Tachibana Tomoyasu, Orita Yorihisa, Takao Soshi, Ogawara Yuya, Matsuyama Yuko, Shimizu Aiko, Abe-Fujisawa Iku, Nakada Michihiro, Sato Yasuharu, Nishizaki Kazunori
Department of Otolaryngology, Himeji Red Cross Hospital, 12-1 Shimoteno 1-Chome, Himeji City, Hyogo 670-8540, Japan.
Department of Otolaryngology, Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama 700-8558, Japan.
Auris Nasus Larynx. 2016 Dec;43(6):648-53. doi: 10.1016/j.anl.2016.01.009. Epub 2016 Feb 6.
Since most patients with peritonsillar abscess (PTA) can be successfully treated with surgical drainage and empirical antibiotic therapy, routine bacteriologic studies for all patients with PTA may be unnecessary. This study tried to evaluate which patients with PTA should certainly undergo bacteriologic studies.
Hundred consecutive patients with PTA were treated and underwent culture tests of purulent contents obtained by surgical drainage between April 2008 and December 2013.
In 62 of the 100 patients, 71 pathogenic bacteria were identified; 61 (86%) were Gram-positive cocci (GPC), 8 (11%) were Gram-negative rods (GNR), and 6 (8%) were anaerobes. Normal flora were isolated in 27 patients, and culture results were negative in 11 patients. Although not significant, primary (without prior antibiotic therapy) case (odds ratio (OR)=2.19; 95% CI, 0.95-5.05) and laryngeal edema (OR=2.04; 95% CI, 0.82-5.03) showed a tendency of associations with detection of pathogenic bacteria. After taking into account interactions between smoking habit and laryngeal edema, the covariate-adjusted OR for non-smokers with laryngeal edema was significant and showed a strong relationship (OR=7.43; 95% confidence interval, 1.05-52.73) compared to non-smokers without laryngeal edema.
Although empirical antibiotic therapy was effective for most of the PTA patients, bacteriologic studies might be indispensable for the patients with laryngeal edema considering the failure of the first treatments. Particularly, the culture tests may be useful for non-smokers with laryngeal edema.
由于大多数扁桃体周脓肿（PTA）患者可通过手术引流和经验性抗生素治疗成功治愈，因此对所有PTA患者进行常规细菌学研究可能没有必要。本研究旨在评估哪些PTA患者确实需要进行细菌学研究。
对2008年4月至2013年12月期间连续收治的100例PTA患者进行治疗，并对手术引流获取的脓性内容物进行培养检测。
100例患者中有62例鉴定出71种病原菌；61种（86%）为革兰氏阳性球菌（GPC），8种（11%）为革兰氏阴性杆菌（GNR），6种（8%）为厌氧菌。27例患者分离出正常菌群，11例患者培养结果为阴性。虽然差异不显著，但初发病例（未接受过抗生素治疗）（优势比（OR）=2.19；95%可信区间，0.95 - 5.05）和喉部水肿（OR=2.04；95%可信区间，0.82 - 5.03）显示出与病原菌检测相关的趋势。在考虑吸烟习惯和喉部水肿之间的相互作用后，与无喉部水肿的非吸烟者相比，有喉部水肿的非吸烟者经协变量调整后的OR具有显著性，且显示出强相关性（OR=7.43；95%置信区间，1.05 - 52.73）。
虽然经验性抗生素治疗对大多数PTA患者有效，但考虑到初次治疗失败的情况，对于有喉部水肿的患者，细菌学研究可能必不可少。特别是，培养检测对有喉部水肿的非吸烟者可能有用。
