Abstract
Because of a recent upsurge in retropharyngeal abscess (RPA) cases due to community-associated methicillin-resistant Staphylococcus aureus (MRSA), we reevaluated the microbiology, clinical manifestations and treatment outcome of RPA over the past 6 years (2004 to 2010). Findings were compared with those of a previous 11-year study (1993 to 2003) period. A retrospective review of medical records of children with RPA. One hundred fourteen children (61 males) with RPA were identified representing a 2.8-fold increase in incidence (per 10,000 admissions) over the previous 11-year period. Abscess drainage was performed in 74 (65%). A total of 116 isolates (93 aerobes, 23 anaerobes) were recovered from 66 specimens. S. aureus was recovered from 25 (38%) of the 66 specimens compared with 2 (4.9%) of 41 in the previous 11 years; 16 (64%) of 25 were MRSA compared with none in the previous 11 years. Children whose abscess grew MRSA were younger (mean 11 months) than the others (mean 62 months) (P<0.001) and required longer duration of hospitalization (mean 8.8 days) than the rest (mean 4.5 days) (P=0.002). Five children had mediastinitis; all caused by MRSA. All MRSA isolates were susceptible to clindamycin. Ceftriaxone plus clindamycin was the most common treatment regimen. All patients had resolution of their abscesses. RPA has increased in frequency in our pediatric population with an associated increase of Staphylococcus aureus, mainly community-associated MRSA. This is likely due to the overall increase in community-associated MRSA infections in our pediatric patients. Treatment with ceftriaxone and clindamycin in addition to surgical drainage was effective.
Highlights
The treatment of retropharyngeal abscess is surgical, the condition is one which merits the attention of the physician on account of its liability to be forgotten in the differential diagnosis of a case of acute dyspnoea in an infant
The reason why it is so important not to mistake the diagnosis is that, whereas the dyspnoea might be such as to require intubation of the larynx or tracheotomy if the condition were diphtheritic, the procedure needed for a postpharyngeal abscess is incision and drainage
It is essential that in every case of supposed laryngeal diphtheria a finger should be inserted into the child's mouth, and the pharyngeal wall gently but quickly palpated; for palpation is the only sure way of detecting a retropharyngeal abscess
Summary
The treatment of retropharyngeal abscess is surgical, the condition is one which merits the attention of the physician on account of its liability to be forgotten in the differential diagnosis of a case of acute dyspnoea in an infant. The reason why it is so important not to mistake the diagnosis is that, whereas the dyspnoea might be such as to require intubation of the larynx or tracheotomy if the condition were diphtheritic, the procedure needed for a postpharyngeal abscess is incision and drainage.
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