S247 – Mediastinitis in Infants: Role of the Otolaryngologist

Abstract

Objectives To describe mediastinitis from retropharyngeal abscess in 3 infants. Methods Case reports of 3 patients. Results 3 patients presented in a span of 2 winter months to a tertiary care, pediatric, inner-city hospital. The patients were 8 months, 9 months, and 18 months old. All presented with retropharyngeal phlegmon on CT scan, were started on clindamycin and cefotaxime, and monitored as in-patients for 2–4 days prior to surgery. Interval CT scans revealed progression to retropharyngeal abscess with mediastinal extension. One patient's retropharyngeal abscess was drained trans-orally, one externally, and one required a combined approach. 2 of the 3 patients required video-assisted thoracoscopic debridement of the mediastinitis. 2 cultures grew out methicillin-resistant staphylococcus aureus, while one grew out methicillin-sensitive staphylococcus aureus (all were clindamycin sensitive). The patients' peak white blood cell counts were 18.4, 30.2, and 44.9 thousand. All 3 patients survived and were discharged on long-term antibiotics. Conclusions Despite appropriate initial empiric antibiotic therapy, all 3 patients developed retropharyngeal abscess with mediastinal extension. The otolaryngologist should maintain vigilance when treating infants with intravenous antibiotics for a deep neck space infection, liberal use of imaging studies should be performed to monitor progression of the infection, a significantly elevated white blood cell count should be interpreted with caution, and initial empiric therapy should include clindamycin. Despite the adult literature that quotes a 50% mortality rate from mediastinitis, infant mediastinitis may be a different disease process, as all 3 of our patients survived.