Microorganisms Isolated From Peritonsillar Abscess and Indicated Chemotherapy

Abstract

\s=b\A bacteriologic study was made of 30 patients with peritonsillar abscesses with the use of both aerobic and anaerobic culture procedures. The abscess was punctured and the pus was aspirated by a syringe with an 18-gauge needle. Aerobes and anaerobes were detected in a frequency rate of approximately 1:2. Peptostreptococcus (30.2%), group A streptococci (27.9%), Peptococcus (16.3%), and Fusobacterium (9.3%) were preponderant pathogens. Anaerobic organisms were isolated in 75% of 30 cases. Aside from group A streptococci, anaerobes play a major etiologic role in peritonsillar abscess. Penicillins or cephalosporins will provide maximum chemotherapeutic benefit. (Arch Otolaryngol 1982;108:655-658) Peritonsillar abscess occurs when bacterial infection of the tonsil spreads to the potential peritonsillar space deep behind the tonsil between the tonsillar capsule and the superior constrictor pharyngeal muscle. Treat¬ ment of the condition consists of first confirming the presence of an abscess formation by puncture, and subse¬ quent incision, drainage, and chemo¬ therapy.Most textbooks of otorhinolaryngol¬ ogy describe the causative organisms as aerobes. However, the fact that the site of the infection is in the proximity of the oral mucosa and is kept away from the open air strongly suggests that anaerobic bacteria might also play a causal role. Nevertheless, there are few reports of attempted investi¬ gations into both aerobic and anaero¬ bic organisms as possible causative agents. Under such circumstances, it is not uncommon for us to be at a loss as to the choice of antibiotic in the chemotherapy of peritonsillar ab¬ scess.The present study represents our attempt to reevaluate the bacteriolo¬ gy of peritonsillar abscess with due emphasis placed on both aerobic and anaerobic bacteria as possible invad¬ ers. The purpose of this report is to describe the antibiotic susceptibility of microorganisms detected from peritonsillar abscesses. SUBJECTSThirty patients with peritonsillar ab¬ scess who were seen at the outpatient services of the Ear, Nose, and Throat This group had the following age distribu¬ tion: two people from 10 to 20 years old; ten people in their 20s; nine in their 30s; six in their 40s; two in their 50s; and one in his 60s. METHODS OF BACTERIOLOGIC STUDYAt the time of the first examination, pus was collected from 30 patients with peri¬ tonsillar abscess by puncture of the soft palate at the site of maximum swelling with the use of a syringe with an 18-gauge needle. This eliminated contamination from indigenous flora in the throat, and prevented the death of anaerobic material from exposure to air. The infectious mate¬ rial was aspirated into rubber-stoppered medium-sized test tubes containing 5 mL of tryptosoy broth and stored in a cold place at a temperature below 5°C until submitted for bactériologie study, which was carried out both at

Gram Staining for the Treatment of Peritonsillar Abscess

“…Anaerobes were isolated from 72% of examined aspirates in this study. However, the proportion of anaerobes varies widely among studies (33%–83%) [3, 6–9]. One reason for the variation is the difference in microbiological handling and culture techniques used.…”

“…Penicillins were the first choice of antibiotics in treating peritonsillar abscess [9, 14, 15]. Snow et al showed that penicillin is effective in the majority of cases and that it should be used as the initial antibacterial agent in nonallergic patients [14].…”

Changing trends in bacteriology of peritonsillar abscess

“…The role of Gram-negative aerobic bacteria in the aetiology of peritonsillar abscess has not been well defined. Gram-negative anaerobic bacteria have been isolated in previous studies 1 , 7 , 8 . However, Gram-negative aerobic organisms, namely pseudomonas sp, have not previously been reported as causative agents in peritonsillar abscess.…”

“…The aetiology of peritonsillar abscess is often varied. Earlier studies indicated that anaerobic bacteria were the predominant species isolated from such abscesses, with peptostreptococcus species being the most common anaerobe isolated 1 . However, recent studies have found a predominately mixed isolate of aerobic and anaerobic bacteria in peritonsillar abscesses 2 .…”

Crystalline surface protein of Peptostreptococcus anaerobius

“…Peptostreptococcus spp. are regularly isolated in infections of the oral region as well as in other parts of the human body (Sugita et al, 1982; Sklavounos et al, 1986; Topiel & Simon, 1986; Brook et al, 1991; Sundqvist, 1992). Several studies have suggested that Peptostreptococcus spp., especially P. magnus, P. micros and P. anaerobius, may have an important role in the pathogenesis of various infections (Brook & Walker, 1984; Papasian et al, 1986; Smith et al, 1986a; Brook, 1988; Davies et al, 1988; Hunter & Chow,1988; Lewis et al, 1989; Panagou et al, 1991; Schenkein et al, 1993).…”