Neff Laura, Newland Jason G, Sykes Kevin J, Selvarangan Rangaraj, Wei Julie L
Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS 66160, United States.
Int J Pediatr Otorhinolaryngol. 2013 May;77(5):817-20. doi: 10.1016/j.ijporl.2013.02.018. Epub 2013 Mar 24.
Acute cervical lymphadenitis is a common condition often times requiring antibiotic therapy and possible surgical drainage. The objective of this study was to describe the clinical characteristics, diagnostic and therapeutic management of children requiring surgical drainage for acute cervical lymphadenitis.
A retrospective, descriptive study was performed at a Midwestern US tertiary-care children's hospital on all immunocompetent children who underwent an incision and drainage procedure of cervical lymphadenitis from January 1999 to July 2009.
A total of 277 patients were identified. Males represented 51% and the median age was 28 months (IQR: 13-59). Lymphadenitis was unilateral in 243 (87.7%) cases and bilateral in 19 (6.9%). Median length of hospital stay was 4 days (IQR: 3-5). Aerobic, anaerobic, acid fast bacillus (AFB), and fungal cultures were obtained intraoperatively in 99%, 98%, 82%, and 78% of cases, respectively. However no fungal cultures were positive and only 1% of anaerobic and 2% of AFB cultures were positive. The most common bacterial etiology was Staphylococcus aureus (35.7%) and Streptococcus pyogenes (18.8%). Of all cultures, 32% were negative. Overall, 22% were positive for methicillin susceptible S. aureus (MSSA) and 13.7% for methicillin resistant S. aureus (MRSA), with 96% MSSA and 100% MRSA susceptible to clindamycin. Median duration of discharge antibiotics prescribed was 10 days (IQR: 7-11). Only 12 (4.5%) patients required a repeat incision and drainage within 3 months.
A single antibiotic that treats S. pyogenes and S. aureus should be the empiric antibiotic for cervical lymphadenitis requiring incision and drain. We recommend sending only aerobic cultures intraoperatively as a routine practice as other pathogens are rare.
急性颈淋巴结炎是一种常见病症，常常需要抗生素治疗以及可能的手术引流。本研究的目的是描述因急性颈淋巴结炎需要手术引流的儿童的临床特征、诊断及治疗管理。
在美国中西部一家三级护理儿童医院进行了一项回顾性描述性研究，研究对象为1999年1月至2009年7月期间所有接受颈淋巴结炎切开引流手术的免疫功能正常的儿童。
共确定了277例患者。男性占51%，中位年龄为28个月（四分位间距：13 - 59）。淋巴结炎单侧发病243例（87.7%），双侧发病19例（6.9%）。中位住院时间为4天（四分位间距：3 - 5）。分别有99%、98%、82%和78%的病例在术中进行了需氧菌、厌氧菌、抗酸杆菌（AFB）和真菌培养。然而，真菌培养均为阴性，厌氧菌培养仅1%阳性，AFB培养仅2%阳性。最常见的细菌病因是金黄色葡萄球菌（35.7%）和化脓性链球菌（18.8%）。所有培养中，32%为阴性。总体而言，22%对甲氧西林敏感金黄色葡萄球菌（MSSA）呈阳性，13.7%对耐甲氧西林金黄色葡萄球菌（MRSA）呈阳性，96%的MSSA和100%的MRSA对克林霉素敏感。出院时开具的抗生素中位疗程为10天（四分位间距：7 - 11）。仅12例（4.5%）患者在3个月内需要再次切开引流。
对于需要切开引流的颈淋巴结炎，一种能治疗化脓性链球菌和金黄色葡萄球菌的单一抗生素应作为经验性抗生素。我们建议术中常规仅送检需氧菌培养，因为其他病原体罕见。
