Fellner Avital, Marom Tal, Muallem-Kalmovich Limor, Shlamkovitch Nathan, Eviatar Ephraim, Lazarovitch Tzilia, Pitaro Jacob
Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300 Zerifin, Israel.
Clinical Microbiology Laboratory, Assaf Harofeh Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300 Zerifin, Israel.
Int J Pediatr Otorhinolaryngol. 2017 Oct;101:112-116. doi: 10.1016/j.ijporl.2017.07.021. Epub 2017 Jul 25.
Recent studies from Western countries showed an increased incidence rate of methicillin-resistant Staphylococcus aureus (MRSA) isolated from pediatric neck abscesses cultures. We sought to examine the microbiology and antibiotic susceptibility of such samples over a 10-year period, and particularly of Staphylococcus aureus (SA), in order to determine whether a similar trend exists in our institution.
A retrospective chart review of children ≤18 years that underwent needle aspiration or surgical drainage of neck abscesses, including suppurative lymphadenitis, retropharyngeal abscesses, and parapharyngeal abscesses was conducted between 1/1/06-31/12/15.
Sixty-two children were identified with a male predominance (34, 55%). The median age was 2 years. There were 37 (60%) suppurative lymphadenitis, 15 (24%) parapharyngeal abscess, and 10 (16%) retropharyngeal abscess cases. Twenty-nine (47%) children received antibiotic treatment prior to admission, most commonly β-lactam agents. Of them, 15 (52%) had positive cultures, including 7 (47%) with SA. On admission, 45 (73%) children had already received amoxicillin-clavulanate. Of those who did not improve, 16 (26%) received ceftriaxone and clindamycin. Twenty-one (38%) cultures were negative. The most common isolated bacteria were SA in 13 (24%), Streptococcus pyogenes in 7 (13%), and Streptococcus viridians group in 9 (16%). Of the SA isolates, there was only 1 (8%) case of MRSA; however, there were 4 (31%) clindamycin-resistant SA isolates.
Unlike previously published data, there was no increase in MRSA incidence at our institution. However, the high prevalence of clindamycin-resistant SA was in line with previous reports. These findings should be considered when starting empirical therapy in pediatric neck abscesses.
西方国家最近的研究表明，从儿童颈部脓肿培养物中分离出的耐甲氧西林金黄色葡萄球菌（MRSA）的发病率有所上升。我们试图研究此类样本在10年期间的微生物学和抗生素敏感性，特别是金黄色葡萄球菌（SA）的情况，以确定我们机构是否存在类似趋势。
对2006年1月1日至2015年12月31日期间接受颈部脓肿针吸或手术引流的18岁及以下儿童进行回顾性病历审查，包括化脓性淋巴结炎、咽后脓肿和咽旁脓肿。
确定了62名儿童，男性占优势（34名，55%）。中位年龄为2岁。有37例（60%）化脓性淋巴结炎、15例（24%）咽旁脓肿和10例（16%）咽后脓肿病例。29名（47%）儿童在入院前接受了抗生素治疗，最常用的是β-内酰胺类药物。其中，15名（52%）培养结果呈阳性，包括7名（47%）为SA。入院时，45名（73%）儿童已经接受了阿莫西林-克拉维酸治疗。在那些病情未改善的儿童中，16名（26%）接受了头孢曲松和克林霉素治疗。21份（38%）培养物为阴性。最常见的分离细菌是SA，共13例（24%），化脓性链球菌7例（13%），草绿色链球菌群9例（16%）。在SA分离株中，只有1例（8%）为MRSA；然而，有4例（31%）克林霉素耐药SA分离株。
与之前发表的数据不同，我们机构的MRSA发病率没有增加。然而，克林霉素耐药SA的高流行率与之前的报告一致。在开始对儿童颈部脓肿进行经验性治疗时应考虑这些发现。
