Bacteriology of peritonsillar abscess in patients over 40 years—a neglected age group

Abstract

The clinical presentation of peritonsillar abscess (PTA) in patients over 40 years is scarcely reported. Since older patients present differently than younger patients, our aim was to investigate possible correlation between illness severity in the older age group and their bacteriologic studies. A retrospective study on all cases of PTA admitted between June 1996 and June 2003 was carried out. Details regarding sex and age were obtained. Bacteriologic studies were analyzed for gram stain, aerobic and anaerobic culture results. Two hundred and eighty-two patients (143 male and 139 female) had 311 hospitalizations due to PTA with known results of the microbiologic studies. Mean age was 29.6 (range 4-80 years). Sixty-five adults over 40 of age were found comprising 23 % of our cohort. Aerobic growth in the older group was found to be significantly lower (P < 0.05). Anaerobic growth was identified in 44.7 % of the positive pathogen growth. The older age group also showed a tendency to higher rates of anaerobic bacterial growth (57.1 % compared to 41 % in the young age group; P = 0.09, OR = 1.91). Older population with PTA presents with significant lower rates of aerobic bacteria and a tendency towards higher rates of anaerobic growth. The dangerous combination of the latter with the higher reported rates of comorbidities and less prominent symptoms and signs compared to the younger patients might clarify the need for prompt and aggressive surgical and antibiotic treatment.

Hospital discharge survey on 4,199 peritonsillar abscesses in the Veneto region: what is the risk of recurrence and complications without tonsillectomy?

“…In the previous literature, recurrence rates after a first PTA episode are still unclear, ranging between 5 and 22 % in various studies, due partly to a limited number of patients, different methods of initial conservative treatment and marked differences in the follow-up period considered [1,4,7,13,19,20]. On the other hand, our data refer to a population of 2,667 patients, all treated with incision and drainage without tonsillectomy, and with an adequate follow-up.…”

“…There seem to be two pathogenically different PTA subtypes, one caused by a single organism, most often group A Streptococcus; the second polymicrobial, due to a variety of facultative and obligate anaerobes and probably representative of a chronic underlying microfloral imbalance. In patients aged 15-24 and in the elderly, Fusobacterium necrophorum is the prevalent pathogen [1][2][3][4] and its growth from PTA aspirates correlates with a higher rate of recurrence, and may serve as an additional relative indicator for tonsillectomy [2,4,5].…”

Renewal of peritonsillar abscess: Impact of the bacterial species of the infection and clinical features of the patient—A prospective comparative aetiological study

“…A Danish group showed that FN is often associated with younger patients . In previous studies, older age has been associated with certain bacterial species as well as more severe symptoms, which was also seen in our study. Smoking has been associated with older age and certain bacterial species; our results did not strengthen that.…”

“…There are speculations of different types of PTA; furthermore, age, gender, smoking status and dental health may have an impact on the clinical picture of the disease; accordingly, symptom renewal could be dependent on these factors. For example, in patients over 40 years of age, a lower percentage of aerobic bacteria have been detected, as well as the presence of more severe symptoms and clinical findings . Additionally, the type of pathogen may also determine the course of the disease .…”

“…For example, in patients over 40 years of age, a lower percentage of aerobic bacteria have been detected, as well as the presence of more severe symptoms and clinical findings. 7,8 Additionally, the type of pathogen may also determine the course of the disease. 1 Several studies, however, have demonstrated that conventional bacterial culture is slow and the results have no impact on the treating physician's decision regarding the treatment protocol of PTA.…”