Management of pediatric peritonsillar and deep neck infections‐ cross‐ sectional retrospective analysis

Abstract

ObjectiveDeep neck infections (DNI) are responsible for significant morbidity in children and healthcare expenditures. Few studies exist specifically addressing the clinical and epidemiologic characterization and management of DNI's in the pediatric population. Our goal was to analyse the demographic characteristics, clinical presentation, diagnostic and therapeutic approaches of peritonsillar and DNI in pediatric patients.MethodsThe medical records of patients, aged up to 18 years, admitted for peritonsillar and DNI at our department, from 2011 to 2016, were retrospectively reviewed and compared with the literature available. Ninety‐eight patients were enrolled.ResultsThe mean age was higher in patients with peritonsillar abscess and lower in patients with retropharyngeal and parapharyngeal infections. Admissions have significantly increased from 2011. There was a seasonal variation for DNI incidence, with a peak incidence in Summer and Spring. All patients included were treated as inpatient and received empirical intravenous antibiotic therapy and steroids regardless of drainage procedures. Incision and drainage was performed in 72 patients. The hospital length of stay was higher among patients with retropharyngeal abscess and in the group with complications. Only 2 patients developed complications during hospital stay. The most common microbiological pattern was monomicrobial and the most commonly isolated pathogens were Streptococcus Pyogenes, Streptococcus Mitis and anaerobic bacteria.ConclusionsSurgical incision and drainage followed by intravenous antibiotic and steroids proved to be successfull with low morbidity related to surgical approach. However, in selected cases, medical therapy may be an alternative to surgical management in uncomplicated infections.

Epidemiological and Microbiological Aspects of the Peritonsillar Abscess

“…In group I (0-18 age group) Staphylococcus aureus has the highest incidence in the summer, the lowest in the autumn (p = 0.0192). In agreement with the literature [1,2,6,23,38,39], we consider the findings regarding the seasonality of the individual microbial agents interesting from an epidemiological point of view. From a clinical point of view, the treatment strategy remains the same.…”

“…Differences in the PTA incidence in individual periods of the year (spring, summer, autumn, and winter) are not significant in our group (p = 0.4396), nor were they significant in studies from Denmark, England, or the USA [13,23,37]. Other studies have reported significant differences in the seasonal incidence of PTA in a group of pediatric patients with the highest incidence in the spring or summer [6,38,39]. In our work, a detailed analysis revealed that the incidence of PTA in boys in group I (0-18 years) is statistically significantly higher during the summer and, conversely, is at its lowest in the autumn (p = 0.0023).…”

Complications of peritonsillar abscess

“…The antibiotic regimens were different from each other in all eight cases with this information provided. In addition to the twelve well-described cases, Hsiao et al and Menezes et al each reported a case of upper airway obstruction among 56 and 71 children with PTA, respectively [ 20 , 21 ].…”

High Risk of Peritonsillar Abscess in End-Stage Renal Disease Patients: A Nationwide Real-World Cohort Study

“…Therefore, once PTA progresses to DNI and mediastinitis, the mortality rate will increase substantially [31]. According to the literature, approximately 2% of PTA may be complicated by DNI, but few studies have explored whether comorbidities increase the chance of the PTA-DNI complication [32]. In our study, PTA was complicated with DNI in 4.2% of the hemodialysis patients-higher than the previously reported prevalence.…”