From the Division of Pediatric Infectious Diseases.
Department for Woman and Child Health-Pediatric Emergency Department, University of Padua, Padua.
Pediatr Emerg Care. 2021 Dec 1;37(12):e1358-e1365. doi: 10.1097/PEC.0000000000002037.
Retropharyngeal and parapharyngeal abscesses (RPAs, PPAs) usually affect young children. Surgical drainage and/or antibiotic therapy are treatment of choice, but no specific guidelines exist. In order to reduce the risk of severe complications, appropriate diagnosis and therapy are necessary. The aims of the study were to review diagnosis and management of children with RPAs/PPAs and to compare surgical versus medical approach.
This is a multicenter retrospective study including all patients younger than 15 years admitted at 4 Italian pediatric hospitals of Florence, Padua, Rome, and Treviso, with International Classification of Diseases, Ninth Revision discharge diagnosis code of RPAs and PPAs, from January 1, 2008, to December 31, 2016.
One hundred fifty-three children were included. The median age was 4.4 years, with overall male predominance. Heterogeneous signs and symptoms (fever, neck cervical, lymphadenopathy, pain, and stiff neck most frequently) and a large mixture of bacteria from pus cultures were detected. Computer tomography (66.7%) and magnetic resonance imaging (27.5%) were performed to confirm the presence of abscess. Fifty-one percent of abscesses were greater than 3 cm. Eighty-seven patients (56.9%) underwent surgery, and 66 (43.1%) were treated with antibiotics alone (mostly ceftriaxone, metronidazole, amikacin, and clindamycin) with median days of therapy of 26.5 days and length of therapy of 16.0 days of median. Median length of stay was 11 days. None had severe complications. Multivariate analysis indicated as independent predictive factors of surgery abscess of 3 cm or greater, high white blood cell count, and-most of all-the hospital of admission.
Deep neck abscesses mostly affect patients in early childhood, with a combination of nonspecific signs and symptoms, and it still emerges as a heterogeneous approach in diagnosis and management of these infections. Thus, common shared protocols represent an essential tool in order to standardize care and improve patients' outcomes.
咽后和咽旁脓肿（RPAs、PPAs）通常影响幼儿。手术引流和/或抗生素治疗是首选治疗方法，但没有具体的指南。为了降低严重并发症的风险，需要进行适当的诊断和治疗。本研究的目的是回顾儿童 RPA/PPA 的诊断和治疗，并比较手术与药物治疗方法。
这是一项多中心回顾性研究，纳入了 2008 年 1 月 1 日至 2016 年 12 月 31 日期间，4 家意大利儿科医院（佛罗伦萨、帕多瓦、罗马和特雷维索）收治的所有年龄小于 15 岁、国际疾病分类第 9 版出院诊断为 RPA 和 PPA 的患者。
共纳入 153 例患儿。中位年龄为 4.4 岁，总体上男性居多。检测到不同的症状和体征（发热、颈部、淋巴结肿大、疼痛和颈部僵硬最常见）和脓液培养的大量混合细菌。为了确认脓肿的存在，66.7%的患儿进行了计算机断层扫描，27.5%进行了磁共振成像。51%的脓肿大于 3cm。87 例（56.9%）患儿行手术治疗，66 例（43.1%）单独接受抗生素治疗（主要为头孢曲松、甲硝唑、阿米卡星和克林霉素），中位治疗天数为 26.5 天，中位治疗时间为 16.0 天。中位住院时间为 11 天。无一例发生严重并发症。多变量分析表明，手术的独立预测因素为脓肿直径≥3cm、白细胞计数高、以及-最重要的是-入院医院。
深部颈脓肿主要影响幼儿，其症状和体征不具有特异性，在这些感染的诊断和治疗中仍然呈现出一种异质性的方法。因此，共同的标准协议是规范护理和改善患者结局的重要工具。
