PED-2019-12"],"award-info":[{"award-number":["PED-2019-12"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Acute mastoiditis (AM) is the most common complication of acute otitis media (AOM) and is one of the most severe acute bacterial diseases in infants and children. In some geographic areas, the incidence of AM is increasing, and the causative role of some bacterial pathogens could be greater than previously thought. In this paper, the results of a study that evaluated the epidemiology and microbial etiology of paediatric AM in Umbria, which is a region of central Italy, are reported. This is a retrospective study of patients aged 0\u201314 years with AM admitted to the pediatric wards of the hospitals of Umbria, Italy, between June 1 and September 30 in four consecutive years (2015\u20132018). A total of 108 children were enrolled. The prevalence of AM in males during the four years of analysis was significantly higher than that in females at 63% (95% confidence intervals [CI]: 0.54\u20130.72). The most frequently affected age groups were 5\u20139 years (45.4%) and 10\u201314 years (31.5%), with statistically significant differences in comparison with children aged &lt;1 year (5.6%, 95% CI: 0.01\u20130.10) and 1\u20134 years (17.6%, 95% CI: 0.10\u20130.25). In most cases (64, 59.3%), AM was associated with spontaneous tympanic membrane perforation (STP). The culture of the middle ear fluid revealed the presence of Pseudomonas aeruginosa in 56 cases (51.6%). The mean incidence rates of pediatric AM in Umbria during the study increased significantly with time, as it was 18.18\/100,000 children\/year in 2015\u20132016 and 29.24\/100,000 children\/year in 2017\u20132018 (CI difference: +2.5 \u2013 +19.9, p &lt; 0.05). The incidence rates of Pseudomonas aeruginosa detection in pediatric AM associated with STP significantly increased with time. The incidence was 6.06\/100,000 children\/year in 2015\u20132016 and 18.61\/100,000 children\/year in 2017\u20132018 (CI difference: +6.1 \u2013 +19.0, p &lt; 0.001). This study demonstrated the high and increasing incidence of AM in the Umbria region during the summer months and the frequent detection of P. aeruginosa as an etiologic agent of the disease in the presence of STP. Confirmation of these results with a larger study population, in different settings, and throughout the whole year is needed to define the first-line approach of AM with STP in pediatrics.<\/jats:p>","DOI":"10.3390\/pathogens8040180","type":"journal-article","created":{"date-parts":[[2019,10,9]],"date-time":"2019-10-09T11:25:57Z","timestamp":1570620357000},"page":"180","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Acute Mastoiditis Associated with Pseudomonas Aeruginosa in the Pediatric Population of the Umbria Region, Italy"],"prefix":"10.3390","volume":"8","author":[{"given":"Guido","family":"Camanni","sequence":"first","affiliation":[{"name":"Paediatric Unit, Ospedale San Giovanni Battista, 06034 Foligno, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonia","family":"Bianchini","sequence":"additional","affiliation":[{"name":"Paediatric Clinic, Department of Surgical and Biomedical Sciences, Universit\u00e0 degli Studi di Perugia, 06123 Perugia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cosimo","family":"Neglia","sequence":"additional","affiliation":[{"name":"Paediatric Clinic, Department of Surgical and Biomedical Sciences, Universit\u00e0 degli Studi di Perugia, 06123 Perugia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonella","family":"Mencacci","sequence":"additional","affiliation":[{"name":"Microbiology Unit, Department of Medicine, Universit\u00e0 degli Studi di Perugia, 06123 Perugia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Baldoni","sequence":"additional","affiliation":[{"name":"Microbiology Unit, Ospedale San Giovanni Battista, 06034 Foligno, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandra","family":"Pacitto","sequence":"additional","affiliation":[{"name":"Paediatric Clinic, Department of Surgical and Biomedical Sciences, Universit\u00e0 degli Studi di Perugia, 06123 Perugia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maurizio","family":"Stefanelli","sequence":"additional","affiliation":[{"name":"Paediatric Unit, Ospedale San Giovanni Battista, 06034 Foligno, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabetta","family":"Cortis","sequence":"additional","affiliation":[{"name":"Paediatric Unit, Ospedale San Giovanni Battista, 06034 Foligno, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4103-2837","authenticated-orcid":false,"given":"Susanna","family":"Esposito","sequence":"additional","affiliation":[{"name":"Pietro Barilla Children\u2019s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,10,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1097\/00005537-200310000-00004","article-title":"Natural history of untreated otitis media","volume":"113","author":"Rosenfeld","year":"2003","journal-title":"Laryngoscope"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1586\/14787210.2014.982093","article-title":"Diagnosis and management of acute mastoiditis in a cohort of Italian children","volume":"12","author":"Marchisio","year":"2014","journal-title":"Expert Rev. Anti Infect. Ther."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Link-Gelles, R., Toews, K.A., Schaffner, W., Edwards, K.M., Wright, C., Beall, B., and Lorentzson, L. (2018). Characteristics of Intracranial Group A Streptococcal Infections in US Children, 1997\u20132014. J. Pediatric Infect. Dis. Soc.","DOI":"10.1093\/jpids\/piy108"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1080\/14787210.2017.1380518","article-title":"What not to do in acute otitis media: The top five recommendations proposed by the Italian Society of Preventive and Social Pediatrics","volume":"15","author":"Chiappini","year":"2017","journal-title":"Expert Rev. Anti Infect. Ther."},{"key":"ref_5","first-page":"9","article-title":"Experimental and investigational drugs for the treatment of acute otitis media","volume":"7","author":"Principi","year":"2019","journal-title":"Expert Opin. Investig. Drugs"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1097\/INF.0000000000002100","article-title":"Dynamics of Severe and Non-severe Invasive Pneumococcal Disease in Young Children in Israel Following PCV7\/PCV13 Introduction","volume":"37","author":"Glikman","year":"2018","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1097\/INF.0000000000001485","article-title":"Serotypes not Included in 13-Valent Pneumococcal Vaccine as Causes of Acute Otitis Media with Spontaneous Tympanic Membrane Perforation in a Geographic Area with High Vaccination Coverage","volume":"36","author":"Marchisio","year":"2017","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1016\/j.ijporl.2015.06.019","article-title":"Children hospitalized due to acute otitis media: How does this condition differ from acute mastoiditis?","volume":"79","author":"Saat","year":"2015","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1007\/s00405-011-1667-y","article-title":"Acute mastoiditis in children: 10 years experience in a French tertiary university referral center","volume":"269","author":"Gorphe","year":"2012","journal-title":"Eur. Arch. Oto Rhino Laryngol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s10096-016-2783-9","article-title":"Acute otitis media with spontaneous tympanic membrane perforation","volume":"36","author":"Principi","year":"2017","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e964","DOI":"10.1542\/peds.2012-3488","article-title":"The diagnosis and management of acute otitis media","volume":"131","author":"Lieberthal","year":"2013","journal-title":"Pediatrics"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1016\/j.ijporl.2010.08.016","article-title":"Acute otitis media: From diagnosis to prevention. Summary of the Italian guideline","volume":"74","author":"Marchisio","year":"2010","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1016\/j.ijporl.2012.02.042","article-title":"Algorithmic management of pediatric acute mastoiditis","volume":"76","author":"Psarommatis","year":"2012","journal-title":"Int. J. Pediatr. 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Otorhinolaryngol."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/8\/4\/180\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:28:31Z","timestamp":1760189311000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/8\/4\/180"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,9]]},"references-count":16,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2019,12]]}},"alternative-id":["pathogens8040180"],"URL":"https:\/\/doi.org\/10.3390\/pathogens8040180","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,9]]}}}