Tansey James B, Hamblin John, Mamidala Madhu, Thompson Jerome, Mclevy Jennifer, Wood Joshua, Sheyn Anthony
Department of Otolaryngology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA.
Ann Otol Rhinol Laryngol. 2020 Apr;129(4):376-379. doi: 10.1177/0003489419890349. Epub 2019 Nov 24.
Assess the outcome of Intravenous (IV) dexamethasone in the treatment of pediatric deep neck space infections (DNSI) in combination with IV antibiotics.
Retrospective chart review of pediatric patients admitted for a DNSI from March 2014 to June 2016. Patient characteristics including demographics, abscess type, antibiotic, dexamethasone, surgery, culture, and length of stay (LOS) were obtained. Patients treated with antibiotics alone versus antibiotics and dexamethasone were compared. Primary outcome measures were rate of surgical drainage and LOS.
Overall 153 patients with DNSI were identified, including 62 lateral neck, 18 parapharyngeal, 40 peritonsillar, 32 retropharyngeal, and 1 submandibular. All patients received antibiotics. Dexamethasone was used in 35% of patients. The rate of surgical drainage in the dexamethasone and non-dexamethasone group was 36% and 53% respectively ( = .043). LOS was shorter for the dexamethasone group (2.9 days) compared to the non-dexamethasone group (3.8 days) but was non-significant, -value-.09. The most common microorganisms cultured were MRSA (25), MSSA (11), and Streptococcus pyogenes (10).
Dexamethasone use was associated with a decreased rate of surgical drainage in pediatric patients with DNSI. Further prospective study is needed to determine the role of dexamethasone in treatment.
评估静脉注射地塞米松联合静脉使用抗生素治疗小儿深部颈部间隙感染（DNSI）的疗效。
对2014年3月至2016年6月因DNSI入院的小儿患者进行回顾性病历审查。获取患者特征，包括人口统计学资料、脓肿类型、抗生素、地塞米松、手术、培养结果及住院时间（LOS）。比较单纯使用抗生素治疗的患者与使用抗生素和地塞米松治疗的患者。主要结局指标为手术引流率和住院时间。
共确定153例DNSI患者，包括62例侧颈部、18例咽旁、40例扁桃体周围、32例咽后和1例颌下。所有患者均接受抗生素治疗。35%的患者使用了地塞米松。地塞米松组和非地塞米松组的手术引流率分别为36%和53%（P = 0.043）。地塞米松组的住院时间（2.9天）比非地塞米松组（3.8天）短，但差异无统计学意义（P值 = 0.09）。培养出的最常见微生物为耐甲氧西林金黄色葡萄球菌（25例）、甲氧西林敏感金黄色葡萄球菌（11例）和化脓性链球菌（10例）。
在小儿DNSI患者中，使用地塞米松与手术引流率降低相关。需要进一步的前瞻性研究来确定地塞米松在治疗中的作用。
