Changing microbiology of pediatric neck abscesses in iowa 2000–2010

Abstract

Objectives/Hypothesis: To examine the changing microbiology of pediatric neck abscesses over a 10-year period with particular interest in methicillin-resistant Staphylococcus aureus (MRSA) infections and their associated antibacterial-resistance patterns, including resistance to clindamycin, a frequently used antibiotic for Staphylococcus aureus.Study Design: Retrospective chart review at a tertiary academic medical center. Methods: One hundred and twenty-two consecutive pediatric patients managed between January 2000 and June 2010 with incision and drainage of a proven neck abscess.Results: Seventy-four patients with 76 abscesses were identified. A microorganism was found in 65 (85%) of the 76 abscesses. Forty-three percent grew Staphylococcus aureus (SA), 12% were methicillin-resistant Staphylococcus Aureus (MRSA), and 31% were methicillin-susceptible Staphylococcus aureus (MSSA). There was a significant increase in the incidence of MRSA infections during the study period, with only one case of MRSA diagnosed in the first half of the study (from 2000-2004) compared with seven in the second half (from 2005-2010) (P ¼ 0.023). The second most common bacterial etiology or isolate was Streptococcus pyogenes in 27%, while the remaining 30% grew mixed oral flora and other microorganisms.Conclusions: These findings demonstrate a statistically significant rise in the proportion of MRSA neck infections in pediatric patients in Iowa. Resistance to clindamycin was highest among MSSA isolates. Clindamycin-resistant S. aureus and Streptococcus pyogenes are established pathogens in neck infections. In communities with similar microbiology patterns, empiric treatment with combination therapy of a beta lactam and vancomycin or trimethoprim/sulfamethoxazole should be initiated until culture results are available.

Suppurative Cervical Lymphadenitis in Infancy

“…[1][2][3][4][5][6][7] Considering our data for infants and children in aggregate, our study had a larger proportion of abscesses caused by S aureus and MRSA than the proportion in these previous reports, with 74% of culture-positive abscesses revealing S aureus and 38% revealing MRSA. [1][2][3][4][5][6][7] Considering our data for infants and children in aggregate, our study had a larger proportion of abscesses caused by S aureus and MRSA than the proportion in these previous reports, with 74% of culture-positive abscesses revealing S aureus and 38% revealing MRSA.…”

“…[1][2][3][4][5][6][7] Considering our data for infants and children in aggregate, our study had a larger proportion of abscesses caused by S aureus and MRSA than the proportion in these previous reports, with 74% of culture-positive abscesses revealing S aureus and 38% revealing MRSA. 1,2,4 In our study, admission blood cultures were obtained for nearly all infants but for only approximately half of children 13 months through 5 years old. 1,2,4 In our study, admission blood cultures were obtained for nearly all infants but for only approximately half of children 13 months through 5 years old.…”

“…[1][2][3][4][5][6] Antibiotic resistance has not been limited to antibiotics in the β-lactam class; in one recent series, clindamycin-resistant S aureus was a frequent pathogen. Multiple studies have documented S aureus, and particularly methicillin-resistant S aureus (MRSA), as increasingly common causes of suppurative cervical lymphadenitis, or deep neck abscess, in pediatric patients.…”

“…[1][2][3][4][5][6][7][8][9] It has been our observation that infants have been increasingly affected by suppurative cervical lymphadenitis. [1][2][3][4][5][6][7][8][9] It has been our observation that infants have been increasingly affected by suppurative cervical lymphadenitis.…”

Update on Epidemiology and Treatment of MRSA Infections in Children

“…In a review of 74 pediatric patients with 76 neck abscesses in Iowa in 2000-10, 12% grew MRSA and 31% grew MSSA. There was only one MRSA abscess in 2000-4 and 7 in 2005-10 (69). Similar results were obtained in a study from Toronto, Canada (70).…”