Harounian Jonathan A, Azab Andrew R, Roberts Christopher A, Carr Michele M
Department of Otolaryngology-Head and Neck Surgery, Temple University, Philadelphia PA, USA.
Penn State College of Medicine, Hershey PA, USA.
Int J Otolaryngol. 2018 May 28;2018:7824380. doi: 10.1155/2018/7824380. eCollection 2018.
To identify differences in cervical infection management in infants versus older children.
Charts of patients 0-18 years, diagnosed with a cervical infection at our institution between 2004 and 2015, were included. Age, gender, presenting symptoms, comorbidities, CT scan findings and management including admission, procedures, antibiotics, cultures, length of stay, readmission rates, and complications were included.
239 patients were included: mean age was 4.6 years, with 55.6% boys and 44.4% girls. Mean length of stay was 3.2 days, with no significant difference between age categories. 12.55% were readmitted within 30 days with no significant difference when stratified for age (p = 0.268). The most common presenting symptoms were fever (74.3%), swelling (71.4%), and neck pain (48.2%). Infants had fewer symptoms documented than older children. 51% has lateral neck infections, and these were more common in younger children (p < 0.001). The most common antibiotic used was amoxicillin-clavulanic acid in 53.96% of inpatients and 48.05% of outpatients. Infants were most likely to have MRSA isolates (29.2% versus 11.7% of older children, p = 0.011). 70.0% went to the operating room for incision and drainage procedures. Younger children were more likely to undergo surgery, with an odds ratio of 2.38 for children under 1 year. (p = 0.029). 90.9% of infants underwent surgery with radiolucencies of at least 1 cm diameter in contrast to 50% of children over 8 years old.
This study emphasizes the importance of considering early operative treatment of cervical abscesses in infants despite fewer symptoms and smaller radiolucencies on CT.
确定婴儿与大龄儿童在宫颈感染管理方面的差异。
纳入2004年至2015年期间在我院诊断为宫颈感染的0至18岁患者的病历。记录年龄、性别、症状表现、合并症、CT扫描结果以及管理情况，包括入院情况、手术、抗生素使用、培养结果、住院时间、再入院率和并发症。
共纳入239例患者，平均年龄4.6岁，男孩占55.6%，女孩占44.4%。平均住院时间为3.2天，各年龄组之间无显著差异。12.55%的患者在30天内再次入院，按年龄分层时无显著差异（p = 0.268）。最常见的症状表现为发热（74.3%）、肿胀（71.4%）和颈部疼痛（48.2%）。与大龄儿童相比，婴儿记录到的症状较少。51%的患者有颈部外侧感染，且在年幼儿童中更为常见（p < 0.001）。最常用的抗生素是阿莫西林 - 克拉维酸，住院患者中占53.96%，门诊患者中占48.05%。婴儿最有可能分离出耐甲氧西林金黄色葡萄球菌（29.2%，而大龄儿童为11.7%，p = 0.011）。70.0%的患者接受了切开引流手术。年幼儿童更有可能接受手术，1岁以下儿童的优势比为2.38（p = 0.029）。90.9%的婴儿接受了直径至少为1厘米的透亮区手术，而8岁以上儿童为50%。
本研究强调了尽管婴儿症状较少且CT上透亮区较小，但仍需考虑对宫颈脓肿进行早期手术治疗的重要性。
